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Inspection on 23/07/09 for Morton House Nursing Home

Also see our care home review for Morton House Nursing Home for more information

This is the latest available inspection report for this service, carried out on 23rd July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home works well with those residents who require intermediate care to get them equipped with the skills and abilities they need to return home. This requires the home to work well with members of the multidisciplinary team, which was evident during the visit. With a large turnover of residents, the expected time for intermediate care is six week, it is essential that staff keep abreast of the changing population of residents and are able to address the broad spectrum of needs that they are admitted with. The home has retained some senior staff for many years that know the workings of the home very well. This is an asset, as they will know all of the Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 local contacts, policies and procedures, routines to ensure the smooth running of the service. The activities are varied and the activities coordinators enthusiastic about their roles providing a varied programme of entertainment.

What has improved since the last inspection?

There have been many improvements made to the environment including resident`s bedrooms and communal areas. The kitchen has been refurbished with new floor, heated trolley and kitchen equipment replaced. Mandatory training has been actioned and most staff have attended updates. Adult protection procedures had improved and those matters deemed appropriate referred to safeguarding. Records for complaints including supporting records were available on site and those seen showed improvement since the last site visit. All information was stored correctly and information retained in a confidential manner. The manager has been in post almost two years and is working through many of the issues she inherited.

What the care home could do better:

Some of the care practices, records and documentation need to be improved upon. Comments received about staff interactions and our own observations of staff did not demonstrate the level respect and dignity towards residents that they should expect. This is further compounded by the large amount of agency and bank staff that are employed who do not fully know what residents need hence shortfalls in care can occur. The home needs to make every effort to fill staff vacancies and reduce the number of temporary workers.

Key inspection report CARE HOMES FOR OLDER PEOPLE Morton House Nursing Home Morton House 12-14 Lewisham Park Lewisham London SE13 6QZ Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 23rd July 2009 09:15a DS0000007035.V376766.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton House Nursing Home Address Morton House 12-14 Lewisham Park Lewisham London SE13 6QZ 020 8314 1075 020 8690 3419 ade@missioncare.org.uk www.missioncare.org.uk Mission Care 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) Gladys Makarawo Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (27) of places Morton House Nursing Home DS0000007035.V376766.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 with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 27) 2. Physical disability - Code PD (maximum number of places: 27) The maximum number of service users who can be accommodated is: 27 4th September 2008 Date of last inspection Brief Description of the Service: Morton House is a care home providing nursing care and accommodation for 27 older people. Mission Care, which is an inter-denominational Christian registered charity, owns it. The organisation has five other homes in South East London and the head office is in Bromley. The home looks out over Lewisham Park and is close to buses and to Ladywell railway station. There are some local shops nearby and Lewisham centre with all its transport and shopping facilities is approximately ½ mile up the road. The home, which is a modern building, opened in 1991 and consists of three storeys. It is in the process of upgrading areas including redecoration. All the bedrooms are single and none have en-suite facilities. There is a passenger lift. The home has parking and a small garden to the rear of the property. Morton House also provides intermediate care for up to 11 service users and there is a portakabin extension at the rear of the property to provide additional facilities for those individuals receiving intermediate care. The home works in close partnership with Lewisham Intermediate Care team comprising of physiotherapists, occupational therapists and social workers, there is at least one member of the team on site at all times. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 5 Fees range between the following £750- £781.01 for intermediate care self funding. Local Authority fees for older persons care are between £599.00 to £615.00 Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over a one day period. The Manager facilitated the site visit. Periods of observation were undertaken on the ground floor. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CQC. This was well completed with comprehensive information including the updates in respect of the issues and requirements specified at the last key inspection. Seven resident’s comment cards were returned prior to the inspection as well as five from staff and seven from relatives. The comments are included in the different section of this report. In addition three staff surveys were completed during the site visit and handed in. On the day we met with several relatives and several residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home works well with those residents who require intermediate care to get them equipped with the skills and abilities they need to return home. This requires the home to work well with members of the multidisciplinary team, which was evident during the visit. With a large turnover of residents, the expected time for intermediate care is six week, it is essential that staff keep abreast of the changing population of residents and are able to address the broad spectrum of needs that they are admitted with. The home has retained some senior staff for many years that know the workings of the home very well. This is an asset, as they will know all of the Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 7 local contacts, policies and procedures, routines to ensure the smooth running of the service. The activities are varied and the activities coordinators enthusiastic about their roles providing a varied programme of entertainment. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 8 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 9 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 Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the 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 registered manager ensures that all prospective residents are appropriately assessed prior to admission; making sure that their care needs can be met by staff in the home. EVIDENCE: Residents are assessed prior to admission; the manager of the service usually does this. Residents and relatives whom we met said that they had been assessed prior to admission and were provided with information on the home. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 11 Comments in the surveys indicated they had service information provided prior to admission and some said contracts had been issued. Contracts were not inspected. Care plans sampled included those for residents on long-term care and those in the intermediate care beds and these included assessment information. Assessment information included the assessment conducted by the home as well as other relevant documentation. Assessment information was included in the care plans of all those looked at. Records included Lewisham Primary Care Trust assessments, hospital discharge summaries, and the assessment conducted by the manager of the home. In these assessments the activities of daily living were identified and a tick box to indicate if there was a problem in that area and additional information added as appropriate. The Social Services assessment was available and this provided good information on the resident’s needs. Any equipment deemed necessary will be obtained prior to admission. An inventory of valuables and personal items is completed on admission. Each bedroom had a Service User Guide, which had been recently reviewed. This sets out the aims and objectives of the home, and provides basic information about the service and the specialist care the home offers. The documents will need to be revised to take account of changes to the organisations senior management arrangements and to amend the Commission’s details (the Commission’s contact centre is now based in Newcastle and not London). Trial visits are often not undertaken as there is little provision in the area for intermediate care. We understand that those residents on long-term placements are offered opportunities to spend time in the home prior to admission although many do not take this up for various reasons although family members do visit. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans seen reflected the assessed health and personal care needs of the individual and gave clear guidance on how these needs were to be met. Some supporting records were not well completed and this may lead to inaccurate information being relayed and adversely affect the care provided. In addition some instances of poor care practices were noted, which was further compounded by the lack of staff and use of temporary workers which means that care delivery is not always to a good standard. The medication policies, procedures and practice ensure that the people who use the service are given the correct medication at the correct time by competently trained staff EVIDENCE: Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 13 The home employs qualified nurses and care staff who deliver the care. They are supported by a multi disciplinary team many of whom are based on site, and work mainly with those residents who are on an intermediate care basis. Male and female staff are employed so that gender care issues can be addressed. There was a lot of equipment available, and in use, including pressure relieving mattresses, walking aids, specialised bathing equipment footstools etc. Pressure relieving mattresses are provided usually through the primary Care Trust and the manager insists these are in place prior to admission for any residents who needs them. Care plans were inspected. Care plans included the issues identified and risk assessments for skin integrity, falls, nutrition and dependency. A continence assessment is undertaken over a three day period. On some of the documentation signatures and dates were omitted. In the section that details the support and care staff need to give – the interventions section, there was good information on which staff could address the care. Records relating to visits made by the multi disciplinary team were located in the files. Daily events mainly referred to physical health issues and were limited on leisure social and psychological care. The reviews on care plans varied in content and in cases were limited. The care plans on social care and leisure, simply indicated that the residents should be kept orientated and social needs met. More information is needed to ensure staff know how to address social and leisure activities as each resident will have preferences. Whilst documentation in this home is reasonably good the outcomes, that is, the quality of care experienced by some residents, seemed less than good. Most significantly we found that the privacy and dignity of residents was repeatedly compromised by some poor practice. We observed staff providing support and assistance to some residents. Staff varied especially in relation to their interactions ad engagement with residents Residents said that staff varied enormously from “ some staff are excellent others very rude “. One resident gave an example of a staff member approaching them saying “ shower “ and then proceeded to take off the person’s pyjamas wash their face and sit them in a chair, then without any further communication or instruction left the bedroom. They also said that that morning they had waited 45 minutes for staff to attend to them and on Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 14 approaching the room, the staff said “ what “ switched off the buzzer and left. This person was very orientated and able to effectively communicate their needs. In the lounge dining area, some poor manual handling practices were observed and in some cases, little communication between residents and staff especially when they were addressing care and support. The staff simply went ahead and did the task without conversing with the resident and letting them know what they were about to do. One resident was sat in light type of wheelchair for a period after lunch. This resident toppled forward and fell on to the floor. Staff rushed to her assistance although it is questionable whether she should have been in this chair any way. The manager said that she was in the chair only for transferring purposes although we observed her to be in it for some time. The food and fluid balance charts were inspected. These are charts, which are required to be kept usually when there is an issue about the resident’s hydration and nutrition. They were found to be inaccurate and confusing, and 24 hour totals were omitted. On some occasions –a total of 350 mls was indicated for a 24 hour period, which is in adequate, yet no further action was indicated and long gaps between drinks either the recording of such or having been given. We were advised that two charts are in operation when residents require hydration via artificial means this could lead to omissions in records. However on the top floor, these charts were well completed. Staff had a good knowledge of infection control procedures, which is essential when working with vulnerable people. The manager audits care plans on a regular basis. We met with two visiting multi disciplinary team members and they were asked to comment on the service. Both provided good comments on how staff dealt with residents saying that they followed instructions correctly, gave good support and care to residents and referred residents to them in a timely manner. Medications were inspected including the records and storage. Each resident has a medication administration chart which has a photograph attached and their allergies recorded. Each bedroom has a secure cabinet as there are residents usually those who require intermediate care who are able to self medicate. Those residents who are able to self medicate are assessed on admission to ensure that they are capable of doing so. There was the medication policy as well as advise from the CSCI- the previous Regulator of the service. In the medication folder there were a number of charts where hand transcriptions were used this is the practice for those Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 15 residents in the intermediate care beds. Some of the charts were untidy and this could introduce a margin for error. Other ways of recording medications had been explored although none had been found to be successful because of the quick turnover of residents who needed intermediate care. Those residents who were long stay have their medication charts pre printed Controlled drugs are safely stored in there own cabinet. The records and drugs checked were accurate. Records for those controlled drugs received and returned to pharmacy were available. There were records of those medication received by the home. Homely remedies are recorded when they are administered. Please see requirement 1. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,1,3,14 and 15. People using the 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 home endeavours to provide appropriate activities to the residents supporting and encouraging them to maintain their chosen lifestyle. The residents are provided with a nutritious and healthy menu; choices are available and they eat in nice surroundings enabling them to feel comfortable and receive appropriate support and encouragement. EVIDENCE: Observation periods were undertaken in the lounge where residents were spending time. Two church members were conducting a quiz, and residents were participating. The residents seemed to enjoy this and the facilitators were very enthusiastic and encouraged residents throughout the session. There were some periods, when residents in the lounge were sleepy and there were limited signs of engagement with one another or their surroundings in general. Some staff did not engage actively with residents although the activities coMorton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 17 ordinator did. The activities coordinator was very caring towards residents, and worked hard to provide stimulation and recreation to residents even those who had limited abilities and communication. She was very pleasant and smiled a lot which gave the impression of a happy friendly person. The AQAA told us the following about activities: Two carers work as activities coordinators. Five days of the week are shared between them. This has enabled us to have a planned, regular and structured approach to activities and events, whilst also increasing the level and variety of activities, in response to the demands and needs of the residents. We are aiming to engage an independent local advocacy organisation/agency to support our residents, especially those that has limited contact with their relatives and/or next of kin. There were comments related in the surveys in relation to food. The comments were variable some saying they enjoyed their meals saying they liked the home made food, others not so. There was a specific comment about the soup being served cold. The cook was asked about this and was aware it had been an issue. A new practice of serving food was implemented and he felt that all food was now served at an appropriate temperature. Prior to lunch the tables were set. Juice was served with the meal serviettes and cutlery were all in place. On the menu sheet food preferences are recorded. Staff assisted residents in an unhurried manner with their meal. There were three choices of hot food on the menu and any additional requests will be met by the kitchen. Fresh fruit and vegetables were available in the kitchen and a good supply of quality food. Visiting is open and relatives were seen to visit throughout the day, which promotes family contact. Morton House Nursing Home DS0000007035.V376766.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have information on how to make a complaint and they can be assured that those received would be investigated. Appropriate procedures for referring adult protection issues are in place and staff have a working knowledge of how to action such matters. EVIDENCE: To check the standards in this section we spoke to residents, relatives and staff; we checked the record of complaints and took note of the various notifications we received since the last inspection and this includes notification about safeguarding residents from abuse (where abuse or neglect may be suspected). Information on how to raise a complaint was made available throughout the home and on each floor. Information on complaints is also available in the Service User Guide and Statement of Purpose. Complaints information was on display in large print. The information provided was to a good standard and included references to external organisations. There are policies and Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 19 procedures in place to direct staff on the action to take when complaints are raised. The organisation must ensure that information is clear on the role and function of the CQC in matters of complaints, as we are not an investigation body but the Regulator of the service. The records for complaints were to a good standard and the standard form covered all aspects of the information required. There have been two complaints since the last inspection, which have been referred through adult protection procedures. To date the conclusion on them has not been made known to the home. The employees handbook also includes a section on whistle blowing which staff are encouraged to make themselves familiar with As part of staff interviews questions were put to staff on adult protection complaints and whistle blowing. Staff were aware of what constituted abuse and what whistle blowing procedures were used for. They told us that they would report such matters. They were aware of the internal reporting systems although less knowledgeable about external organisations. Staff had a better grasp of abuse than whistle blowing and in some cases this will need to be revisited with further training. Staff said that they had received training on POVA. The AQAA stated that 90 of staff had completed training on the topic, and added: “Concerns or complaints are investigated and dealt with appropriately within 28 days. We maintain a good record of all complainst with details of what was done and how we have achieved closure, where possible”. Relatives and residents with whom we met rasied some isues regarding staffing levels, and their knolwdge of the resident’s needs, and the quality of some staff, these are refered to in the approprite sections. Morton House Nursing Home DS0000007035.V376766.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the 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 home provides residents with satisfactory accommodation in which to live with adequate bedroom and communal areas. EVIDENCE: There have been a number of improvements made to the home including the replacement of the kitchen floor and new equipment. Bedrooms have been upgraded and many have been redecorated. The home has bought a new flat screen TV, curtains had been replaced. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 21 Areas were clean and tidy generally. There is a lot of equipment in this home and storage areas are limited. Some areas were congested and this would pose a hazard to both residents and staff. The lift access is available to all floors. Residents seemed satisfied with their accommodation and level of cleanliness. Residents can personalise their bedrooms and this was evident in many of the longer term resident’s bedrooms. The staff room has been refurbished and this provides staff with more congenial surroundings to spend their break times. The AQAA stated the following: A maintenance programme is now in place Dedicated maintenance team now allocated to the home Resident’s chairs at the main lounge have been changed and replaced with new ones. We have changed all the lighting making the home look brighter. The first Floor has been changed. The kitchen has been refurbished and old equipment replaced. The passenger lift had a complete overhaul and is running well. To continue redecoration of all rooms and relevant areas (painting, change of curtains and old furniture) until the process is complete. Plan to introduce a database to record maintenance and repairs. Morton House Nursing Home DS0000007035.V376766.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At times there are insufficient staff numbers to meet resident’s needs and the use of temporary workers can lead to inconsistencies in care. Training in mandatory subjects has been addressed to ensure that staff are safe and competent to undertake care practices. Additional training on topics specific to residents needs is provided and staff are supervised. EVIDENCE: The home is managed by a qualified nurse who has two senior clinical nurses who work in support of her. There are two qualified staff on each of the day shifts and one on the night duty. Carers and ancillary workers support the qualified nurses. There is an administrator who works 21 hours a week. The home has a number of vacancies and either bank staff or agency are used to fill the shifts. Recent recruitment has not proved as positive as it was thought it would, with staff that have completed the recruitment checks failing to take up post at the last minute. The manager advised us that approximately ten shifts a week are covered by temporary staff, although they are never left Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 23 in charge, however this will have an impact on care and continuity of care which may adversely affect residents and this was referred to several times in correspondence to us. Staffing levels may leave staff too busy to engage with residents or staff may not be motivated to provide social contact, see previous section Daily Lives and Social Activity. One staff was on her first day of employment doing induction. She was reading policies and procedures as well as watching DVD’s on topics such as health and safety as well as manual handling. Whilst these are valuable practical sessions should be conducted to consolidate the training. We were advised that practical tuition would be provided at a later stage during her induction. Other staff with whom we met confirmed that they had received induction over a period of time. They confirmed that interviews CRB clearance and references had all been included as part of their recruitment. Personnel files looked at confirmed that robust recruitment checks were undertaken including those stated above and identity confirmation offer letters contracts. Some references were personnel and some of the work related ones were without official stamps or confirmation. Staff have set questions asked at interview and their answers are noted. Every staff member is on a threemonth probation period. Equal opportunities are monitored. Supervision is conducted by senior staff in the home on a two monthly basis. Training was said to be offered every month and a number of topics had been taught in the last few months including nutrition, catheter care and dignity. Recent training had included management of strokes, diabetes, male catheterisation, and St Christopher’s had covered a number of topics on bereavement and care planning. The home has a number of designated staff, who have had additional training, one is the Dignity Champion and one leads on tissue viability. Comments received in comment cards relating to staff were very variable. Comments referred to “ kind care”, “ staff are kind”, “ staff are helpful – the home takes good care of me. Other comments referred to the large number of agency staff used and the fact was that these staff did not know the needs of residents, lack of enough staff in the day room areas, some residents well cared for and others not so, and some staff are better than others. Another relative commented that in their opinion there were not enough staff at weekends and the quality of care especially at weekend was very variable. Staff comment cards again indicated a variable standard of support and induction received. One saying that they received no induction another saying, “ more training always welcome”. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 24 Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the 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 home, the residents, relatives and advocates benefit from having a qualified, competent, accountable, and committed manager and management structure in place. The home has open and transparent quality assurance systems in place ensuring that the aims and objectives can be measured and are achievable. The home has systems in place to ensure the health and safety of the residents, relatives and staff. EVIDENCE: Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 26 The organisation has had a change of personnel including change in the senior management. A new Executive Director was appointed April 2009 and a Clinical Practice Director has been in post since April 2009. The Operations Director has also recently left the organisation. His responsibilities will be shared by the remaining management team. The manager has been in post for almost two years and has worked hard to improve the home. She has completed the RMA training. She is an experienced manager having worked in this type of setting before and is a qualified nurse. The manager has completed training in mentorship and is planning to a distance learning Dementia Course. The home has qualified nursing staff on throughout the 24 hour period although only two staff have completed the four day first aid course and not all staff have attended first aid training it is recommended that a trained first aider is on duty throughout the 24 hour period and more staff need to be trained in first aid. The home has 4 appointed fire marshals that are responsible for all fire safety in the home including training. Two of the fire marshals are working on night duty to provide maximum cover. In those bedrooms seen individual fire risk assessments were on display. Other fire precautions included regular servicing of the fire alarm extinguishers and fire panel. The emergency lights were last services February 2009. Fire drills had been conducted January and May 2009 and staff signatures confirmed attendance. The hoist had maintenance stickers to indicate they had been recently serviced under the LOLER regulations, which require that all lifting aids be maintained, and services at intervals of not more than every six months. There is no money retained on site for residents. Each resident is provided with a safe that provides safe storage of money and valuables. The AQAA told us the following about quality assurance in the home: We hold residents and family members and meetings. These meetings enable residents and their family members to voice their views, ideas and raise their concerns. They are encouraged to be actively involved in these meetings. The meetings are also used to keep residents informed of any relevant information about Morton House specifically and Mission Care in general. We hold periodic focus group sessions on specific issues and/or emergent Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 27 issues. For example, the last session was focussed on quality of care, meals, activities and the environment. Minutes of meetings and focussed group sessions are circulated to all residents and posted on notice boards. We hold periodic surveys on specific issues, also as a means of engaging residents that do not attend focus group sessions and/or meetings. The last survey was carried out in March 2009. Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 28 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 3 3 Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 Care plans need to fully reflect social and leisure aspects of individual residents to ensure they receive the support they need. Staff must have, or be trained to acquire, a better understanding of resident’s needs and a level of understanding that will enable pro-active support of residents. Efforts must continue to fill the current vacancies to provide a stable staff team. Timescale for action 30/11/09 2 OP27 18 30/11/09 3 OP27 18 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Morton House Nursing Home DS0000007035.V376766.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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