Inspection on 17/10/08 for Morningside

This inspection was carried out on 17th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morningside 15/11/06

Morningside 02/02/06

Morningside 20/07/05

Morningside 21/10/04

Morningside 27/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Morningside 52 Swanlow Lane Winsford Cheshire CW7 1JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Porter     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Morningside 52 Swanlow Lane Winsford Cheshire CW7 1JE 01606592181 01606552719 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Medingate Limited Name of registered manager (if applicable) Donna Liddiatt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To services 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. The maximum number of service users who can be accommodated is: 31. Date of last inspection Brief description of the care home Morningside is a care home that provides personal care and accommodation for thirtyone older people. It is a two storey detached Edwardian house set in large grounds in a residential area of Winsford, within easy reach of facilities such as shops, pubs, GP surgery and other amenities. The accommodation consists of 31 single bedrooms, one of which can be used as a double room. Sixteen of the bedrooms have en-suite facilities. There is a passenger lift as well as stair lifts providing access to the first floor. Communal facilities include three lounges, a conservatory leading on to a patio with seating, meals are taken in the lounges or the conservatory, there is a designated Care Homes for Older People Page 4 of 26 care home 31 Over 65 31 0 Brief description of the care home smoking area in the home. There are very large, pleasant grounds planted with trees and bushes, which are well maintained and accessible. Information in respect of the cost of living in the home is available form the manager. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. We carried out this unannounced visit to Morningside on 17 October and followed it up on 23 October. The visit lasted a total of 9 hours and was carried out by one inspector. The report says we when referring to what we did, as it is written on behalf of the Commission for Social Care Inspection. This visit was just one part of the inspection. We also looked at other information we had received about the home since our last inspection there. Before the visit the manager was asked to complete a questionnaire to provide up to date information Care Homes for Older People Page 6 of 26 about the service. We also made questionnaires available to people living in the home, their relatives and staff so they could let us know what they think about the home. During our visit, we looked at various records and walked round the building. We talked with people living in the home, their relatives and staff who were on duty on the days we visited. Their views about the way the home is run are included in this report. What the care home does well: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move to the home so that they can be assured their needs can be met there. Evidence: We looked at the care files of two people who live at Morningside to check on what had happened before they moved to the home. Both files showed that each persons needs had been assessed before they moved in so they and the staff would know their needs could be met at the home. Standard assessment documents are available for this purpose and cover details of support needed in relation to personal care, mobility, health, diet, medication and likes and dislikes. Assessment documents identify if there are any risks involved with daily life and providing support for the person. The manager told us that she or one of the two deputies would meet with the person before they moved to the home to assess whether or not their needs could be met by Care Homes for Older People Page 10 of 26 Evidence: living at Morningside. We could not find any evidence to show that either deputy had received training or had qualifications to show they are competent to make these assessments about peoples needs. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health is monitored and care plans identify what is needed so that people living in the home have the care and support they need in a manner they wish. Evidence: We looked at the care files of two people living in the home to see what care they needed and how this was being provided. One of the care plans we saw was written in the new format that has been developed and is being implemented in the home. Both plans we saw clearly identified the persons needs but the new format was better at showing how and by whom these needs would be met. The care files we saw identified that other health professionals were also involved with peoples care and records were being maintained of visits by the doctor, district nurse, chiropodist. The manager told us that all consultations people who live at the home have with health care professionals are now held in private to make sure their dignity and confidentiality is maintained. Both the care plans we saw had been agreed by the people whose plans they were, to show they knew what care was to be provided for Care Homes for Older People Page 12 of 26 Evidence: them and how. We noted that some information in the care plans we saw was not as clear as it should be. For example, one care plan, in respect of staying safe, said, check regularly through the night. Information such as this needs to be more specific so it give clear guidance to staff on, for example, how often they should be making such checks. There is a policy on medicine administration at the home. There is also a policy about people managing their own medicines so people living at Morningside can stay as independent as possible for as long as possible. We checked the medication administration records and found that there were a number of omissions of staff signatures to show that medication had been given. We found that information was not recorded in one instance of why medication had not been given, although staff were able to confirm that it this was because the person who should have received the medicine was asleep at the time. During the time between our first visit to the home and the follow up visit, the manager had addressed these matters. We have been provided with an action plan to show that staff have been spoken with, that retraining will be offered where necessary, monitoring is in place and action will be taken if further omissions occur. This is to make sure that the people who live in the home receive their medicines safely, as prescribed by their doctors. Throughout our visit, we saw staff speaking with the people who live in the home in a pleasant way, sharing a joke with them and their relatives and knocking on doors before entering. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to remain active and maintain contact with people who are important to them so that they continue to keep in touch with their families and friends. Evidence: There is an activities coordinator employed to arrange activities for the people who live at the home. He also provides material that other staff can use for activities, for example, a memories box that can be used to help people to reminisce. This contained items from the war, wedding photos and fashions of the day. The evening before our visit a number of people who live at the home had been to a show at the local town hall, accompanied by staff and some relatives. An activities board was kept up to date in the home and reflected the activities that were happening during the day, with general knowledge and bingo being very well attended. Many visitors were seen during the time we spent at the home and we spoke with three relatives about the care/support that their relatives are given. All were positive and said that they visited at various times of the day and were always made to feel welcome. Information was seen in the home regarding the services offered by the local advocacy Care Homes for Older People Page 14 of 26 Evidence: team. The manager confirmed that residents are encouraged to manage their own finances for as long as possible, or that families are involved and where this is not possible appropriate systems have been put in place. We observed breakfast on the day of our first visit. This was unhurried, served as and when people wanted it. We joined the people living in the home for lunch of fresh salmon, potatoes and fresh vegetables; the food was well cooked and nicely presented. One person we spoke with said that the food in the home was gorgeous. Plates were emptied and the chef was seen asking each person did they want any more. Some people had remembered what they had chosen for their lunch but some had forgotten when staff and the chef asked them again. It may be helpful to them to consider ways of reminding them what they had ordered. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are confident and comfortable raising issues and feel that they are listened to in respect of their wishes. Evidence: There is a written complaints procedure for the home. People living in the home told us, in questionnaires they completed and when we spoke with them during our visit, that they know how to make a complaint if they needed to. They and their families said that if they raise any issues with staff, prompt action is taken to resolve matters. At our last inspection of Morningside in November 2006 we made a requirement that staff at the home must receive training on safeguarding people from abuse. We were told at the time that this had been done. However, when the new manager reviewed staff training to provide us with up to date information, it was identified that although some staff did receive training in March and November 2007, 16 staff still need to have training relating to protecting vulnerable adults. We have now been provided with information that this training has been booked and paid for and will take place on 10 December 2008. The manager confirmed that one referral has been made to the local authority adult protection team. This showed that correct action had been taken to protect the people who live in the home from possible harm. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that people live in comfortable, clean, homely surroundings. Evidence: During our visit, we walked around the home to look at the communal rooms, the bathrooms and some bedrooms. We found that all areas of the home were well maintained, fresh and bright. A maintenance person is employed at the home for three days a week to make sure that small jobs are completed, with larger jobs being contracted out. Records showed that since 24 August 2008 the lift engineer had visited the home nine times to test and rectify a fault with the passenger lift. There is a stair lift that can be used as an alternative way for people to get from floor to floor in the home and the owner confirmed to us on 13 November that all necessary measures are in place to ensure the safe running of the passenger lift on a day to day basis and moreover, should there be occasions when problems arise, there are contingency procedures. All the people living in the home at the time of our visit had varying degrees of difficulty with their mobility, most people either needing a walking stick, a frame or a wheelchair to support them in getting around. We observed two people at lunch who could not raise themselves to a standing position and were therefore dependent on staff to get them on their feet. A number of people we saw would benefit from Care Homes for Older People Page 17 of 26 Evidence: occupational health input to see if adaptations and equipment would support them further with their independence. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough recruitment checks are made to make sure that staff are suitable to work with the people who live at the home but their mandatory training is not up to date so people living at Morningside may not be receiving care safely in line with current good practice guidance. Evidence: There is a very low turnover of staff at Morningside so they have got to know the people who live in the home very well. On the day of our visit, we saw enough staff on duty to meet the needs of the people living there. More than 50 percent of care staff have achieved NVQ in care at level 2 or above. Following a review in the training records of all staff the new manager has identified that mandatory training has not been maintained and she has taken steps to address this. We looked at staff files of four newly recruited members of staff to see what checks had been carried out. All files contained a completed application form with details about the person, two written references and evidence that a Criminal Records Bureau (CRB) disclosure had been obtained for the member of staff. We also checked the file of a volunteer who works at the home because at the last inspection, we made a requirement that a CRB disclosure should be obtained for them, Care Homes for Older People Page 19 of 26 Evidence: as they come into contact with the people who live at Morningside. There was no evidence that the disclosure had been obtained. The manager met with this person on 23 October 2008 and alternative arrangements have been made until a CRB disclosure can be obtained. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and people who live there and the staff have opportunities to express their views about the home to help make sure it is run in the best interests of those who live at Morningside. Evidence: The manager, who is experienced and knowledgeable, spoke positively about the level of contact she has with the owner of the home although he does not live in the local area. We saw information in the home about forthcoming meetings with people who live there, staff meetings and staff training events. During our visit, we saw people who live at the home laughing and joking with the manager and the staff. People had told us they were confident to speak with staff and we heard one visitor telling staff he was just going to make his mum a cup of tea so she would think he was good. Families we spoke with said that they found the manager very approachable and easy to speak Care Homes for Older People Page 21 of 26 Evidence: to. There is an established quality assurance process for the home and regular visits are made by the owner to make sure the home continues to run well. Records are made of these visits and these are kept in the home. The manger told us she does not act for any of the people living in the home in respect of their finances and any of the previous arrangements that were in place have now stopped and been taken on by the local authority. Small amounts of money are kept in the home for people who want this. Accurate records are kept of any transactions made to make sure that peoples money is properly accounted for. We checked the accident record which showed 17 accidents had happened since the new owner took over the home. The records we saw were appropriate and showed what had happened; most were about slips, trips and bumps. Service contracts were in place for the fire safety equipment, the passenger lift and hoists. The fire officer visited the home on 10 October 2008 and recommendations he made have been acted upon. The manager had already identified the shortfalls in staff training before we made our visit. Since the new owner of the home took over, an action plan to address any shortcomings they have found has been drawn up. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 13(6) Staff must receive training relating to adult protection 31/01/2007 2 29 19(1)(b) All staff must have a CRB 31/01/2007 disclosure or POVA first check completed before they start working in the home. Volunteers must have a CRB check before they start to work in the home or with the residents. Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 13 Staff must receive up to date training in relation to moving and handling, infection control, health and safety, and 1st aid. This is to make sure they have the necessary up to date training to be able to provide safe care for the people who live at the home. 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Staff members from the home who carry out assessments of the needs of people who may move into the home should be suitably trained or qualified to do this. This is to make sure that accurate assessments are done so that peoples needs are correctly identified and the home can show that these needs can be met there. Staff should receive training in safeguarding adults every two years in line with Department of Health guidance No Secrets. This is to make sure they have up to date 2 18 Care Homes for Older People Page 24 of 26 information on what they need to do to make sure people who live in the home are protected from abuse. 3 22 Arrangements should be made for the people who live in the home to be assessed by occupational therapists to make sure that all the aids and adaptations they may need to help them move around the home are available for them. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!