Care Home: The Moorings

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What the care home does well A substantial number of care staff have achieved a nationally recognised qualification in care. This helps to ensure that residents receive care and support from a well-trained staff team.Residents in the main felt they received a good quality of care. One person said, "The carers are always there whenever I need them". Another person said, "I find everything O.K. No complaints". There is a good relationship between residents and staff that makes people living at the home feel comfortable, safe and relaxed. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. The home has a thorough and robust recruitment process in place, helping to protect and safeguard vulnerable people. What has improved since the last inspection? The home`s Statement of Purpose and Service User Guide that tell people about the services and facilities provided has been reviewed and updated to reflect the change of ownership. The physical environment of the home has improved since the last inspection. The new owners have replaced the emergency call bell system, and a new industrial washing machine and dryer have been provided. An air conditioning unit has been fitted to the kitchen area and some new kitchen equipment provided. Communal areas have been refreshed and some bedrooms redecorated with new beds and bedding purchased. The home now has the services of a maintenance team to undertake work as required to ensure the home is kept in good order and a comfortable place for people to live. What the care home could do better: The individual care plan that tells staff about the needs and requirements of each resident should be more detailed. This would help ensure a consistent service is provided and that staff have the written information they need to provide a high standard of care. Although there has been some improvement in the way medication is managed, there is still room, for further improvement. The recording of medication administered or otherwise should be more accurate and the new regulations for the storage of controlled drugs implemented. Some people living at the home thought that the programme of activities could be improved. These comments were shared with the homeowners so that anynecessary action could be taken to ensure that residents individual social care needs could be met. CARE HOMES FOR OLDER PEOPLE The Moorings The Moorings 58 North Promenade St Annes On Sea Lancashire FY8 2NH Lead Inspector Denise Upton Unannounced Inspection 09:00 1st July 2008 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 The Moorings DS0000071274.V368379.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. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Moorings Address The Moorings 58 North Promenade St Annes On Sea Lancashire FY8 2NH 01253 721601 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) Lakeview Rest Homes Ltd Mrs Dawn Ward Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people 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. The maximum number of people who can be accommodated is: 21 Date of last inspection 4th April 2007 Brief Description of the Service: The Moorings Care Home provides residential accommodation for up to 21 older people who do not require nursing care. Recently the home has had a change of ownership but is still managed on a day-to-day basis by the same registered manager. The home is located on the promenade, in close proximity to the centre of the town and within easy access to community services and resources. The accommodation is arranged over two floors and provides in the main, individual en-suite bedroom accommodation for people who live at the home. A small proportion of bedroom accommodation is for twin occupancy for people who have made a positive choice to share accommodation. A passenger lift and ramped access is also provided to enable ease of access to all areas of the building. The grounds of the home are landscaped and offer a private and secluded area to sit out in the warmer weather. The Moorings provides a weekly `in house` activity programme and transport is readily available to enable residents to enjoy escorted social outings. Participation in independent community activity is also encouraged. In addition, relatives and friends are made welcome to visit at any time of the resident’s choice. The Home offers a varied menu with a wide choice to suit individual taste. The current cost of residential care at The Moorings ranges from £412:00 per week to £450:00 per week. The Moorings DS0000071274.V368379.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 that people who use this service experience good quality outcomes. This unannounced site visit took place during the course of a mid-week day and a short period of time on a second day. In total the visits spanned a period of approximately eleven and a half hours. Twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a re-assessment of the requirement and recommendations identified in the last inspection report. The inspector spoke with a senior carer on duty, the registered provider and two other members of the external management team. In addition, individual discussion took place with four people living at the home and two relatives. Several other residents were also briefly spoken with in various communal areas of the home. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry areas and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. Prior to the site visit taking place, seven Commission for Social Care Inspection (CSCI) surveys were completed and returned by people living at the home. This helped to form an opinion as to whether individual needs and requirements were being met to the satisfaction of people living at The Moorings Care Home. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. What the service does well: A substantial number of care staff have achieved a nationally recognised qualification in care. This helps to ensure that residents receive care and support from a well-trained staff team. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 6 Residents in the main felt they received a good quality of care. One person said, “The carers are always there whenever I need them”. Another person said, “I find everything O.K. No complaints”. There is a good relationship between residents and staff that makes people living at the home feel comfortable, safe and relaxed. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. The home has a thorough and robust recruitment process in place, helping to protect and safeguard vulnerable people. What has improved since the last inspection? What they could do better: The individual care plan that tells staff about the needs and requirements of each resident should be more detailed. This would help ensure a consistent service is provided and that staff have the written information they need to provide a high standard of care. Although there has been some improvement in the way medication is managed, there is still room, for further improvement. The recording of medication administered or otherwise should be more accurate and the new regulations for the storage of controlled drugs implemented. Some people living at the home thought that the programme of activities could be improved. These comments were shared with the homeowners so that any The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 7 necessary action could be taken to ensure that residents individual social care needs could be met. 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. The Moorings DS0000071274.V368379.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 The Moorings DS0000071274.V368379.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): 1 & 3 Standard 6 was not assessed, as the home is not registered to accommodate people in the intermediate care category. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide have been revised and updated to reflect the change of ownership. These documents provide detailed information about the services and facilities provided at the home. The pre admission assessment enables an informed decision to be taken to make sure that the prospective resident’s current strengths and needs could be met at The Moorings. EVIDENCE: The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 10 Since the last inspection, new owners have purchased The Moorings Care Home. Consequently the home’s Statement of Purpose and Service User Guide, that tell residents and prospective residents about the home and services and facilities provided, have been reviewed and updated to make sure that both booklets contain current, accurate information. Both documents are freely available in the reception area of the home and it is understood that each newly admitted resident is to be provided with an individual copy of the Service User Guide. There is a structured pre admission assessment process in place to make sure that people are only admitted to the home if their individual needs and requirements could be met. It is usual practice that a member of the management team visits the prospective resident in their current environment in order to undertake the pre admission assessment and to provide further information about The Moorings. This is coupled with an invitation for the prospective resident and their family to visit the home to meet staff and existing residents and assess the accommodation for themselves. This enables an informed decision to be made about living at the home. Further information is also often provided by family and friends or from professional assessments undertaken by Care Managers or through hospital discharge information. This combined information is then collated and provides the basis for the initial care plan. Whilst it was clear that the needs of recently admitted people to the home were being met, there is a requirement that any person who has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective resident’s current needs and requirements could be met at the home. This should be provided prior to admission. There was no evidence that this had occurred. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a consistent care planning system in place however the written information provided could be more detailed. This would ensure that staff are provided the information they need to ensure a consistent service that satisfactorily meet resident’s needs. The medication in this home is generally well managed however there were some inconsistencies that could potentially be detrimental to resident’s health and welfare. It was observed that personal support was provided in such a way as to promote and protect the privacy and dignity of residents. EVIDENCE: The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 12 During the course of the site visit three residents were ‘case tracked’. This means assessing all the written information kept in respect of these people. In consequence, the care plans that direct staff about the strengths, needs and requirements of these three residents were viewed. Whilst the care plans seen were holistic and covered a range of strengths and needs, as identified in the last inspection report, detail was sometimes lacking as to the level of support required and clear direction for staff as to how a task was to be completed. This is important to ensure that a consistent service is provided. For example, one care plan evidenced stated that the resident required full assistance with bathing but did not specify or give clear direction as to what full assistance meant. In another instance the care plan stated in regard to bathing and showering that the resident required a small amount of assistance with both but again no information about what sort of assistance that was required. There was evidence that care plans had been reviewed monthly. Never the less, residents spoken with and resident’s comments on the Commission for Social Care Inspection surveys confirmed that people living at the home were satisfied with the level of care and support received. Out of the seven people who completed a survey, six said that they always received the care and support they needed and the remaining person said they usually did. One person had written on a survey form, “When I need the support/assistance the carers are always there to provide it” Another person said, “the carers are there whenever I need them”. A number of risk assessments were in place that included a medication risk assessment and nutritional risk assessment. However in respect of one person ‘case tracked’ the assessment indicated a history of falls but a specific risk assessment in respect of this matter could not be evidenced. It is essential that in order to reduce or eliminate the risk, whenever a risk is identified a formal written risk assessment is undertaken with significant outcomes incorporated in the care plan. The senior carer spoken with was very aware of each individual residents requirements and appeared to have an excellent rapport with people living at the home. One person spoken with stated that she got on well with all the staff describing them as “kind and helpful”. Through discussion with a number of residents, a relative and observation of documentation, it was clear that the health care needs of residents are well met. This was also confirmed by residents that completed a CSCI survey form. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 13 There continues to be a good relationship with health professionals in order to maintain health and well-being. From discussion with the new owners it is understood that there had been concerns about the way medication had been managed. There was particular concern about the storage, administration and recording of controlled drugs. The new owners took immediate action and staff with responsibility for the administration of medication, have now received updated medication training. In addition, medication audits have taken place including one undertaken by the pharmacist who supplies medication to the home. This highlighted areas where improvements should be made to ensure that the administration and recording of medication was safe, accurate and protected the people living at the home. However this is an ongoing process and there is still room for further improvement. At the time of inspection a small sample of drug administration records were observed. It was noted that on at least one occasion there were dose omissions without explanation. This suggests that some staff are not completing the drug administration record immediately after the drug has been administered or alternatively refused. It is essential that the administration record be completed in line with the home’s policy and procedures regarding the administration and recording of medication to ensure that an accurate record is kept. It was also evident that hand written drug administration records are not being signed or countersigned by a second person to confirm that the hand written entry was an exact replica of the dispensing label supplied from the pharmacy. It could have serious consequences if medication details on the hand written drug administration record were not the exact replica of the pharmacy label with the possibility of medication being administered not as prescribed. It was also noted that short life medication had not been dated on opening. The only date evident was the date the medication had been dispensed by the pharmacist. This does not necessarily relate to the date the medication was first used. It is strongly recommended that all short life medication be dated on opening. This would help to ensure that ‘short life’ medication was not administered past the expiry date. It is recommended that the recently introduced internal medication audit continue to take place on a regular basis. This would assist in quickly highlighting any medication recording errors that may occur. The evidence obtained could then be used to identify areas of concern and assist in advising staff of the correct procedures to be followed. An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation were explained to the management team. These requirements must The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 14 be put into place within a specified time scale. It is understood that this requirement will be addressed by the homeowners within the time scale specified. Staff was observed to speak appropriately to residents and treat them with respect. One resident spoken with stated that the staff were, “really very good” and confirmed that she felt her privacy and dignity were being well respected by the staff team. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training. . The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Residents generally enjoy a lifestyle that satisfies their social or recreational interests and needs however this is an area that could be improved. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that generally meets individual taste and choice. EVIDENCE: The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 16 Visitors are welcome at any reasonable time and residents can entertain their guests in any communal area of the home or in the privacy of their own individual bedroom. One relative spoken with on the day of the site visit said that she visited her relative very frequently, felt comfortable visiting the home was always made welcome and that staff were approachable and kind. A range of ‘in-house’ activities are made available that includes board games, cards, bingo, outside entertainers, nail painting, residents talking with each other and talking with staff, reading, and watching television. The home also has a car that is used for taking residents shopping, doctor appointments or visits out to places of interest. People living at The Moorings had always enjoyed this facility. However on this occasion, one resident spoken with stated that outings in the car had in the main, stopped taking place since the change of ownership. This had been a great disappointment to her and she also said that activities had been ‘not as good’ in recent weeks. This same resident also said that she would like more entertainment in the evening period after tea because this time was “very boring” with nothing going on. This information was discussed with the homeowners who explained that there was no reason why the car should not be used as previously and that in addition to the car, a mini bus that was shared with the other homes in the Lakeview Rest Home group had also been offered to enable residents to access the community but this offer had not been taken up. The homeowners also confirmed that there was sufficient staff on duty to ensure that activities and outings that suited residents individual needs and preferences should be taking place. During individual discussion, a number of residents had some ideas of what sort of activities they would like to see introduced. One person said that she thought there was not sufficient physical or mental stimulation going on and suggested that musical activities/quizzes particularly in relation to classical music would be enjoyed. This same person also suggested that a reading group would be a good idea with interested residents (and/or a staff member) reading a chapter each and then discussing what they had read. It was also suggested that structured activities take place in the morning rather than the afternoon as “a lot of sleeping goes on in the afternoon”. Another person spoken with had no interest in joining with any sort of activities preferring to spend his time by himself in his bedroom. This was respected. Another resident said she would like more time for carers to sit and chat. Half of the residents who completed a CSCI survey, in answer to the question, ‘Are there activities arranged by the home that you can take part in’ had written sometimes rather than always or usually. This suggests that not all residents social care needs are being met. On person had written, “There is bingo weekly but I don’t wish to do this. I enjoy the activities around Xmas and the twice yearly family/friends buffet” The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 17 The new owners are aware that this is an area that should be developed and expanded upon and will be taking steps to engage residents in discussion about what sort of activity they want to be taking place and when. People living at the home are encouraged to maintain control of their own financial affairs for as long as they wished to be or assisted in this task by their family or advocate. Information regarding the local advocacy service is made available to enable residents and/or relatives to access independently if they so wish. As previously observed meals and mealtimes at The Mooring are relaxed with a wide variety of foods being offered. One person spoken with stated that there was “very good food” provided. Another person had written “I am a fussy eater but efforts are made by the staff to find something I do like”. A third person wrote, “The food is excellent. I am a vegetarian and there is always a good choice for me”. It is understood that there is a four-week rotating menu but there is some flexibility in menu planning to reflect what is in season and what foods are freshly available. One resident commented that, “Good, fresh produce is always used. Several vegetables at lunch, nice fish weekly”. Residents are asked prior to each meal what they would like from the menu choice of the day although an alternative of the residents choice would be provided if required. Residents enjoy breakfast in bed at a time to suit themselves. In addition to main meals, drinks and snacks are available at regular intervals and as observed, will be provide on request. In the main people living at the home were very satisfied with the quality and quantity of the meals served however one lady did say that although she enjoyed the midday meal she did not always enjoy the evening meal that she felt could be improved upon. This lady suggested that on occasions egg on toast could be served for tea and she would like her evening drink later than it was usually served. However the same lady also said that staff do make toast and tea later in the evening for anybody would like it. Another person had written, “Lunches are very good, teas could sometimes be better”. Residents are offered a varied, wholesome and nutritious diet and specialist diets in respect of religious, cultural or medical need can be accommodated. The home has been awarded the Fylde Borough Council’s ‘Food for Thought’ certificate of compliance award The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. Members of staff have been provided with updated adult abuse training that helps to protect residents. EVIDENCE: The Moorings Care Home has a comprehensive, complaints policy in place, which included all of the required detail and outlined the steps that could be taken if a resident was unhappy with the service provided. The policy is made available to residents and their relatives by way of the Statement of Purpose and Service User Guide. Since the last inspection one complaint was made to the home. This was investigated using the home’s internal complaint procedure and the concern was found to be unsubstantiated. The Commission for Social Care Inspection The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 19 did not receive any complaints. As observed, the relationship between staff and residents is relaxed and friendly and residents and relatives spoken with stated they would have no hesitation in raising any concern or complaint directly with a member of the management team. Since the site visit two anonymous concerns were received relating to perceived recent changes at the home. These concerns were shared with the homeowners so that any necessary action could be taken. The Moorings Care Home continues to have in place a variety of policies and procedures for the protection of residents. This includes an Adult Protection Policy based on the `No Secrets In Lancashire’ document and a whistle blowing policy to help protect people living at the home from abuse or discrimination. Recently an incident occurred that was referred for consideration under the local adult protection protocols. This issue is ongoing and still under investigation. The management team at The Moorings are fully cooperating with the enquiries. Staff have received recent updated adult protection training. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is in the main now good, providing residents with comfortable and homely environment that suits their needs. EVIDENCE: From individual discussion with a number of residents and two relatives during the course of the site visit and comments made on the Commission for Social Care Inspection surveys, no concerns were expressed with regard to the The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 21 physical environment of the home. People expressed satisfaction with the communal and individual accommodation provided. However, the new homeowners stated that on completion, there were a number of issues regarding the physical environment of the home that required immediate attention. In consequence, a programme of maintenance has now been introduced, communal areas have been refreshed/redecorated and there is ongoing redecoration of bedroom accommodation. Air conditioning has been fitted to the kitchen area and a new call bell system has been installed. Some new carpets, beds and bedding have been provided and additional equipment purchased for the kitchen. The laundry area has been provided with a new washing machine and industrial dryer and attention has been given the garden area with new plants planted to provide an attractive environment for residents to sit out in. A ‘sleeping in’ room has also been created to provide accommodation for the designated person with ‘sleeping in’ responsibility each night. Improvements to the environment will be ongoing. A small number of bedrooms were observed, on one occasion while speaking with a resident and a member of his family in his bedroom accommodation. The décor in the bedroom was tired and in need of redecoration however the resident expressed no concerns and his relative did explain that the redecoration of the bedroom had taken place about twelve months previously to their satisfaction, but that the small bedroom was heavily used during the day and she felt that this had contributed to the current condition. The two other bedrooms observed were of a good standard although the radiator guard in one of the bedrooms was broken in part. It is understood that this was to be attended to as a matter of urgency. A new housekeeper has been employed to help ensure that the internal physical environment home is kept clean and tidy. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. National Vocational Qualification (NVQ) training has been given high priority to ensure staff are provided with adequate skills to provide a good quality service. There is a good match of permanent members of staff who demonstrated an understanding of their roles The standard of vetting and recruitment practices are good with appropriate checks being carried out to protect residents. EVIDENCE: The staffing ratio at The Moorings Care Home is determined by the dependency needs of resident’s accommodated. It is understood that the new owners have introduced a new staff rota that takes into account, times of the day when residents requirements are highest to ensure that sufficient staff are on duty during these busy times. The new homeowners gave assurances that there are The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 23 sufficient staff on duty at all times to ensure that the physical, social, emotional and psychological needs and requirements of each resident can be met. National Vocational Qualification training at The Moorings has been given high priority. At the time of the site visit the current staff-training matrix could not be located and the registered manager was not available to offer assistance. However the Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to the site visit, indicated that over 80 of the care staff team have achieved at minimum an NVQ Level 2 qualification in care. This is commendable. It is understood that a number of staff have also achieved the higher level NVQ 3 or Level 4 of this award and that two members of staff were hoping to commence the Registered Managers Award. The Moorings Care Home has in place a structured recruitment process that helps to protect people who live at the home. Since the last inspection, new members of staff have been appointed. From observation of a recently appointed staff member’s personnel file, it was evident that the recruitment practices had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) POVA clearance had been obtained prior to the applicant actually taking up post at the home. All newly appointed staff are provided with the General Social Care Council, Code of Conduct that sets out the requirement of staff working in social care. As previously stated, the staff-training matrix could not be located and a recently appointed member of staff was not available to speak with. However it is understood that all newly appointed care staff are provided with a basic induction to the home and then work through the detailed induction training package that is compliant with ‘Skills for Care’ nationally recognised inductiontraining standards for care staff. This ensures that newly appointed staff have the basic skills to provide a good quality service. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is organised and managed in a way to ensure that residents experience a good quality of care The financial arrangements for people living at the home are thorough to ensure that individuals’ finances were protected. A system is in place of self-review and consultation, which includes seeking the views of residents, staff and relatives. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager at The Moorings is competent, qualified and experienced to run the home and meet its stated purpose, aims and objectives. There are systems in place to seek the views of residents and relatives in order to monitor the quality of care people receive when living at the home. This has included, a suggestion box and suggestion form for residents and staff to complete at any time, annual anonymous client and relative feedback sheets and a comment book that is left in a communal area of the home. However in order to strengthen this process, it is understood that quality assurance questionnaires are now being provided to a small number of different residents on a monthly basis. A number of resident and relative meetings and staff meetings have taken place since the change of ownership and a newsletter has recently been provided for relatives along with a questionnaire to complete. This all helps to make sure that the homeowners have a clear understanding about what people feel about living at The Moorings and also enables relatives to have their say. There are procedures in place, regarding residents monies held in safekeeping, with appropriate records and receipts being kept, helping to ensure that people’s finances are safeguarded. However it is recommended that all transactions be dated as well as signed by the person making the entry and that where ever possible, the resident signs their financial record when a transaction has taken place rather than two members of staff signing the document. There was some evidence of previous formal staff supervision having taken place although it appeared that this had been allowed to lapse of late. However on the staff file of one recently recruited member of care staff, there was evidence of a more recent supervision record and a current training and development plan. All care staff should receive formal one to one documented supervision at least six times a year. This should cover at minimum all aspects of practice, philosophy of care and career development needs. It is essential that all staff that supervises others have the knowledge, skills and abilities to undertake the task. All staff do receive daily informal supervision as part of the management role. There is a mandatory staff training programme in place that includes moving and handling training, infection control training, food hygiene training, health The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 26 and safety training, fire training, adult protection training and staff with responsibility for the administration of medication have all received recent updated medication training. As previously stated in this report, at the time of the site visit the staff-training matrix could not be located. Therefore it was difficult to establish if all staff had been provided with all elements of the mandatory training programme. From discussion with the homeowners it was established that any member of care staff that had not received this important training would be provided with the training in the near future. Maintenance records were available to confirm that various routine Health safety checks are maintained on a regular basis. As part of the wider company, Then Moorings now has access to a maintenance team that is improving the physical environment of the home. There is also a new style maintenance book for recording work to be undertaken and when completed. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 27 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1)(d) Requirement Timescale for action 01/09/08 2 OP9 13(2) Prospective residents must receive confirmation in writing, that their current needs and requirements could be met at the home. The storage of controlled drugs 01/11/08 must be maintained in line with the recently amended regulation. 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 3 4 Refer to Standard OP7 OP7 OP9 OP9 Good Practice Recommendations Care plans should be detailed to advise staff how an objective is to achieved A formal risk assessment should always be complete when a risk has been identified. Risk assessments should be clear with relevant outcomes incorporated in the care plan. The medication record should be signed immediately after medication has been given to an individual person. Hand written medication administration records should be the exact replicas of the instructions supplied by the pharmacist. The person making the record should sign to DS0000071274.V368379.R01.S.doc Version 5.2 Page 29 The Moorings 5 6 7 OP9 OP9 OP12 8 9 OP19 OP36 this effect and a second member of staff who has confirmed accuracy of the recording should countersign the record. All ‘short life’ medication should be dated on opening. The internal medication audits should continue on a regular basis until there is confidence that medication is well managed. It is recommended that residents be consulted about what activities they would like to take place. The activities programme should then be designed taking into account the responses received. All radiator guards in resident accommodation should be of sound construction. Formal documented staff supervision should take place at least six times a year. The Moorings DS0000071274.V368379.R01.S.doc Version 5.2 Page 30 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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