Care Home: Moss View Nursing Home

What the care home does well At the time of our visit to Moss View Nursing Home we saw that people living there looked clean and well cared for. They appeared to be comfortable with their dignity being constantly protected. Those living at the home who required 1: 1 care and support were allowed freedom of movement, but at the same time were being discreetly supervised for their own safety and that of others. Records showed that preferences of residents were a high priority for those living at Moss View and people spoken to told us that routines of the home were fairly flexible. Appropriate pressure care was administered and external professionals were involved in the care of those living at the home, to ensure that the correct procedures and treatmentwere being delivered. We established that medical advise was sought as required and that people living at the home were transferred to hospital as was deemed necessary. Regular beverages were routinely served to ensure that those living at Moss View Nursing Home received an adequate fluid intake in order to maintain good hydration. Visitors were made welcome to the home and were offered beverages at each visit. New staff were guided through a detailed induction programme, following which regular training was provided, so that all staff were able to do the job expected of them. Accident records were maintained in line with data protection regulations and assessments were in place to ensure that any potential risks were identified and strategies implemented to promote the safety of those living at the home. What the care home could do better: There could have been some form of written agreements from the families of those residents who remained in their nightwear during the day, to ensure that their preferences were being taken in to consideration and to protect them from any distress. The garden areas of the home could have been better maintained and less overgrown, so that a more pleasant outdoor seating area was provided for the people living at Moss View. The recruitment practices adopted by the home could have been better, so that all required checks were conducted before employment, to ensure people were fit to work with this vulnerable client group. The allocation of staff could have been better, so that two members of care staff being on duty together, who had not received formal moving and handling training or proper guidance on the use of a hoist could have been avoided. All relevant care records could have contained accurate written entries about daily activities and what had taken place in day to day practice, so that staff were aware of any significant events. The Care Quality Commission could have been informed about accidents occurring in or outside the home, which resulted in any serious injury to people living or working at Moss View. Any serious injury could have also been reported under RIDDOR regulations. Random inspection report Care homes for older people Name: Address: Moss View Nursing Home 15/16 Moss View Ormskirk West Lancs L39 4QA two star good service 18/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vivienne Morris Date: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Moss View Nursing Home 15/16 Moss View Ormskirk West Lancs L39 4QA 01695579319 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Khuram Shahzad Type of registration: Number of places registered: Conditions of registration: Category(ies) : ExcelCare Service Limited care home 22 Number of places (if applicable): Under 65 Over 65 0 0 22 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 22 0 0 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age,not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 22 Date of last inspection 1 8 1 1 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home Moss View Nursing Home is located in a quiet residential area of Ormskirk, close to the town centre and all local amenities. The home provides accommodation in both single and shared facilities on two floors, served by a passenger lift and stairs. There are spacious communal areas available, incorporating lounges and dining areas within the conservatory. The home provides personal and nursing care for up to 22 people requiring support associated with dementia. The service users guide, which contains relevant information about the home, including the most recent inspection report, is given to people who are thinking about living at Moss View, so that they are able to decide if the home is suitable for their needs. The scale of charges at the time of our visit to this service ranged from £110 - £1730 (for continuing care) per week. Additional charges were being incurred for hairdressing. Care Homes for Older People Page 3 of 11 What we found: We conducted a random inspection at Moss View Nursing Home on 28th June 2010, which lasted four hours and was in response to information received from several anonymous sources. We examined the care records of some people living at the home and looked at all relevant documentation. We spoke to residents, staff and visitors, who gave us some positive feedback about the service provided. A tour of the premises was conducted when all communal areas were seen and a random selection of private accommodation was viewed. Three of the four residents we spoke to told us that they were assisted with bathing on a regular basis and that they were helped to wash daily. Records seen confirmed this information with any refusal of personal care intervention being recorded. One person living at the home who was able to independently bathe himself said the bath he preferred to use was very slow to fill and therefore he did not bathe as often as he would like. We visited this bathroom and found the mechanism on the bath needed adjusting to switch from the shower unit to the bath. The manager of the home agreed to show this person how to operate the mechanism, so that the bath filled at an acceptable rate. All four residents we spoke to told us that they were very happy living at Moss View. One of them said, As far as the care goes you couldnt get better anywhere. The staff are fantastic. At the time of our visit to this service there were three people sitting in the lounge in their nightwear during the afternoon. We discussed this with the manager of the home, who told us that these three people required regular bed rest periods for effective pressure relief and to constantly change them would be distressful for them because of their frailty and severely contracted limbs. We were told that families had been consulted and were satisfied with this arrangement. These three people were clean and well presented. They looked comfortable with their dignity being respected. We established that several people living at the home were highly dependant on staff assistance to maintain activities of daily living. At the time of our visit there was one person with a pressure wound and records showed that the General Practitioner(GP) and District Nurse were involved in the care of this individual to ensure that appropriate treatment was being delivered. A GP was on site at the time of our visit to the home. We were told that some residents do spend longer times in bed, but only because of medical reasons and to provide effective pressure relief. One person we visited was sitting comfortably in her bedroom. We spoke to this lady at length, who told us that she preferred to spend the day in her bedroom in her nightwear, but that staff were always willing to assist her when necessary to wash and change her nightwear. Records showed that this resident frequently requested to get up very early in the morning, which she confirmed. The manager told us that the other people living at the home do not usually rise until after 6am, but it is their choice when they wish to get up. Records seen did not show that residents or their families had been consulted about certain people remaining in their nightwear during the day whilst spending time in the Care Homes for Older People Page 4 of 11 lounge and written agreement had not been obtained. We spoke to four people living at the home, three staff members and one visitor who all told us that residents were able to ask for beverages whenever they wanted and that drinks were routinely served regularly during the day, which we observed. We were told that fresh milk is delivered every day and we saw 11 liters in the fridge, which was ample for the number of people living at the home. The visitor we spoke to told us that she is made to feel very welcome to the home and was always offered beverages when she visited Moss View. One visitor and two residents told us that the gardens could do with tidying up. We did notice that the grounds were quite overgrown and in need of cutting back in order to provide more pleasant outdoor areas for people to sit in. At the time of our visit there were 13 people living at Moss View. One person was receiving 1:1 care in order to promote his own safety and that of others. The rota showed that three staff members were on duty at all times of the day and night. We were told that the provider calculated the staffing levels in accordance with the assessed needs of those living at the home to ensure that care and support was being provided as required by each individual. Staff we spoke to told us that the number of people leaving employment had increased recently, but they had been replaced by new starters. The manager of the home told us that five people had left Moss View this year, but that there were also some long serving staff, which promoted continuity of care. We examined the records of three people employed at Moss View in order to assess the recruitment practices adopted by the home. We found that two of the three staff members had been appointed without a full enhanced Criminal Record Bureau(CRB) disclosure or an Independent Safeguarding Authority(ISA) check and therefore the recruitment procedures in this case were not thorough enough to protect the people living at the home. We were told by the manager and the Administrator that no-one starts work before an ISA check is received. However, the ISA check confirmations were dated after employment commenced. We were told that the umbrella body responsible for making checks on prospective employees contact the home by phone to confirm they have been received before written confirmation is sent. However, there was no evidence to support this information. We looked at the practices adopted by the home in relation to the reporting of infectious diseases. We established that two people living at the home had suffered an episode of diarrhoea and vomiting during December 2009, which does not constitute a reportable incident under RIDDOR (Reporting of incidents, diseases or dangerous occurrence regulations) or regulation 37 conditions. We saw that the person requiring 1:1 care was in the lounge area of the home. He was being supervised by an allocated member of staff at all times. He was being allowed freedom of movement and no restrictions were being imposed. The manager of the home assured us that restraint was never used to restrict this persons movements and he was able to wander around the home at his leisure with constant supervision. We looked at the accident records, which were maintained in line with data protection Care Homes for Older People Page 5 of 11 regulations. We tracked the care of two people who had received serious injuries following a fall at the home. One of these people had sustained a dislocated shoulder and a fractured wrist in two separate incidents. One entry in the daily records of the 15th January 2010 stated, Swelling right wrist due to fall last night. However, although the fall had been recorded in the accident book there was no mention of it in the daily notes, making sure that staff were fully aware of all significant events. The second resident had sustained facial injuries due to falling over some wheelchairs in the corridor, which were immediately removed. However, the Care Quality Commission had not been informed of these accidents under regulation 37 of the Care Home Regulations and no reports had been forwarded under RIDDOR regulations. All accidents were appropriately recorded and risk assessments had been conducted with strategies implemented to ensure that any possible hazards were minimised. Any unexplained bruising was recorded on a body map and retained in individual files. Accident records showed that on the 5th June 2010 one resident had slipped out of the hoist and had fallen to the floor, sustaining a small haematoma to the left side of her head. The care plan for this person showed that a hoist was required for all transfers and a moving and handling assessment had been conducted telling staff how the resident needed to be moved. The General practitioner was contacted and visited on the same day. However, the record showing visits by external professionals recorded a fall on the 5th June 2010, but failed to show that the resident had fallen out of the hoist. We identified that the two staff members who were transferring this person in the hoist had not received formal moving and handling training, which put the resident at risk. The staff matrix showed that the last moving and handling training had been provided in November 2009 and we were told that some staff were booked on an update in July of this year. The manager said that he had shown staff how to use the hoist following the incident in which a resident had slipped out. Records showed that a detailed induction programme was provided for staff when they started working at the home, so that they received relevant information before working alone. We were told that when the chef was off duty the administrator prepared the meals for people living at the home. We discussed this with the administrator who felt quite comfortable taking on this role and she had received a food hygiene certificate, which training she intended to update next month. The manager told us that care assistants are not allocated cooking responsibilities, but that they complete laundry tasks when ancillary staff are not on duty. What the care home does well: At the time of our visit to Moss View Nursing Home we saw that people living there looked clean and well cared for. They appeared to be comfortable with their dignity being constantly protected. Those living at the home who required 1: 1 care and support were allowed freedom of movement, but at the same time were being discreetly supervised for their own safety and that of others. Records showed that preferences of residents were a high priority for those living at Moss View and people spoken to told us that routines of the home were fairly flexible. Appropriate pressure care was administered and external professionals were involved in the care of those living at the home, to ensure that the correct procedures and treatment Care Homes for Older People Page 6 of 11 were being delivered. We established that medical advise was sought as required and that people living at the home were transferred to hospital as was deemed necessary. Regular beverages were routinely served to ensure that those living at Moss View Nursing Home received an adequate fluid intake in order to maintain good hydration. Visitors were made welcome to the home and were offered beverages at each visit. New staff were guided through a detailed induction programme, following which regular training was provided, so that all staff were able to do the job expected of them. Accident records were maintained in line with data protection regulations and assessments were in place to ensure that any potential risks were identified and strategies implemented to promote the safety of those living at the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Criminal Record Bureau 31/07/2010 disclosures must be obtained on behalf of new staff before they start working at the home, except in exceptionally circumstances, which must be recorded. This is so that people living at Moss View are protected by the recruitment practices adopted by the home. 2 38 37 The Care Quality Commission 31/07/2010 must be informed about accidents occurring in or outside the home, which result in any serious injury to people living or working at Moss View. This is so that the Commission can monitor and if necessary investigate the results of accidents. Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 It is recommended that written agreements are obtained from the families of those residents who remain in their nightwear during the day, to show that the home are acting in the best interests of the people living there. All relevant care records should contain accurate written entries about daily activities and what has taken place in day to day practice, so that staff are aware of any significant events. The garden areas of the home should be better maintained and less overgrown, so that a more pleasant outdoor seating area is provided for the people living at Moss View. The allocation of appropriately trained staff should be reviewed in order to avoid two members of care staff, who have not received formal moving and handling training or proper guidance on the use of a hoist being on duty together, Any serious injury should be reported under RIDDOR (Reporting of incidents, diseases or dangerous occurrence regulations), so that the appropriate authority may conduct an investigation if deemed necessary. 2 8 3 19 4 38 5 38 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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