Inspection on 21/07/05 for Mornington Hall

This inspection was carried out on 21st July 2005.

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 18/12/06

Mornington Hall 09/05/06

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 Announced Inspection 21 and 22nd July 2005 10:00am st 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 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 G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Mornington Hall Address 76 Whitta Road, Manor Park, London, E12 5DA Telephone number Fax number Email 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 BUPA Care Homes Limited Ms Patience Ajayi Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th April 2005 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; general residential care, residential care for people with dementia, general nursing care and nursing care for people with dementia. Each unit comprises of thirty bedrooms and communal facilities. The home is located in Manor Park, within a short walking distance of an overground station and bus routes. There is car parking facilities for visitors within the grounds of the home. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over two days. A second CSCI inspector, Anne Chamberlain, joined the lead inspector on the second day. The inspectors gathered information through speaking to service users, their relatives, the registered manager and staff. A randomly selected sample of twelve care plans was read (10 of the home’s care plans) and the inspectors looked at policies, procedures and other relevant documentation. Additional information was gathered through a pre-inspection questionnaire completed by the home and via the receipt of CSCI surveys completed by service users and/or their relatives. Anonymous information was sent to the CSCI regarding the management of one of the units. What the service does well: What has improved since the last inspection? Six requirements and one recommendation were issued in the last inspection report. Four of the requirements were due to be met at the time of the inspection; three of these requirements (correct information in the Service User Guide, accurate menu plans and the promotion of prospective service users entitlement to visit the home) had been met. A requirement for staff to receive medication training by 31/07/05 was also met. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 6 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. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5. Prospective service users and/or their representatives are provided with satisfactory information in order to consider whether they wish to pursue a placement in the home; however, the home should produce information to demonstrate an active approach to ensuring that service users visit before they move in. Minor amendments are required to the Statement of Purpose and wider availability of the inspection reports is needed. Service users are assured a comprehensive contract upon admission. EVIDENCE: The inspectors looked at the home’s Statement of Purpose and Service Users Guide. Some minor amendments to the Statement of Purpose were advised (such as the home removing a statement that it possessed a ‘Residents Council’ which it did not); these amendments were undertaken during the course of the inspection. The Statement of Purpose also stated that alternative therapies could be provided but did not specify if these services would be charged for. The Service Users Guide was satisfactorily presented. Relatives identified that it would be useful if the home displayed a copy of the most recent inspection report on each unit, as they do not always visit at times when the main foyer/ administration suite is open. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 9 The home issued different contracts, depending upon whether a service user is self-funding or has been placed at the home via a local authority. The inspectors looked at a range of these contracts, which were found to contain appropriate information. Pre-admission assessments were co-ordinated by service users social workers, or a pre-admission assessment was undertaken by the home if a service user is self-funding. All pre-admission information received from placing authorities was supplemented by the home conducting their own assessment of a service users needs. Some of the issues of concern identified with the home’s care planning (as reported in Standard 7 of this report) demonstrate a lack of thoroughness in the home’s ability to identify specific care and welfare needs prior to admission. The home’s capacity to meet the specialised needs of individuals admitted to the home was not clearly demonstrated at this inspection, particularly the needs of people with dementia. A requirement was issued in the previous inspection report for the registered manager to promote the entitlement of prospective service users to visit the home before moving in for a trial period. Via discussion with the registered manager, it was indicated that a more robust approach is now being undertaken to promote this entitlement. The registered manager is advised to maintain written information in each new service users file to demonstrate whether a visit occurred before admission and to document if the service user declined a visit. Standards 1,3 and 5 were assessed at the unannounced inspection in April 2005 and Standard 6 was not applicable for assessment. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. The care plans did not accurately reflect the healthcare, personal care and social needs of the service users. Documentation within the care plans did not indicate a consistent approach to recognising and responding to health care needs. The management of medication was satisfactory; however, staff must be aware of the potential risks attached to using medication when the prescription label has become damaged or obscured. Service users should be consulted as to whether they would like a facility to enable them to use the mobile payphone in their bedrooms. The care of service users who are dying was satisfactory; however, professional practice in working with the ambulance service has been addressed in this report. EVIDENCE: The inspectors read ten care plans during this inspection. Inconsistencies were found such as conflicting information relating to a pressure sore recorded on the same date within two separate documents in one care plan and conflicting dates stating when a medical problem was observed and reported to the General Practitioner in another care plan. The inspector randomly selected a care plan to read prior to meeting the service user; it was therefore very concerning to discover that the service user had an evident medical problem that had not been addressed with a written plan of care. The inspector spoke Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 11 to a staff nurse who was the allocated ‘key-worker’ for the service user; the staff nurse offered no nursing knowledge regarding recognition of this evident care need. One of the care plans evidenced that a service user had gained a significant amount of weight within one month; however, there was no action taken such as re-weighing the service user, monitoring of their food intake or any nursing/medical exploration to ascertain potential underlying causes. The home uses an assessment tool to examine an individual’s susceptibility to developing pressure sores; one of the care plans contained separate documents with very different risk scores for the same service user but dated at the same time. Another care plan stated that an individual required a specific nursing procedure to be undertaken every three months; there was no record of this procedure being carried out between January 2005 and July 2005. The inspectors read the pre-admission assessment for a service user (conducted by the placing authority) that stated this person had previously actively practiced their religious beliefs; however, the care plan written by the home gave no indication as to whether the service user wished to continue with any religious practices. The inspectors acknowledged that there had been deterioration in the individual’s health status and cognitive functioning that would exclude attending religious services but there had been no assessment of whether they would like an alternative, such as a short visit from a religious minister. The inspectors checked the medication on one of the units; the storage of medication and the documentation on the medication administration records was generally satisfactory. The inspectors found a bottle of medication with a torn prescription label; no arrangements had been made to notify the pharmacist of the need for a new label. A requirement was issued in the previous inspection report for the home to ensure that staff received on-going medication training; this requirement had been met. Service users could install their own telephone in their rooms or use a mobile payphones, which were located in the communal lounges. The staff stated that service users could use the telephone in the office if they wished to make a private telephone call. The inspectors considered that this could be impractical if the offices are being used for meetings, supervisions or the telephone is needed for several calls to manage an urgent situation. Information received from a visitor prior to this inspection indicated that a payphone was out of order for an extended period of time. Written information is sent to the inspector when a service user is admitted to hospital and when a death occurs either at the home or in hospital, in the form of a standard notification and a more detailed accompanying brief report. The inspector was satisfied that the home sought medical guidance and consulted with the families of service users to ensure that the needs of service users who are dying are met. Staff had recently undertaken a training session related to ‘Death and Dying’; the inspector spoke to a member of staff who found the training very useful; however, their colleague stated that had been away at the Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 12 time of this training which indicates a need for the course to be repeated as soon as possible. A serious complaint was recently received from the Medical Director of London Ambulance Service; this has been addressed in Standards 16-18 of this report. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The provision of 60 hours per week of structured activities is inadequate to meet the needs of 120 service users, although the quality of the limited service provided is good. Staff on Hamfrith Unit did not demonstrate a holistic understanding of the specific social and environmental needs of people with dementia. These concerns have been addressed by requirements and recommendations in previous inspection reports, and will be discussed with the home’s area manager and registered manager within four weeks of the service receiving this report. The food was varied and of a good quality; however, fresh fruit should be visibly available throughout the day on each unit. EVIDENCE: The inspectors looked at the activities programme for the home. The programme was varied and included shopping trips, bingo, visiting entertainers, meals out, tea dances and beauty parties (with a visiting beauty therapist). Other events took place during the year, such as summer and Christmas fetes. The service users received monthly visits from religious ministers and had developed links with a local Brownies group. The home operated a flexible visiting policy; visitors were observed throughout the inspection and were offered light refreshments. One of the visitors stated that they would like to participate in some of the outings but did not know how to access information on forthcoming events. It was later observed that this information is available on leaflets in the front entrance of each unit. Via Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 14 discussions with service users and relatives, the inspectors were told that the quality of these activities was satisfactory; however, concerns relating to the limitations of the activities service were expressed. The home allocates 60 staffing hours per week for the provision of organised activities, which is intended to meet the needs of 120 service users. The home does not have any volunteers to assist the activities staff, although there are occasional short placements for college students. The inspectors were informed that the care staff will promote activities on the units, such as the use of sensory and art equipment, although this was not witnessed during the inspection. The inspectors were concerned about their observations on one of the units (Hamfrith). Care staff recorded in the care plans that one of the regular activities for people with dementia was watching television; observations by two inspectors over two days indicated that service users did not watch the television, although two televisions (on different channels) were being broadcast in the lounge. A requirement was issued in the previous report for the home to address unnecessary noise levels in the communal areas; however, the inspectors found that loud and inappropriate music was being played on Hamfrith Unit whilst service users were having their evening meal. Staff were unable to explain to the inspectors why a progressive music commercial radio station was being broadcast during a time that service users need a relaxed environment to be supported with their dietary needs. The radio was switched off after service users had completed their evening meal; two televisions and an electrical carpet sweeper were switched on. This type of observation was also noted in the previous inspection report. The inspectors found that service users who were able to discuss their needs and preferences clearly expressed that they felt consulted about their choices (for example, daily routines and which activities they wished to join). The inspectors looked at the minutes for a service users meeting on a residential unit; evidence of only one meeting in the past twelve months was produced. The inappropriate terminology recorded in these minutes was of some concern to the inspectors and was discussed with the registered manager. The inspectors joined service users for three meals during the course of the inspection. The menu was found to be varied and balanced, with a satisfactory degree of choice. Service users stated that they were happy with the food. The inspectors did not observe the availability of fresh fruit on the units. The manager stated that fruit was prepared in the main kitchen and sent to the units on a daily basis; the inspectors did not observe this and staff were not able to inform the inspectors of this practice. Information was forwarded to the CSCI prior to this inspection by a visitor of a service user to state that (1) portions of fresh fruit and vegetables were limited and (2) fruit juices were diluted. A limitation of vegetables and the diluting of fruit juices was not observed at this inspection and will be monitored at the next (unannounced) inspection. The home is reminded of their responsibility to meet the complex dietary needs of older people through the provision of a healthy diet which Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 15 takes into account individual preferences. Water should not be added to fruit juices unless requested, or necessitated in accordance to the instructions of a doctor or dietician. Concerns were also expressed to the inspector regarding the home not having sufficient supplies of biscuits and sugar substitutes for people with diabetes, although this was not the case at the time of the inspection. Checks will be made at the unannounced inspection to ascertain that a satisfactory supply of these products are ordered and made available on the units. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 Service users and their representatives are provided with a comprehensive complaints procedure and complaints are appropriately investigated. The home must be more vigilant in removing obsolete notices that have been subject to concerns expressed by complainants and the CSCI. Although progress has been achieved in training staff following complaints from London Ambulance Service, evidence is sought of a rigorous approach to ensuring that all staff are aware of their responsibilities. The recent complaint within the remit of Adult Protection demonstrates that the home needs to provide staff with on-going training and supervision to promote their full understanding of how to protect vulnerable adults from potential and actual abuse. EVIDENCE: The complaints procedure was clearly written and informed service users and their representatives of their entitlement to refer their complaint to the CSCI and/or their placing authority (this is applicable to service users who have been placed at the home through their local social services). The inspectors were aware that the home had not been able to secure the services of a local advocacy organisation due to a lack of local advocacy organisations, although the home will advise complainants of advocacy sources if they wish for external support with making a complaint. The inspectors looked at the complaints received since the last inspection in April 2005. There was one serious complaint, which was being investigated at the time of the inspection. A BUPA Regional Support Manager had prepared a report and further actions were due to take place. The nature of this complaint was within the remit of ‘Adult Protection’ and had been appropriately reported to the complainant’s social worker and the CSCI. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 17 The CSCI were informed of a different complaint from the London Ambulance Service relating to their observations of poor practice by care staff on one of the residential units. An investigation was undertaken by the home and sent to both the complainant and the CSCI. The issues of concern included staff not being trained to perform basic life support; which was a serious concern previously identified via a complaint from London Ambulance Service in 2004. The home had responded to this in 2004 by staff training for both qualified nurses on the nursing units and appointed first aid staff on the residential units. A requirement has been issued in this report for the home to produce a specific action plan for managing the needs of service users who require basic life support and strategies to work effectively with the ambulance service, in order to prevent any further occurrences of concern. The CSCI will meet with the organisation’s Area Manager and the home’s Registered Manager to discuss this action plan, within four weeks of this report being sent to the home. The CSCI received an anonymous complaint earlier this year regarding a notice that was displayed on communal notice boards. The complainant felt that the notice implied that service users families should assume a lead responsibility for escorting people to hospital appointments. A copy of this notice was sent to the lead inspector; following discussion with the registered manager it was agreed that this notice was inappropriately worded and would be removed immediately. An inspector found one copy of this notice still displayed in the home on the first day of the inspection. The home worked in accordance with its own Adult Protection procedure and the local area Adult Protection procedures (issued by Newham Social Services). Staff are due to receive Adult Protection training in July 2005, which was one of the internally produced recommendations following the investigation of a complaint by the regional support manager. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,25 and 26 The home needs to meet the requirement issued in the previous inspection report for the provision of more ‘quiet’ communal spaces. The standard of maintenance in the garden areas needs to be improved. The communal seating provision need to be assessed by an occupational therapist or a professional qualified to undertake such assessments. The standards of décor, comfort and cleanliness were otherwise satisfactory within the premises. EVIDENCE: The home is divided into four separate units. The standards of decoration and comfort on these units were observed to be generally satisfactory. A requirement was issued in the previous inspection report for the home to create ‘quiet space’ within the communal lounge and dining rooms; the inspectors were informed that funding has been requested for constructing room partitions. The inspectors observed that the gardens were not well maintained; the registered manager stated that this was due to problems in finding a gardening service that had now been resolved. The inspectors noted Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 19 that some of the service users were provided with communal armchairs in the lounge that did not appear to be comfortable for their individual needs (for example, petite service users were placed in standard sized armchairs that did not offer support full support). All of the service users are provided with individual bedrooms with an en-suite bedroom; these rooms were of a satisfactory size in accordance with the National Minimum Standards for Care Homes for Older People. The bedrooms seen by the inspectors demonstrated that service users are encouraged to bring in their own pictures, framed photographs, ornaments and small items of furniture, if they wish to. A visitor informed the inspectors that they had not been made aware of the fact that a number of service users were affected by gastro-intestinal illness until after they had brought an older visitor in to the home. The visitor felt that it would have been beneficial if a discrete notice had been displayed in the front entrance, advising visitors to seek guidance from staff. The home was observed to be clean and free from any offensive odours at the time of the inspection. Standard 21 was assessed and met at the previous inspection. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The staffing arrangements must enable managerial staff to have allocated time for their managerial duties. Mandatory and National Vocational Qualification (level 2 in Care) were satisfactorily provided; however, access to management training for staff performing management duties should be offered and more dementia care training must be provided. The registered provider (BUPA Care Homes Ltd) needs to consider the quality of the current provision of dementia care training since staff are not implementing the knowledge they should have gained via their training. EVIDENCE: Relatives expressed some concerns regarding how busy staff appeared to be. The staffing levels for the units varied; the rotas for the nursing units demonstrated six staff on an early shift and six staff on a late shift, and the residential units provided five staff on an early shift and four staff on a late shift. Each unit employed three staff per night duty. The inspectors did not find a consistent approach across the units for ‘supernumerary’ time for unit managers (when a unit manager is allocated to be an additional presence to the agreed staffing levels in order to undertake duties such as auditing the quality of care plans, providing formal supervision to staff, supporting new staff as a part of their induction programme and promoting activities for service users). One of the rotas did not accurately reflect the staff working on Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 21 a unit; a care worker explained that they had swapped shifts with a colleague but this had not been documented on the rota. The inspectors viewed a randomly selected sample of staff personnel files and found that safe recruitment procedures were adhered to, in accordance with the Care Homes Regulations. The training records for staff demonstrated good compliance with mandatory training (such as moving and handling, food hygiene and health and safety). Staff are offered other training opportunities relevant to their roles and responsibilities. The home’s progress with National Vocational Qualifications (NVQ) in Care at level 2 was satisfactory; 50 of the care staff must possess this qualification by the end of 2005 (excluding qualified nurses). The inspectors noted that not all of the unit managers have been offered NVQ level 4 management training, although they manage units larger than some care homes for older people. The inspectors were provided with evidence of nursing and care staff undertaking dementia training although the observations at this and previous inspections did not demonstrate an application of theory based recognised good practice in the care of older people with dementia. The trained nurses were able to access a dementia care training course (3 days) provided by a university in partnership with the Alzheimer’s Society. Very clear guidance is provided by the Alzheimer’s Society relating to the need to reduce noise stimuli and of the importance of maximising an individual’s ability to hear their carer without distractions; however, these practices were not promoted by the unit manager (present at the time of the inspector’s observations) and nursing staff. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37 and 38. The internal auditing and monitoring of care within the home needs to be increased by the registered manager and the unit managers. It has been noted that the overall standards of care practice on one of the units is significantly lower than the other three units. A more rigorous approach is needed for the staff supervisions. The storage of care plans one of the units did not promote the confidentiality of service users and the unit manager’s approach to this concern was puzzling and unrealistic. The financial procedures and health and safety practices maintained the safety and welfare of service users. EVIDENCE: A unit manager manages each 30-bedded unit and the Registered Manager manages the four units. The observations on this inspection demonstrated that there is a greater need for overall monitoring and auditing of standards of care. For example, the inspectors found a poster displayed on Hamfrith Unit Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 23 that was inappropriate for inclusion within a ‘reminiscence display’ although it could be used for staff training purposes. The poster featured a poem about dementia that could be distressing for the relatives of service users unless they had received an explanation as to why it was deemed a professional decision to display such literature. The Registered Manager should monitor material on general display and the unit manager should use their professional judgement to determine what constitutes good care practice. The auditing of care plans required a far more rigorous approach and spot-checks should be undertaken on written records (such as the minutes for service users meetings and staff supervision sessions). Evidence was produced to demonstrate that managers conducted regular meetings with staff. The inspectors looked at the supervision records for staff on one of the units. Although the frequency of the supervision was satisfactory (supervision should take place at least six times per year), it was noted that the records for some supervision sessions consisted of one sentence only to evidence an in-depth one-to-one meeting of at least forty minutes duration. The quality assurance systems in the home need to be further developed in order to promote the best interests of service users. The area manager undertakes a monthly visit and the home undertakes annual ‘service user satisfaction’ surveys. Regular written ‘spot checks’ reports (conducted at varying times, such as evenings, weekends and night-time) by the registered manager were not presented. The inspectors found specific incidences of poor practice occurring during an evening on the first day of the inspection. The home’s accounting systems and management of service users finances were found to be straight forward and clear. The arrangements for ensuring the security of confidential information within the main administrative office were very satisfactory; however, concerns have been identified regarding the storage of confidential information on the units. The inspectors observed that the care plans were being stored in an unlocked office on one of the units. The unit manager stated that they were able to monitor the security of this unlocked office at all times, even during emergency situations. The inspectors checked a random sample of the home’s health and safety records and practices, which were found to be satisfactorily maintained. These checks included water temperatures, maintenance of hoists and adapted bathing equipment, portable electrical appliances testing, refrigerator and freezer temperatures and safe storage of hazardous substances. Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 2 x 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 2 2 2 3 3 2 2 3 Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 25 NO 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 1 Regulation 5 Requirement The Registered Manager must ensure that the Statement of Purpose specifies whether service users are expected to pay for alternative therapies. The Registered Manager must ensure that the Statement of Purpose and the Service User Guide are regularly reviewed. The Registered Manager must ensure that service users receive a comprehensive assessment of their needs prior to admission. The Registered Manager must ensure that service users have accurate care plans to state how their health and welfare needs are to be met. The Registered Manager must ensure that medication with incomplete presciption labels are returned to the pharmacist. The Registered Manager must in crease the staffing hours for activities. The Registered Manager must ensure that fresh fruits are visibly available on the units. The Registered Manager must ensure that an Action Plan for working effectively with London Timescale for action 30/09/05 2. 1 6 15/06/05 3. 3 14 31/08/05 4. 7 15 30/09/05 5. 9 13(2) 31/08/05 6. 7. 8. 12 15 16 16(2)(m) 16(2)(1) 22 30/11/05 31/08/05 With the return of Action Plan Page 26 Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Ambulance Service is produced. 9. 10. 19 20 23(2)(o) 20 The Registered Manager must ensure that the standard of the garden is improved. The Registered Manager must ensure that service users are provided with quiet communal areas and are not exposed to simultaneous broad casts of television and music. The Registered Manager must ensure that the suitability of the communal seating is assessed by an occupational therapist or suitably qualified person. The Registered Manager must ensure that unit managers are allocated supernumerary hours to undertake their management roles. The Registered Manager must ensure that staffing rotas accurately record the staff on duty per shift. The Registered Manager must ensure that staff receive training in care planning and the care needs of people with dementia. The present training provided must be increased to ensure staff competency in these areas. The Registered Manager must ensure a more rigorous approach to auditing/monitoring the standards of care within the home and this auditing/monitoring must be documented. The Registered Manager must monitor information/posters displayed in public areas of the premises. The Registered Manager must ensure that confidential information regarding service users is kept securely on the units. for this report 30/11/05 31/08/05 11. 22 23(2)(n) 31/10/05 12. 27 18 31/10/05 13. 27 17(2) 31/08/05 14. 30 18(1) 30/11/05 15. 31 12(1) 30/09/05 16. 31(and 16) 12(1) 31/08/05 17. 37 17(1) 31/08/05 Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 27 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 1 5 Good Practice Recommendations The home should provide copies of the most recent CSCI inspection reports on each unit. The home should maintain a written record of whether new service users have visited the home prior to moving in. Reasons as to why a visit was not facilitated should also be documented. Service users and their representatives should be consulted as to whether they would like a telephone socket in their bedrooms to enable them to use the mobile payphone. The training session related to Death and Dying should be repeated for all staff who were not available when the training was provided. Staff should be encouraged to promote informal activities for service users, taking into account their assessed needs and interests. This is a repeated recommendation from the previous inspection report.Staff should recognise that the recording of watching television as an activity on Hamfrith Unit is not deemed as a fulfilling and meaningful activity in accordance with the assessed needs of individuals. Visitors should be informed by a discrete notice of the importance of seeking guidance from staff in the event of specific illnesses within the units. The need for unit managers to undertake management training at NVQ level 4 should be prioritised. 3. 10 4. 5. 11 12 6. 7. 26 30 Mornington Hall G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ National Enquiry Line: 0845 015 0120 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 G57 G06 S7363 Mornington Hall V227377 210705 Stage 4.doc Version 1.40 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. 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!