Inspection on 14/07/08 for Alan Morkill House

This is the latest available inspection report for this service, carried out on 14th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alan Morkill House 01/02/06

Alan Morkill House 15/03/05

Alan Morkill House 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Alan Morkill House 88 St Mark`s Road North Kensington London W10 6BY Lead Inspector Louise Phillips Key Unannounced Inspection 09:30a 14th 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 Alan Morkill House DS0000010842.V364457.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. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alan Morkill House Address 88 St Mark`s Road North Kensington London W10 6BY 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) 020 8964 1123 020 8968 7247 www.servitehouses.org.uk Servite Houses Myriam Stella Navarro Care Home 49 Category(ies) of Dementia (49), Old age, not falling within any registration, with number other category (49) of places Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 49 7th November 2006 Date of last inspection Brief Description of the Service: Alan Morkhill House is a purpose built care home that provides care for older people, some whom may have dementia. The home is able to accommodate up to 49 residents. The home is situated in North Kensington, close to St Charles Hospital, and has access to bus routes for the area. There is provision for car parking on site. The service is managed by Servite Houses. Weekly fee levels at the time of this inspection were: £714.30 for privately funded residents. £761.28 for privately funded residents with dementia care needs £550.00 for Royal Borough of Kensington and Chelsea (RBKC) funded residents requiring residential care (including respite) £745.42 for RBKC funded residents with dementia care needs £474.21 for residents funded by Westminster local authority Alan Morkill House DS0000010842.V364457.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 stars. This means the people who use this service experience good quality outcomes. This inspection took place over one day by one inspector. Time was spent talking to three staff, four residents and viewing paperwork. A tour of the premises was carried out and care records were inspected. Information has been gained from the inspection record for the home, the Annual Quality Assurance Assessment (AQAA), that the manager completed and surveys received from 2 residents, 7 staff, 5 relatives/ advocates of residents and 2 health/ social care professionals involved with the service. What the service does well: What has improved since the last inspection? What they could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include continued improvements to the activities provided for residents with dementia, more person-centred care planning and improving staffing levels. Please contact the provider for advice of actions taken in response to this Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 6 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. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 7 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 Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 8 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): 3 and 6 Quality in this outcome area is good. The residents are appropriately assessed prior to moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective residents to Alan Morkhill House are appropriately assessed by the manager or senior carer, to ensure that the service is able to meet their needs. At the start of the assessment the service receives needs assessments and care plans from the social worker and from this carries out its own assessment. This information is then used to form the basis of the care plans for the resident when they move to the home. This covers a number of areas such as personal care, mental state, mobility, diet and communication. As part of the assessment process potential residents are invited to visit the home to meet staff and residents and look at the service provided. Residents move in for an initial trial period of six weeks. Prior to the end of the six Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 9 weeks a review meeting is held between the resident, their relative, social worker and manager of the home to review their stay and for the resident to decide if they want to stay. Some relatives spoke about their involvement in the assessment process, and choosing a home for their relative. They said that they receive enough information to enable them to make a choice, and were able to look around the home. One relative commented that ...the home is perfect, close to family an friends, and we feel able to visit at any time that suits us..... Intermediate care is not provided by the home. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 10 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 and 11 Quality in this outcome area is adequate. The residents’ healthcare needs are met, though improvements need to be made to the care planning to ensure individual needs and preferences are recorded. Some improvements are needed to the medication reviewing systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The responses to the surveys provide a valuable insight into the experience of residents living at Alan Morkhill House, along with the observations of their relatives. Responses from residents indicate that they feel they get good care and support from the care staff. Residents say that the care is delivered with kindness and with respect to their privacy and dignity. One resident said: …the care I am getting is OK for me. The carers are doing a good job.... Relatives similarly comment on the care, adding that they believe the home is able to meet the needs of the residents and that staff keep them informed of Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 11 important issues affecting their relative. One relative commented that: …everything is done to make sure the residents are as comfortable as possible..., whilst another said ...the residents are well treated, in a very respectful way, every effort is made to ensure the residents are washed/shaved each day and clean clothing put on…. However, one relative did say that their relative is: ...is fed, washed and clothes laundered and that’s about it...I thought they would attend to things like cutting toe-nails, but I have to do it.... Responses from staff reflect that they are positive about their work, where they state that …we have respect for privacy..., …we take pride in the dayto-day hygiene care of our residents.... One carer also said that: …we make sure we meet the residents needs, and if we cannot we seek support from other professional teams who can assist us to meet these needs for the resident.... This was similarly echoed by the health and social care professionals involved with the service, where they said that they feel the home contact them when necessary, and that staff seek and utilise the advice that they give. One professional commented that: ...I am happy with the overall care Alan Morkhill House provides.... Where asked if they feel they get good medical support, the residents said that they do, and that any concerns regarding their health is dealt with immediately. A record is maintained of any visits by healthcare professionals to the home, and the outcome of these recorded, such as alterations to medication, or where the resident has been taken to hospital. The staff say that this information is used to update the care plans as necessary. The care plans for a number of residents were looked at during the inspection. These contain a photo and information about the resident under different headings. The care summary enables details to be recorded about the essential routines important to the resident, their life history and ‘health and limitations’, their strengths and limitations. However, further work is needed in some care files, as information did not contain much information, where for one resident the ‘essential routines section’ provided information about medication giving only. And for another resident the section about their ‘strengths and limitations’ was blank. The care plans detail residents’ needs in relation to personal care, communication, meals and nutrition, safety and protection and mobilising. These are more individualised, saying such things as ‘remind to use frame for mobilising’, and encourage to wash parts (resident) can reach. Whilst being individualised, the care plans need to be more person-centred and show evidence of the involvement of the resident and their next of kin, and staff need to receive training in this. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 12 Some further work is needed to ensure that resident’s wishes in the event of their death are recorded, as the care plans state ‘…for (residents’) wishes to be respected…’, which does not provide any information about such things as who the resident would like to be contacted, specific religious observances, funeral preferences, etc. The care files contain information about minimising risks to residents, which were seen to include risk assessments for residents going out alone, and where the resident may be come aggressive or agitated. However, for one resident who regularly refuses to attend to their personal care (or assistance with this), there was no risk assessments or care plan for this, despite the daily record indicating that there were gaps of 2-3 weeks between them accepting assistance with this. The daily records indicate that staff need training in this area, where it was noted that some entries had been crossed out and not initialled or dated, and there were also gaps between entries. In one incident, in a residents’ care plan regarding communication, a staff member had written that the resident ‘…can be manipulative…’, which is an inappropriate phrase to use. The medication on one unit was checked and found to be well managed, with the medication being stored correctly and appropriate records maintained. This is apart from two areas identified for the same resident, where the code of ‘O’ (‘other’) on the MAR (medication administration record) chart was seen a number of times for Ibuprofen tablets and Lactulose, though no record on the chart or in the care file as to what other means. Additionally, on the same chart, where Ibuprofen Gel was prescribed, the code R had been used a number of times, indicating that the resident had refused this. Consideration should be given to having the prescribing doctor review this, and maybe have this re-written as a PRN (as necessary) medication instead of regular medication. The medication trolleys should also be replaced, as these are old and worn. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is adequate. Residents have the opportunity to be involved in some activities, though improvements are needed to ensure all residents are able to access a variety of in-house activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: …I am going on a trip to the seaside soon..., ...I dont get to go out much and I would love to but there are not enough staff..., These were comments from residents who say that whilst they enjoy living at Alan Morkhill House, and that their relatives can visit when they want, they would like the opportunity to go out more. Responses to relatives is positive in that they feel able to visit anytime and the staff are always polite and courteous to them, where one relative said that ...the staff have very good manners, always helpful and very friendly.... Two relatives say that there are a lot of activities planned, whereas a majority feel that there should be more activities, particularly for the residents with dementia. Comments received from relatives include: …my relative has Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 14 dementia and they like to talk, but no-one listens..., ..they need more activities, particularly for those with memory loss..., ...they just wonder from their room to the room with the TV, which looks very lonely and boring.... The staff say that they feel the service does well at providing activities, arranging outings and taking people out for lunch. Staff also say that they work hard to motivate the residents to maintain independence in their lives. The issue of activities was discussed with the manager during the inspection. She highlighted a number of external activities that some residents are involved in. These include three residents who do Tai Chi at day centre in Chelsea, other residents who go to other day centres, and do cooking, etc., trips and taking some residents out for lunch in the local area. She said that the service has good links with a local school and some residents are invited there once a month for a lunch prepared by the children. She also discussed plans to utilise the front garden more, to make it more appealing for the residents. Regarding in-house activities, there is no activities co-ordinator at present, and activities are provided by the care staff. She said that the plan is to have one carer take on activities between 11am and 1pm each day. During the inspection one resident was seen waiting to go to the day centre, and one carer was observed sat in a lounge area talking to two residents. The service needs to improve the activities it provides in-house, and externally, particularly for residents with dementia and those who are unable to attend regular outside activities. A structured programme of activities needs to be in place, and records maintained of all residents involved in these, how long they were involved, their participation and how they enjoyed the activity. Responses from the surveys and conversations with residents during the inspection were positive about the meals provided at the home. Comments from some relatives were that they feel the food is of a high standard. Residents said that they usually always like the food on offer, and are able to choose an alternative if they wish. One spoke about how they look forward to having …soft fried eggs a couple of times a week.... During the inspection one resident was observed talking to the chef, requesting pilchards for tea sometimes, the chef assured them that these are available whenever the residents would like them. The service should consider incorporating these into the afternoon meal menu, as the option of sausage roll seems to appear almost every day. It would also allow all residents to have the opportunity of having fish without having to ask for it. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. There are systems in place to minimise risks to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is displayed around the home. Feedback from residents is that they know how to make a complaint if there was something they were not happy about. Relatives said that they are aware of how to raise any issues, through ...literature available in reception area... and the availability of the manager during office hours. Survey responses from staff demonstrated that they have a good awareness of how to deal with a complaint should they receive this, where they feedback that they would refer to the complaint procedure and direct the complainant to more senior staff in the service. They also said that they would encourage the person raising concerns to complete a complaint form and discuss issues with the manager. There is a book held in the managers’ office specifically for the logging of complaints, along with records of actions taken and the outcomes of these. There are also copies of any relevant correspondence. It is recommended that the ‘outcomes’ section of the complaint log is enlarged to provide more detail Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 16 about how the complaint was resolved, and also a copy maintained of any complaint form sent to the organisation to investigate. At the time of inspection a number of staff had received recent training in abuse awareness and safeguarding adults, so to minimise risks to residents. The manager showed evidence of planned training for the rest of the staff team to receive this. Some of the staff also spoke about how they are encouraged by the manager to report any safeguarding issues immediately. Staff spoken to during the inspection had a good understanding of what they should do should there be suspicion of abusive practice taking place, and they were of ‘whistle blowing’ procedures. In addition, most staff have been recently trained in moving and handling, with further training planned for those who need refresher training. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22 and 26 Quality in this outcome area is good. The environment is welcoming and relaxed, however improvements are needed for the comfort and safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents comment that they are happy with their room and that the home is fresh and clean, with one saying that ...the domestic staff are doing a good job.... One relative said that ...there could be more access to a telephone direct to the residents within their unit.... Also, during the inspection one resident did say that they would like to have a telephone in their room, or easier access to one. The manager said that there is a ‘wheeled’ payphone on one of the floors and there are two cordless phones for use. However, the service should Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 18 consider having a cordless telephone on each unit to ensure accessibility and privacy can be maintained for the residents in making and receiving personal calls. A number of staff feedback that improvements are needed to the environment, these include: …need to provide better furniture for the residents...”, “…some furniture looking very tacky, old, drawers broken..., ...some carpets are very old and dirty.... During the inspection a tour of the communal facilities was carried out, no bedroms were looked at. The home is purpose-built, bright and airy, with neutral colours throughout. A number of areas were seen to need addressing, and these are listed below: - the first floor bathroom, opposite bedroom 9 is in need of re-decorating, and made more homely-looking, as it has cracked paint on the walls. The tiles around the sink also need re-grouting. - in unit 1B, the lounge contained a chair with ripped cloth and the television stand was chipped – both in need of replacing. - in unit 1B, the bathroom needs to be made to look more homely and inviting. - in lounge on second floor – the crack on the wall beneath the window needs to be made good, and the picture frame needs replacing. - the carpet on the stairs in the stairwell leading from the second to the ground floor is stained and in need of cleaning. - the flooring in the shower room on the ground floor is a trip hazard, where it has become raised and creased, and is in need of replacing. - the yearly planner of activities on the ground floor is confusing and needs reconsideration, possibly breaking down into a weekly/monthly activity programme. - also having all the 4-weekly rolling menus on display on the ground floor is confusing, and re-consideration should be given to this. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. The service provides training so that residents receive a good level of care, and recruitment procedures protect the residents. Staffing levels need to be kept under review to ensure that needs can continue to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Alan Morkhill House has a staff team comprising of staff who have worked at the service for a number of years, plus newer staff. Staff feedback that they are confident that the service they provide promotes the independence and meets the care needs of the residents. Feedback from residents is good, where they say that the staff are caring, kind and respectful of their privacy, however they do say that they sometimes feel the home is short staffed, and often have to wait a while for a carer to attend to them. Similarly, an area that some relatives comment on was that they feel there are not enough staff, where there “…often seems to be no-one around when I visit…”. However, a number of relatives said that they feel the staff have the right skills and experience to meet needs, and that they are also introduced to new staff. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 20 Where staff were asked in the survey about whether there are enough staff to meet needs, the general overall response was ‘sometimes’. Some satff said that there are simply not enough permanent staff, with shifts being covered by agency staff, whereas others said that there are rarely two staff working on each unit, and one commented that: ...some units have one staff looking after seven residents, it is impossible to meet individual needs in that situation.... Staff suggested having more staff on duty in the morning, as they say this is the busiest time, whereas others say they need more staff at night. The staff rota for the ten days prior to the inspection shows that a ‘float’ member of staff does help out occasionally in the morning, though this was mainly at weekends and for occasional days during the week, though this was not consistent. The manager said that they are currently in the process of recruiting more care staff to address shortages. The home holds recruitment information on each member of staff. The staff files contain relevant information such as proof of identification, immunisation information, correspondence relating to offer of job, two references and record of the interview of staff. The staff details’ form provides evidence of a CRB (Criminal Records Bureau) check and POVA (Protection Of Vulnerable Adults) First check having been carried out. All new staff receive an induction to the service, which covers areas such as fire safety, first aid and communication. Staff who responded to the survey say that they received a good induction that prepared them well for their work. Staff comments on this were: …there was a clear explanation and accurate details of every subject given..., ...I understand my role and responsibilities as a carer.... Staff also said that they get enough training to support them in their role. With one commenting that there is: “…the service does well in terms of training…”, and another saying they had done recent training in “...health and safety at work, equality and diversity, and recognising abuse…”. The staff training records indicate that staff receive training in these areas, in addition to first aid, medication training and food safety. It is recommended that staff receive training in dementia care, to enhance the care given to the resdients with dementia. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. There is a committed manager at the home who is progressing the service for the benefit of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: ...the management are very good, always very helpful and always willing to listen and spend time with you... This was a comment received from a relative who visits the service. Staff also say that the manager is supportive, regularly asking them if they have any problems in their work, or any issues regarding the residents. One staff Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 22 member said that they would like to feel more supported when the bring new ideas to improve the service. Staff said that they receive good communication, and are informed about inportant information that affects them. There are a number of staff meetings held at the home, for the carers and senior staff, though some have not happened for some time and the manager needs to ensure that these occur regularly. The AQAA completed by the manager, and conversations with manager demonstrate that she has a very good understanding of what is needed to continue to improve the service for the benefit of the residents. She has a number of years experience in care of older people, and is appropriately qualified for the role. The manager meets with the residents at a monthly meeting, in additiona to being at the service from Monday to Friday each week. The records of the most recent residents meeting in June 2008 details that residents have the opportunity to discuss issues regarding the meals provided, activities and laundry. During the inspection trhe issue of staff supervision was discussed with the manager, as records indicate that this was not occuring regularly, where some files state that they had not received supervision since February 2008, and for one night staff member, since 2006. The manager said that group supervision occurs with the night staff, however there must also be one-to-one sessions provided, to enable them to discuss issues confidentially. All staff must receive supervision a minimum of six times a year, at regular intervals. The home holds a personal allowance for each resident that is funded by themselves, their family or through social services. This money is used for when a resident wants to go shopping or use the hairdresser, etc. Records are maintained of all transactions, with receipts maintained. The manager and area manager for the service oversee the management of the money. The service maintains records to demonstrate that appropriate health and safety checks are carried out on the fire system and equipment, electrical installation, gas safety and Portable Appliance Testing, etc. It was observed that not all staff wear uniforms whilst working, seen mainly wearing their own clothes. It is recommended that all staff be provided with a uniform for health and safety and to avoid any confusion for the residents and visitors. Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(1) Requirement The care plans must be personcentred and be developed with the involvement of the resident or their representative. The Registered Persons must ensure that the care plans and risk assessments detail all the needs of each resident. The service must provide a varied programme of activities that caters to the needs of all the residents. Full records are maintained of actual activities provided. The Registered Persons must ensure that staffing levels are increased to enable more outside, and one-to-one activities to occur with residents. The Registered Persons must ensure that: - the first floor bathroom, opposite bedroom 9 is redecoratted and the tiles around the sink re-grouted. DS0000010842.V364457.R01.S.doc Timescale for action 31/08/08 2. OP7 15 31/08/08 3. OP12 16(2) (m)(n) & 18(1) 30/09/08 4. OP14 18 31/10/08 5. OP20 & OP21 23(2)(b), (4)(b), 13 31/12/08 Alan Morkill House Version 5.2 Page 25 - the damaged furniture the lounge, in unit 1B is replaced - the bathroom in unit 1B is made to look more homely and inviting. - the crack on the wall beneath the window in the lounge on the second floor, is made good, and the picture frame replaced. - the carpet on the stairs in the stairwell leading is cleaned regularly. - the flooring in the shower room on the ground floor is replaced. 6. OP27 18(1)(a) The staffing levels must be 31/10/08 reviewed, and adjusted where necessary, to ensure there are appropriate staff on duty to meet the needs of the residents. The staff must receive training in person-centred care planning. All staff must receive supervision a minimum of six times a year, at regular intervals. 30/03/09 31/08/08 7. 8. OP30 OP36 18(c)(1) 18(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The manager should ensure that all medication prescribed is kept under review, and raised with the prescribing doctor as necessary. This is particularly where a resident refuses medication over a period of time. The manager should ensure that each resident’s wishes in the event of their death are recorded. 2. OP11 Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 26 3. OP16 It is recommended that the ‘outcomes’ section of the complaint log is enlarged to provide more detail about how the complaint was resolved, and also a copy maintained of any complaint form sent to the organisation to investigate. Consideration should be given to re-formatting the yearly planner of activities, and the four-weekly rolling menu on the ground floor. The service should consider having a cordless telephone on each unit to ensure accessibility, and privacy can be maintained for the residents in making and receiving personal calls. It is recommended that staff receive training in dementia care. The manager should ensure that all staff are trained in good record-keeping techniques, and use appropriate wording at all times. It is recommended that all staff are provided with a uniform for carrying out their work. 4. OP19 5. OP22 6. 7. OP30 OP37 8. OP38 Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alan Morkill House DS0000010842.V364457.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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