Care Home: The Moorings

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What the care home does well The service delivers a well planned and well managed level of support to the residents of the home, and from observations made and information provided clearly puts the interests of those living their first. A positive working relationship exists between the home and the local health professionals. The premises are spacious, and equipment needed to help meet the identified needs of the residents is provided, including various types of hoist, specialist baths and pressure relieving beds and mattresses. Attractive and safe outside areas are also available for the residents to use, with views across open countryside. Staff receive a good level of training in most areas, and one told us it was a fantastic place to work. The service identifies the likes and dislikes of people living in the home and wherever possible some of their background through a life story book, and this is used to ensure activities and pastimes are arranged to suit their individual likes. The management team have a very positive approach to the service they provide, striving to further improve this at all times, and this was shown through some of the more recent changes mentioned below. What has improved since the last inspection? Since our last visit, the service have introduced a number of changes, including; Implementation of the MUST nutritional tool Detailed in house dementia training, following a recognised 6 week course Recruitment of a second activity worker to provide activities 7 days a week Introduction of a newsletter A new website Improvements in the quality of menu and food served What the care home could do better: The service plans to continue the development of the home, and develop further the training they offer as a group. Improved storage areas for medication are planned, together with a refurbishment of the managers office to provide better storage facilities for the records held there. Further training for staff is planned in a number of areas, and we pointed out that all staff should receive manual handling training and annual updates. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Moorings Church Road Earsham Bungay Norfolk NR35 2TJ     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Moorings Church Road Earsham Bungay Norfolk NR35 2TJ 01986892269 F/P01986892269 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sally Crawford,Mr Robert James Blackham,Mr Malcolm Paul Blackham care home 39 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 34 39 dementia old age, not falling within any other category Additional conditions: 0 0 The home shall have one person on shift at all times who has received training in dementia awareness. Thirty-nine (39) Older People may be accommodated of which thirty-four (34) may have dementia. Total number not to exceed thirty-nine (39). Date of last inspection Brief description of the care home The Moorings is an extended property situated in six acres of grounds in the village of Earsham, close to the town of Bungay. The home is registered to accommodate up to thirty-nine older people but due to recent conversion of double bedrooms to single rooms, the home currently accommodates thirty-four service users in twenty-eight single and three double bedrooms. The three double bedrooms have an en-suite facility. Four single rooms do not but Care Homes for Older People Page 4 of 27 Brief description of the care home there are plans for en-suite facilities to be provided in two of these. Bedrooms are on the ground and first floor with the first floor accessed by passenger lift. There is car parking to the front and the side of the property. Fees in the home range between 412GBP and 600GBP depending on the room and occupied, and the needs of the resident. A copy of the last inspection report is available in the home and included within the Service User Guide. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, and carried out over a four hour period, during which time we discussed the service in detail with the manager and one of the providers, and also spoke with the deputy manager, another staff member and several residents. Prior to the inspection visit, we received an Annual Quality Assurance Assessment (AQAA) from the providers, which detailed changes made since the last inspection and contained relevant information about the service, which has been used in writing this report. During our visit we looked at the records for some of the staff and residents including Care Homes for Older People Page 6 of 27 training records and care plans, and looked around the building What the care home does well: What has improved since the last inspection? What they could do better: The service plans to continue the development of the home, and develop further the training they offer as a group. Improved storage areas for medication are planned, together with a refurbishment of the managers office to provide better storage facilities for the records held there. Further training for staff is planned in a number of areas, and we pointed out that all staff should receive manual handling training and annual updates. Care Homes for Older People Page 8 of 27 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that detailed assessment information is obtained before anyone moves into the home, which makes sure that the person moving in can be confident the service knows what needs they have, and are able to meet those needs. Evidence: During our visit to the home we discussed the admissions process with the registered manager and one of the proprietors. This process remains very much as noted in previous visits, and as part of the process a detailed assessment of need is carried out, generally by the manager, and either in the prospective new residents home, or sometimes in hospital. Wherever possible one of the care staff, likely to be the persons key worker if they Care Homes for Older People Page 11 of 27 Evidence: move into the home, accompanies the manager to ensure that all aspects of their support needs are covered. As part of the process additional information is gathered from family members and from other health and social care professionals who are involved the the persons care and support. In many cases, the prospective resident would visit the home as part of the process, often initial enquiries begin with such a visit, whilst on other occasions, initial visits are made by family members looking to find somewhere similar. As part of the assessment, the impact on the other residents already living in the home would be considered, to ensure for example that they did not have too many people at one time who needed assistance at meal times. During our visit, we looked at the individual records for four people currently living in the home, and the records examined all showed clear evidence that the process that was described to us is being followed. The service also has a very low rate of failed placements, which again evidences that their process is working. The service does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans show how the identified needs of the individual residents should be met and ensure that individuals preferences are followed. Medication procedures ensure that people are supported to take prescribed medication safely. Evidence: Once the pre admission procedure has been completed, and a decision made that the prospective resident moves to The Moorings, initial care plans are prepared. These show brief details of the new residents needs, and how those needs will be met. Over the first few days of the residents stay, care plans are discussed with the resident and often their family to provide further detail, including wherever possible some social background. This is generally contained within a life story book, which is sent to the family of the resident for them to provide as much background as they are able. The plans also show details of the likes and dislikes of the person, food preferences Care Homes for Older People Page 13 of 27 Evidence: and activities and pastimes enjoyed. The plans are reviewed on a regular basis, normally by the manager and key worker, and amended to reflect changing need. As we mentioned earlier, we looked at four individual plans, and they all contained detailed individual plans, which showed how the resident had been involved, and what the intended outcome of the plan was. The plans also showed that regular reviews are taking place. The service have a good relationship with their local GP and health professionals, and he doctor visits the home for w weekly surgery, although can of course be called out at any time. Everyone living in the home undergoes a nutritional assessment, and where necessary their diet is adjusted, either to assist weight loss, or maintain and increase weight. Medication is administered under the Boots monitored dosage system, and all staff responsible for administering medication receives the required training. Medication records are audited monthly within the home, as well as through an external audit from the local NHS team, and they received a very positive report following their last audit. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of activities are available, and residents are able to choose what activities they would like to do. A varied menu offers residents a wide choice of home cooked food. Evidence: The service employs two activity co-ordinators, and they are able to offer a wide range of activities to people living in the home. Activities are not restricted to weekdays, but available over the weekend as well, and include games and exercises, musical entertainment, arts and crafts, cake making, trips out, fetes, Christmas and Easter parties and talking newspapers. A comprehensive assessment has identified particular activities suited to various individuals, and a copy of this was provided to the inspector on the day of our visit. This shows how most of the people living in the home are able to take part in activities suited to them as individuals,in groups or in teams. As already mentioned, a variety of trips out are planned including an annual trip on the Norfolk Broads, an annual Pantomime, and a visit to a local museum depicting rural Care Homes for Older People Page 15 of 27 Evidence: life in years gone by. The service is very close to the local church and a few residents are supported in going to Church should they wish, although a regular Communion service is also available for those who prefer to stay at home, although they do hope to encourage more residents to attend. Families are always welcome, and involved in many of the social aspects of the home, and the home encourages married residents to invite their spouse to dinner on a regular basis. A good range of home cooked food is served, and fresh peeled and sliced fruit served every afternoon and a choice is available at every mealtime. Mealtimes are regarded as another social event and unhurried, allowing people to sit and talk to their friend over a relaxing meal. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that any concerns, complaints or allegations are dealt with quickly and appropriately, and residents know who they should speak with if they do have concerns Evidence: We discussed the homes complaints procedures with the manager and one of the providers. In the past year, no complaints have been received, and the service ensures that any concerns that may be raised are quickly dealt with Everyone living in the home receives a copy of the complaints procedures, and people we spoke to during our visit confirmed they were aware of who they should speak to if they had concerns. Both the manager of the home and the providers have undertaken training around Deprivation of liberty, and are aware of procedures that should be followed. Residents living in the home are supported if they wish to vote in local or national elections, and a Charter of Residents rights is displayed in the home. Safeguarding procedures are in place in line with local authority guidance, and all staff receive training as part of their initial induction as well as ongoing training updates. Since our last visit there have no safeguarding issues in the home. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is set in a spacious building which offers people living there a clean and safe home, with a range of equipment to help meet their needs. Evidence: The service is set in an older style house, its its own extensive grounds, and which has been extended to provide spacious and comfortable accommodation for the people living there. The grounds are well maintained, and people living in the home are able to access the garden in safety, as the gardens are surrounded by an appropriate fence, which still allows a view over the adjacent meadows. During our visit, we looked around the home, and were particularly impressed with the range of pictures and ornaments on display, giving it a very homely feel. Facilities and equipment are provided appropriate to the people living in the home, and there are a variety of communal areas, including a conservatory. Individual rooms were well equipped, and clearly showed that residents are able to bring possessions and some furniture to the home, and personalise their own rooms. Care Homes for Older People Page 19 of 27 Evidence: On the day of our visit, the home was very clean and free from any unpleasant odours. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures ensure that all staff undergo sufficient checks so that people who receive support know that they are suited to their role, although the service should ensure that everyone working in the home receives appropriate training and updtaes. Evidence: On the day of our visit, we looked at the recruitment and training records for staff working in the home. The service has 7 care staff working during the day and 2 at night and there were clearly sufficient staff working on the day we visited, and while we were looking around the home, and talking to residents, we were able to observe staff interacting in a positive manner with the residents. As well as care staff, the service also employs kitchen and domestic staff and two activity coordinators, who work alternate weekends, ensuring residents have activities every day of the week. During our visit, we looked at the recruitment and training records for three members of staff, and these contained all the required information including application forms, Care Homes for Older People Page 21 of 27 Evidence: two references, details of previous experience and training and CRB disclosures. We also looked at the training matrix in the training room. This showed the planned training for the coming year. Althouhj care staff are receive suitable training, the service must ensure that all staff receive training appropriate to their role, as for example only care staff were receiving moving and handling updates. They should also ensure that training is updated on a regular basis. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a strong management team, and people living in the home are involved in all aspects of their residency in the home. Health and safety procedures ensure it is safe to live and work in the home Evidence: The service is one of three under the same ownership, all within easy reach of each other, and the providers spend time in each of the services, supporting the registered manager of the home where necessary. The management team meet on a regular basis, and feedback information to everyone working in the home through regular team meetings and supervision for all staff. People who live in the home are consulted at every opportunity to ensure that their views and wishes underpin planned developments in the home. This is done in a number of ways, both formally and informally including quality assurance surveys, Care Homes for Older People Page 23 of 27 Evidence: review meetings. and informal discussions. People we spoke to during our visit, both staff and residents told us how happy they find the home and what a good atmosphere there is, and he relatives survey recently completed achieved a 99 satisfaction level for the helpful and friendly staff. Health and safety procedures are in place to ensure that anyone living, working or visiting the home is safe, and regular staff training provided. The AQAA indicated that all the required health and safety policies are in place. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!