Inspection on 18/12/06 for Mornington Hall

This inspection was carried out on 18th December 2006.

CSCI 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 CSCI 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.

Other inspections for this house

Mornington Hall 13/06/08

Mornington Hall 20/09/07

Mornington Hall 09/05/06

Mornington Hall 21/07/05

Mornington Hall 07/04/05

Mornington Hall 01/11/04

Mornington Hall 01/04/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mornington Hall 76 Whitta Road Manor Park London E12 5DA Lead Inspector Sarah Greaves Unannounced Inspection 01:00 18 and 21 December 2006 th st 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 Mornington Hall DS0000007363.V320564.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. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mornington Hall Address 76 Whitta Road Manor Park London E12 5DA 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 8478 7170 020 8478 6793 www.bupa.com BUPA Care Homes (CFHCare) Limited POST VACANT Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 30 at Cornwell House 30 Elderly Mentally Ill at Haywood House 30 Elderly Mentally Ill Nursing at Hamfrith House 30 Nursing at Roding House Minimum Staffing Notice Date of last inspection 12th October 2006 Brief Description of the Service: Mornington Hall is a registered care home for older people, owned by BUPA Care Homes Ltd. The home is divided into four separate units; residential care, residential care for people with dementia, nursing care and nursing care for people with dementia. The home is located in Manor Park, within short walking distance of an overground station and bus routes. There are car-parking facilities for visitors within the grounds of the home. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector conducted this unannounced inspection on Monday 18th December. This day was spent talking to service users and visitors, and reading care plans. The inspector observed the standard of care that service users received and closely watched how staff communicated with service users. The home was informed on Monday 18th December that the inspector would spend one more day at the service; therefore the visit to Mornington Hall on Thursday 21st December was announced. On this date the inspector checked practices and records for medication, looked at service users financial records for their personal spending allowances, spoke to staff, service users and visitors, and joined service users for lunch. At the time of this inspection the regional support manager, who was present on both days, was managing the home. What the service does well: What has improved since the last inspection? The last inspection of the key standards was conducted in May 2006 and there have been two short inspections since then (random unannounced inspections in August and October 2006). A requirement was given for the service to evidence better liaison with other organisations used by service users, such as day centres. At the time of this inspection, the service had developed good links with the organisers of a bingo club for older people and an Asian luncheon club. A requirement for the home to employ better systems to manage the care of people admitted for respite care was evidenced to be occurring at the Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 6 first random inspection. The home demonstrated that any offensive odours were eradicated and the care plans demonstrated a clearer approach to ensuring that service users have a suitable supply of clothing. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mornington Hall DS0000007363.V320564.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 Mornington Hall DS0000007363.V320564.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users received a suitable assessment of their needs prior to admission to Mornington Hall, which involved their representatives if feasible. EVIDENCE: The service undertook its own pre-admission assessments for all prospective service users, in addition to receiving assessments from the placing authorities (social services). The inspector spoke to several relatives of service users, who stated that they were able to discuss the individual needs of the person that they wished to place at Mornington Hall with the nursing and care staff and ascertain whether the service could cater for specific individual needs. Relatives spoke of choosing Mornington Hall rather than other care homes that they had visited because the service offered particular features (for example, Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 9 environment, staffing approach, atmosphere and social activities) that suited the needs of the service user. The service’s pre-admission assessments were conducted by senior staff and were comprehensively designed, in accordance with the criteria for assessment stipulated in the National Minimum Standards for Older People. Standard 6 was not applicable for assessment, as the service does not offer intermediate care. Mornington Hall DS0000007363.V320564.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service identified some strengths with care planning; however, improvements are required in order for the care plans to be fully individualised and comprehensible. A more rigorous approach must be applied to meeting service users health care and medication needs. EVIDENCE: The inspector read twelve randomly chosen reports during this inspection (three reports from each 30 bedded unit). The representatives of the service users had signed eleven of the care plans and a service user had signed one care plan. The inspector found that the vast majority of service users were not in a position to sign their own care plans due to cognitive impairment and/or physical frailty. All of the care plans had been reviewed at least once a month. Via reading one care plan and speaking to the regional support manager, the inspector noted that families could attend monthly care- planning meetings if Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 11 they wished to. The care plans were detailed and addressed a wide range of actual, and potential, health and social care needs. The care plans were usually appropriately focused upon the needs of individuals; for example, a care plan for a service user with diabetes addressed the clinical management of diabetes, as well as separately identifying the impact of diabetes to other aspects of daily living (for example, maintaining personal care, risk assessments for prevention of pressure sores, and promoting nutritional status). Some issues were identified during the inspection and were discussed with unit managers and the regional support manager, such as: 1) Inappropriate terminology. One care plan stated that a service user “is toilet trained”. 2) Incorrect numerical style for recording weight losses and gains. 3) Inaccurate interpretation of assessment of service users ‘home circumstances’. Staff did not recognise that this assessment category referred to service users home prior to admission. An assessment to establish if a service user had retained numerical skills was being applied in different ways throughout the home. Staff needed guidance on assessing this skill in a manner that is meaningful for service users. 4) An entry in a care plan provided an ambiguously worded statement that an individual wished to practice their religion but did not state how this would be achieved. 5) An incorrect scoring found on a Waterlow chart (document for assessing an individual’s risk of developing a pressure sore). 6) Incorrect height recorded for a calculation of a service user’s body mass index. 7) An objective to support a service user to dress in a manner that promoted a dignified, comfortable and positive body image was not clearly explained. 8) A care plan described a service user’s problem as being “low dependency”. A second problem for the same service user was entitled “daily routine”. 9) A care plan for a service user’s pressure sore did not reflect that a significant change had occurred on a particular date; however, this information was found in the service user’s daily record sheet. 10) The medical record sheet for a service user was found in another service user’s file. 11) Care plans contained guidance on how to keep service users cool during hot weather (in December). Staff were continuing to evaluate this objective although there was also guidance regarding how to keep service users warm in cold weather, which they also evaluated. The care plans demonstrated that systems were in place to assess and monitor health care needs. The care plans identified that specialist medical and health care was promptly sought; for example, a community tissue viability nurse was involved in the care of the aforementioned service user with a pressure sore. Weighing programmes were found to be rigorously undertaken in the care plans viewed at this inspection, and appropriate Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 12 action was taken to respond to significant changes (for example, increased frequency of weighing, referral to General Practitioner (GP) and/or higher calorie diet offered). One of the care plans did not contain evidence that a service user that required weekly weighing had been weighed for a few weeks; however, the unit manager produced this information in a separate book for service users weights. Each service user’s file contained an ‘external professionals’ page for entries by visiting doctors, podiatrists, specialist nurses and other practitioners. These entries, when viewed in conjunction with the home’s records, did not indicate concerns regarding staff accessing external health care for service users in a timely fashion and the service’s ability to comply with instructions from the GP and other persons. The service received input from the visiting Primary Care Trust nurses and service users on the residential units received district-nursing services to attend to any nursing needs. Via observations, the inspector noted that a pressure mattress was not functioning properly (control equipment was bleeping). The service user was in bed at this time and was assisted by a care worker to have their supper. The care worker did not report this malfunction to a staff nurse or the unit manager. Evidence gathered since the last inspection and prior to this inspection indicated health care practices that needed to be improved. The inspector was concerned by the service’s delay in appropriately responding to observations (blood pressure and pulse recordings) that were not within a service user’s normal range. Concerns were also identified in regard to staff knowledge of how to calculate a person’s Body Mass Index (BMI) in order to determine if their weight presents any care needs. The need for senior staff in the residential units to pass on significant information health care information (such as a doctor’s instructions) to the person in charge of the home (a registered nurse) has not been consistently demonstrated. This body of evidence also raised concerns regarding how the home addressed the personal care and clothing needs of individuals. At this inspection, the inspector found that service users were comfortably and smartly dressed, and clothing inventories indicated that service users had a reasonable amount of clothing. The inspector checked the storage, recording and administration of medication on one of the residential units. It was positively noted that some service users were supported to self-administer medications, subject to their choice and a risk assessment. The inspector observed that the member of staff giving out medication handed it to a care worker (to administer to a service user) rather than directly administering. The member of staff acknowledged that this was not permitted by the service’s medication procedures. The member of staff was unable to identify a couple of the medications that they had administered to service users (for example, what the medication was prescribed for). The staff member stated Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 13 that they were aware of the need to look up any medications that they were unfamiliar with. The inspector observed that tubs of thickening granules for fluids (prescribed by the GP) were left on service users bedside cabinets. The inspector recommended that a more secure location within a bedroom should be sought to ensure the safety of others. The inspector observed that staff interacted with service users in a respectful and polite manner. Service users and relatives stated that they found the staff to be cheerful and helpful; this view was expressed throughout the inspection. The inspector did not observe staff undertake any personal care of an intimate nature in communal areas. All bedrooms were designed for single occupancy. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Service users are offered a varied and fulfilling programme of activities, and opportunities to maintain their links with the local community. The quality of the food is good; however, staff must consistently ensure that service users are appropriately supported to enjoy their food. EVIDENCE: The inspector met with one of the activities organisers. The service employed three activities staff, working a total of eighty hours. Each unit was provided with its own weekly timetable of activities, which included pub lunches, tea dances, golden oldie film shows, visiting entertainers, aromatherapy massage, hairdressing, cake decorating, keep fit, one-to-one activities and coffee mornings. Service users accessed external groups such as a bingo club and an Asian luncheon club. The inspector was informed that a multi-sensory box (tactile and colourful items to promote stimulation and well-being) had been purchased for the residential and nursing units for people with dementia. At the time of this inspection, service users were being supported to use this sensory equipment by the activities staff as the nursing and care staff had not Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 15 received training. The inspector discussed this finding with the regional support manager and was informed that training would be made available. In addition to the multi-sensory box, the residential and nursing units for people with dementia possessed ‘sensory baskets’ which could be used at all times. The care plans contained information about the preferred daily routines of service users. The inspector observed that a group of service users were sitting in a lounge at approximately 9.45pm on the first day of this inspection. The service users were offered drinks and snacks, and were being supervised and chatted to by a member of staff. The inspector was informed that this group of service users regularly stayed up late, as this was their preference. The inspector thought that a very homely and relaxed atmosphere was achieved for this group of service users. The service offered flexible visiting hours. The inspector observed that visitors were accustomed to being offered beverages and chatting to staff. Visitors reported that they always felt welcome. Religious ministers visited the home and service users were offered opportunities to celebrate religious festivals, such as Christmas and Diwali. Through checking a sample of the service user’s financial records, the inspector found that service users were exercising choices regarding how to spend their personal allowance (this applied to service users with the cognitive ability to do so). One of the financial records demonstrated that a service user liked to regularly buy sweets and chocolates. Service users could access local shops with support from staff (or their visitors) or purchase items from the trolley shop in the home. The receipts seen by the inspector identified that staff undertook shopping for service users. The inspector viewed a sample of menu plans and spoke to the catering manager. The service offered a couple of choices on the menu for lunch and the evening meal, in addition to providing ‘off menu’ items (for example, an omelette if a service user does not want either of the two main choices for lunch). The catering manager provided information about how the service fortified foods to cater for people who were at risk of losing weight due to dementia and/or other conditions related to the ageing process. The inspector observed the evening meal being served on one of the nursing units. The start time for the meal was meant to be 5pm; however, service users had already completed parts of their meal when the inspector arrived on the unit at 5pm. The inspector was concerned to be told by a member of staff that the evening meal could be started at 4.30pm. The inspector observed that a service user who chooses to eat without utensils was given a fried egg that had not been cut up into a more manageable size. It was also noted that a service user who was lying flat in their bed was feeding herself; this observation was immediately reported to the unit manager and the service user was assisted to sit up in bed. It was also noted that a number of service users had not been offered a drink with their evening meal, although jugs of cold drinks had been Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 16 placed on a table opposite to the dining tables. The inspector joined service users for lunch on the second day of this inspection; this mealtime was managed in a supportive way for the service users. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The service has not been able to present written evidence of all complaints received, although the known complaints have been appropriately investigated. The service has implemented correct procedures for managing any allegations of Adult Abuse; however, the allegations since the last key inspection have demonstrated the need for staff to receive on-going guidance in order to recognise situations in which they require more support and training. EVIDENCE: The service produced an appropriately written complaints procedure, which was given to service users and their representatives. The inspector read all of the complaints received by the service since the previous key inspection in May 2006. These complaints had been dealt with in a timely manner and the investigations by the service were found to be of an acceptable quality. The service possessed an appropriate Adult Protection procedure and staff had received training from a representative of the London Borough of Newham Safeguarding Adults Team. Since the last key inspection, the CSCI has been notified of three separate complaints that have been investigated by the Newham Safeguarding Adults Team. The inspector conducted an unannounced random inspection visit Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 18 following the first two Adult Protection strategy meetings and a second unannounced random inspection visit was held prior to the third strategy meeting. Requirements were issued in both of these inspection reports, which were found to have been met. The most recent Adult Protection strategy meeting identified that the CSCI were not informed of all of the complaints that had been made to the service by a local day centre (attended by a service user). No requirement or recommendation has been issued in this report in regard to these omissions as the former registered manager has resigned. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a comfortable and hygienic environment. EVIDENCE: Mornington Hall is a purpose built care home, which comprises of four separate units. All of the communal areas and bedrooms are fully accessible to wheelchair users. Each unit contained a small kitchen, two communal lounges, toilets and bathrooms, service users bedrooms (with an en-suite toilet) and clinical/storage areas. The home offered a hairdressing salon, which was used for a short time as a tearoom; however, this practice has been discontinued due to concerns regarding fumes from the products used for hairdressing. Garden areas surround the home; however, due to this inspection being conducted in the winter, service users and their visitors were not witnessed to be using the outdoor facilities. No specific issues of concern were identified Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 20 with the premises. The service was pleasantly decorated, clean and comfortable. The home was free from any offensive odours. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. Service users are supported by a satisfactory number of staff that have received statutory training. A recent issue with staff recruitment has been managed very promptly in order to ensure the well being of service users. Staff need to receive sufficient supervision. EVIDENCE: The staffing rotas evidenced that a satisfactory number of staff were employed at each shift, in accordance with the service’s Minimum Staffing Notice. Staff attainment of National Vocational Qualifications (NVQ) in Care was noted to be satisfactory. Care staff were provided with NVQ level 2 training; continued training for NVQ levels 3 and 4 were offered to staff that undertook supervisory/management roles and responsibilities. The inspector checked two staff files during this inspection; these files were observed to meet the specifications of the Care Homes Regulations. The CSCI was notified on the first date of this inspection that the service had detected irregularities in regard to some staff documents (for example, visas). The service had commenced appropriate actions to investigate this matter, which has now been concluded with the termination of nine staff contracts. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 22 The two random unannounced inspections and the Adult Protection strategy meetings identified issues that staff needed specific training for. These issues included effective communication/liaison skills with other organisations, how to calculate body mass indexes and the management of complex and/or challenging situations (such as unexpected discharges of short-term and respite service users). Certain events at the home have indicated that senior staff need to know when they should contact an on-call manager for ‘on-thespot’ advice, particularly if they have not had previous experience of a complex situation. The issues identified with the care planning within this report have demonstrated that staff need training to fully understand the home’s care planning system. The inspector looked at the service’s training matrix, which identified that staff had attended mandatory training; there has also been cultural awareness training. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have benefited from the present management. Their views have been sought in order to continue to develop the service. Safe premises are provided. EVIDENCE: At the time of this inspection the regional support manager was managing the service. The home had a deputy manager and a unit manager for each of the four units. The registered manager has not been working at the service since September 2006. The CSCI has been informed that the registered manager has resigned and a new manager will be in post in January 2007. The inspector Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 24 has therefore not been able to assess the performance of a permanent home manager. The regional support manager has been managing the home since September 2006. The inspector found that a recognisable level of work had been done in order to address the concerns raised at the Adult Protection strategy meetings. The home had sent quality assurance surveys to service users in September 06; the results of these surveys had not been finalised at the time of this inspection. Service users meetings were conducted on the nursing and residential units for people with physical frailties. Service users representatives stated that they felt that their views about the service were listened to and acted upon by staff. The inspector checked a random sample of service user’s financial records. These records indicated that service users accessed their money for their own needs, such as entertainments, hairdressing, sweets, clothes and toiletries. No unusual transactions were detected and receipts were maintained. The inspector noted that one of the service users was spending money on a taxi to a clinic appointment; the regional support manager stated that she was pursuing this matter to ensure this service user’s access to free transport for such journeys. The inspector looked at four supervision records on one of the units. With the exception of one member of staff, the other staff had received regular supervision. The inspector confirmed that the unit managers had not been receiving monthly or bi-monthly supervision. The inspector checked the maintenance and health and safety records. These were thoroughly maintained and evidenced that the maintenance person undertook regular checks (such as equipment maintenance, fire alarms, hoists and water temperatures). Valid certificates demonstrating safety checks by external contractors were in place. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 25 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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 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 X X 3 Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 26 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 24 Requirement The Registered Person must ensure that the quality of the care planning is improved. Training of staff and care plan auditing must address inappropriate terminology and ambiguous statements, and ensure that staff fully understand assessment questions. The Registered Person must ensure that the issues related to health care provision within this report are addressed-such as monitoring of pressure relieving equipment, auditing of both Waterlow charts and BMI documents for accuracy. The Registered Person must ensure that staff adhere to safe procedures for giving out medication and that staff look up any medications that they are not familiar with. The Registered Person must ensure that service users are provided with the appropriate support at mealtimes-such as positioning, access to fluids, DS0000007363.V320564.R01.S.doc Timescale for action 30/06/07 2. OP8 12 (1) 28/02/07 3. OP9 13(2) 15/02/07 4. OP15 12(1) 30/11/07 Mornington Hall Version 5.2 Page 27 5. OP18 13(6) 6. OP36 18(2) 7. OP30 18 (1) assistance with cutting up food and meals commenced at correct times. The Registered Manager must ensure that there is an on-going emphasis on discussing how best to protect adults from abuse, through supervision and staff meetings. The Registered Manager must ensure that all staff receive regular supervision (a minimum of six supervisions per year). The Registered Person must ensure that the annual training programme is amended to address issues raised within this report. 31/07/07 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP12 Good Practice Recommendations The prescribed food thickeners should be stored in a more discrete position within service users bedrooms. The training for using the multi-sensory box should be provided to all nursing and care staff on the two units for people with dementia. Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Mornington Hall DS0000007363.V320564.R01.S.doc Version 5.2 Page 29 - 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. 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