Inspection on 08/06/06 for Mornington House

This inspection was carried out on 8th June 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 found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Mornington House 10 Ashfield Lane Milnrow Rochdale OL16 4EW Lead Inspector Jenny Andrew Unannounced Inspection 8th June 2006 08.45 Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 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 House DS0000066122.V291503.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 Adults 18-65. 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 House DS0000066122.V291503.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mornington House Address 10 Ashfield Lane Milnrow Rochdale OL16 4EW 01706 218091 01706 63777 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) Mrs Linda Bell Mrs Janet Kinsella Miss Alexandra Charlotte Bowling Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 7 service users, to include: up to 7 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Since the change of ownership, this is the first inspection of this service. Date of last inspection Brief Description of the Service: Mornington House is a privately owned, small care home accommodating up to 7 younger adults with learning disabilities who need support to lead independent lives. The home is a spacious detached house, close to local community facilities and the motorway networks. Bedrooms are situated on the ground and first floors and a lift is fitted for people who have mobility problems. Car parking space is available at the side of the house and there is a small garden area provided. The weekly fees, as at June 2006, range from £979.00 - £1366 dependent upon the assessed needs of the individual. Additional charges are made for private chiropody, hairdressing, newspapers and toiletries. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which is given to new residents. This is the first inspection since the new providers took over the home. A copy of the Commission for Social Care (CSCI) inspection report will be displayed within the home. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There have been recent changes in the ownership and management of the home. In November 2005, the home changed hands and is now jointly owned by Mrs Linda Bell and Mrs Janet Kinsella who have two other small residential homes in the area. When the new owners took over, there was a lot of work needed to be done in the building and several changes were made to the team of staff. Both the owners and the manager have worked hard to address these as well as other areas, which have improved the quality of life for the service users. This unannounced inspection took place over six and a quarter hours. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly as well as looking at how the medication was given out. The files of the staff were also checked. In order to obtain as much information as possible about how well the home looked after the service users, the manager, deputy manager, 1 support worker, 4 service users and a visiting care manager were spoken to. In addition comment cards were sent out before the inspection to relatives, residents and professional visitors to the home. Of these 4 service user, 4 relative/visitors and 1 care manager questionnaires were returned. Other information, which has been received about the service, since it was registered in November 2005, has also been used as evidence. What the service does well: Before new service users came to live at Mornington House, the home made sure they had all the right details about them, so that they were clear that Mornington House was the right place for them to live and that their needs would be met. Staff were trying hard to encourage service users to do more for themselves such as shopping, cooking, washing and ironing. Three people felt this was good because at some stage, they wanted to move out to their own house or flat and needed to learn new things. The home was good at making sure service users’ health was well taken care of. Records of all visits made to dentists, doctors and hospital were kept as well as showing what needed to be done as a result of the visits made. Service users were going out into the local area and taking part in activities, which they enjoyed. Evening and weekend activities were also arranged so Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 6 that the service users did not get bored and those spoken to felt their social lives were good. What has improved since the last inspection? 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 House DS0000066122.V291503.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The service user guide was not being given to new residents so they would have the information they needed about the home. Pre-admission assessments were being done in order to make sure the home could meet their needs. EVIDENCE: When the new owners took over Mornington House, a new Statement of Purpose and Service User Guide were written. From speaking to the two new service users, it was identified their placements had not been planned but had arisen as a result of emergency situations. However, since moving in, neither had been given a copy of the service user guide, although a copy guide was seen on a service user’s file, which was kept in the office. The guide must be given to each new service user, either prior to them moving in or, if admitted on an emergency basis, then upon admission. This will ensure that they have all the relevant information about staying at the home. Detailed care management assessment documents were on 1 persons file. The good practice of obtaining nursing assessment documentation was also noted. The other file contained a screening assessment, together with medical information about the service user. During the inspection, the care manager visited the home to return the original assessment. She said the home had Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 9 been given a copy of the level 4 assessment when the service user first moved in but that she had removed it for amendment. Both assessments gave a very clear picture of the needs of each individual. Where problems had been identified, the home was liaising with care managers who were supporting and advising the staff. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area was adequate. This judgment has been made using available evidence including a visit to this service. Care plans for the newer service users were incomplete and some risk areas had not been assessed which could impact on their safety. Independence skills were being encouraged and service users were able to make informed decisions about their daily lifestyles. EVIDENCE: Three care plans were looked at, one for a service user who had lived at the home for sometime and two for the newer service users. Each service user had 4 separate files for finance, medication, a working file and a general service user file. One plan was detailed, giving a lot of information about the service user, the way they needed support, their strengths, needs and the goals they were working towards. The plan was up to date and had been written and agreed with the service user. Care management reviews had been held in February 2006 and August 2005. The two newer plans were incomplete in that social histories/background information had not been obtained; the strengths and Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 11 needs section in 1 plan had not been completed although goals had been set; 1 weekly activity timetable was blank and the other had not been updated to reflect the changes which had been made; the care plan for 1 service user with a medical condition was insufficiently detailed about the support he needed. The manager said she was aware that the plans were in need of further work and that she would make this a priority area. Any restrictions on choice or freedom were recorded and behavioural management strategies were in place where required. Whilst risk assessments were in place in all 3 files, some shortfalls were identified. One person who was furthering their independence skills did not have assessments in place for travelling independently, using electrical appliances etc. and this must be addressed. Service users who could sign their plans and risk assessments had done so and from discussions, it was clear that the service users were involved in the care planning process. Challenging behaviour was monitored and recorded in order that staff could establish whether there were any triggers or particular patterns leading up to behavioural issues. The care manager spoken to said she was really pleased with how staff were managing and supporting her client. She said he had settled in the home very well and that the home was meeting his needs. A key-worker system was in place and 3 of the service users spoken to knew whom this person was. One service user said his key-worker usually supported him when he went to the supermarket to do the weekly shopping. Two of the service users described examples of practical staff support and encouragement, which had resulted in their independence skills and selfconfidence increasing. They also felt that equal access to ordinary life activities were promoted by the staff team. Rules and regulations were kept to a minimum, ensuring that service users had control over their lifestyles. All the service users were able to make choices about their daily routines, within the restrictions of timings to go to college, day centres etc. At weekends, they could be more flexible and one person said they enjoyed having a lie in. Those service users who were able to manage their own money were encouraged to do so with the necessary staff support. One of the owners was the corporate appointee for five of the service users. All the service users had some contact with family and there was no need, at this time for the involvement of advocacy services. Feedback from the visiting care manager and from a returned questionnaire, was very positive about the home since the change in ownership. Both felt communication had improved and that the care and support of the service users had greatly improved. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgment has been made using available evidence including a visit to this service. The range of opportunities available for service users to pursue leisure and intellectual activities reflected the diversity of service users and their social, intellectual and physical capacities. Individuality was respected and the menus showed that healthy eating was encouraged. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and activities. EVIDENCE: Staff encouraged and supported the service users to take part in meaningful daytime activities. One service user enjoyed working in a charity shop and said “this allows me to meet people and make new friends”. He also said he was able to use public transport and enjoyed going out shopping, meeting his friend and going to the Gateway club together. Two of the service users attended a day centre and staff said they were always eager to go. One of the service users spoken to said he “liked the centre”. Two service users attended college courses, one supported by a member of the staff. One of the service Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 13 users said he really enjoyed going to college and went four days a week. He had also joined a gym and one of the other service users sometimes went with him, supported by a staff member. The service users involvement in community and social activities had improved enormously. Service users said they went out to the park, Hollingworth Lake, swimming, to the gym, local shops, supermarket, pubs and cafes. The local pub “The Hungry Horse” seemed to be a favourite eating place. The service users also enjoyed evening activities and went to the Gateway Club or another club called O’Gradys. The owners had recently bought some new garden furniture and the manager said she was going to buy a barbecue so that they could enjoy meals in the garden during the good weather. The original large lounge/dining room had been partitioned off to make two separate lounges and this enabled the service users to choose whether to sit and watch television or go into the quieter lounge for more privacy. Smoking for service users was allowed at the back door where a chair was provided. Staff were only allowed to smoke outside. Feedback from staff and service users, indicated staff supported service users to maintain family links. Four relative comment cards were returned, two felt staff kept them informed of important matters affecting their relative, one said sometimes they were kept informed and the other one felt this area could be further improved. The staff also encouraged service users to keep in contact with friends. One service user enjoyed going to tea at one of the owners other homes where he knew two of the service users living there. Another person said he was really pleased that his friend could come for tea and felt that the staff made her really welcome. From speaking to the service users and interviewing staff, it was apparent that furthering service users’ independence skills was a high team priority. Two of the service users said they were cooking meals once or twice a week and that they really enjoyed this with some support from the staff. They were also doing their own washing, ironing, changing beds and keeping their bedrooms clean and tidy. There was an expectation that service users would help around the house, as far as possible, within the constraints of risk assessments. The shopping, planning of meals and service user participation had greatly improved. Staff and service users would sit and plan the weekly meals, with two of the service users deciding what they would like to cook, ensuring that everyone liked the choices made. One service user said he had recently made braised steak and onions with vegetables, stew and dumplings and spaghetti bolognaise. Another service user had started to do some baking, with support from the staff. The menus seen reflected healthy eating with plenty of meat, Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 14 fish, vegetables and fruit being offered. Desserts were also healthy as staff were trying to make sure that service users did not increase their weight. Usually fruit yoghurt or fresh fruit was offered after the evening meal with ryvitas, toast or fruit being available during the evening. All the service users spoken to were very satisfied with the meals provided. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area was good. This judgment has been made using available evidence including a visit to this service. The health and personal care needs of the service users were well met with evidence of good multi-disciplinary working taking place. EVIDENCE: Each service user had a file, which included details of medication, correspondence and appointments with health care professionals and other relevant information. Records showed that service users were supported to attend regular dental check ups and other health care visits. From discussions with service users, relatives and staff, it was evident that service users health care needs were closely monitored with referrals being made to appropriate professionals as necessary such as dieticians, psychologist and speech therapist. When any problems were identified either emotional or physical, the manager was knowledgeable about whom to seek help and advice from. An Occupational Therapy referral had resulted in the home making plans to convert the first floor shower into a wet room, which would meet the needs of a physically disabled service user. A date for this work to be undertaken had been made. The home had excellent links with a community behaviour management worker. Where problems in this area were identified, he would Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 16 be requested to come into the home to give advice and training to the staff. Several of the staff had also received training in epilepsy. Diabetic diets were being followed as necessary and risk assessments were in place so that the staff were clear about what steps to take should they monitor high levels of blood sugar. All the service users were given the appropriate level of support and assistance to ensure their personal care needs were being met. This was evidenced during the inspection. The Commission for Social Care Inspection had been contacted before the inspection, with concerns about a service user missing his medication. This was followed up and the manager had done an investigation. The homes policies/procedures had been reinforced to the staff team. Medication procedures were being followed and subject to a satisfactory risk assessment, service users could self medicate. One service user had taken control of some of his tablets, the day before the inspection, but no risk assessment had yet been done. The manager said she would address this. The medication files contained “Consent to Medication” forms, which had been signed. There were no service users taking controlled drugs. All staff responsible for the administration of medication had received training as part of their induction but 2 of the more recently recruited staff had not received accredited training. The manager said she would arrange for them to go on a training course when the 2 vacant positions were filled. In the meantime, these staff should not dispense any medication. All unused medication was returned to the pharmacist who signed upon receipt. Health care professionals regularly reviewed medication. Feedback from relative questionnaires indicated satisfaction with the way service users were cared for. Comments included, “this is the first time I have felt happy about the care my son is receiving. He is making excellent progress there” and “I am very grateful for all the excellent work and effort all the staff are putting in for my son”. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area was adequate. This judgment has been made using available evidence including a visit to this service. Whilst a complaints procedure was in place not all the service users had a copy so they would know the steps to take if they were unhappy. EVIDENCE: The service user guide and statement of purpose contained a copy of the home’s complaints procedure. The two new service users did not have a copy of the service user guide so were unaware of the steps to be taken if they had a complaint. However, they were very clear that if they had any problems or were unhappy about anything, that they could speak to the manager or any member of the staff team and that they would be listened to. The Commission for Social Care Inspection have not had cause to investigate any complaints in the home, since the new owners took over in November 2005. One concern was phoned through about the misplacing of a service user’s medication but this was appropriately addressed by the manager. The manager could not find the complaints book so another book was made available for the logging of complaints. She said no official complaints had been received. One service user representative was met with monthly, by the manager and a community worker to discuss any problems she wished to talk about. The manager felt this worked well and minutes of the meeting in April were seen. The meetings held in May and more recently in June had not yet been typed up. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 18 The Rochdale MBC Protection of Vulnerable Adult training had been done by the manager and the two owners. Following this training, the manager had done in-house training for the staff team. Due to the staff turnover, only 5 of the staff were still working at the home and the manager should now ensure that the remaining staff receive this training. The Learning Disability Award Framework (LDAF) training also covers abuse and 5 of the current staff had done this training as well as the manager. Discussion took place about recording minor concerns as well as complaints, so that records were in place to show how these had been actioned and resolved. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area was good. This judgment has been made using available evidence including a visit to this service. The new owners had considerably improved the standard of decor and cleanliness throughout the home and made it more homely and comfortable for the service users. EVIDENCE: The home was registered for 7 people and all the bedrooms were spacious. It is near to local community facilities and the service users are able to walk to the newsagents and local pub where food is served. The premises were accessible to all service users with a lift fitted to the first floor. Since the owners took over the home in November 2005, they had redecorated some of the bedrooms and communal rooms, had new double glazed external doors fitted throughout, purchased some new furniture and divided up the large lounge/dining room to make two separate lounges. The large kitchen was now used for dining purposes. All the service users spoken to were satisfied with their rooms which they had been able to personalise. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 20 In order to improve bathing/showering arrangements, an Occupational Therapist had been requested to assess the first floor bathroom in order to advise on how it should be changed in order to meet the needs of one of the service users. As a result of this assessment, arrangements had been made for the room to be adapted as a wet room and the work was to start on 26 June 2006. A shower chair had also been purchased. This work will greatly improve the quality of life for the service user. Infection control policies/procedures were in place. Appropriate staff hand washing facilities were provided in the staff toilet. Disposable gloves and aprons were also supplied. Recently, risks were identified in relation to the spread of infection and risk assessments, were in place to address the identified risk areas. Adequate laundry facilities wsere provided. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area was poor. This judgment has been made using available evidence including a visit to this service. The recruitment and selection policy/procedures were not being followed which could mean that service users were placed at risk. Whilst some staff had received relevant training, several had not and this needed to be addressed in order to ensure the staff were able to meet the needs of the service users they were supporting. EVIDENCE: As usually happens when homes change hands, some staff leave as they do not want to be part of changes that new providers wish to implement. The manager said that whilst some staff had remained and were proving very willing to encompass the changes she had made, others had left or were asked to leave, due to them proving to be unsuitable. New staff had been recruited although 2 vacancies still remained. The staff spoken to said they felt the new team were working well together and that communication between them was good. Currently the home is accommodating 6 service users and the staffing levels had been increased during the day and evening to reflect this. It was usual to have 3 staff on each evening, so that service users could pursue their individual interests or remain at the home. During the day the home was Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 22 staffed according to the number of service users remaining on site and whether anyone required support for college or to attend health appointments. Two feedback questionnaire felt that staffing levels were not meeting the needs of their relative, but from checking rotas and speaking to staff and residents, it was felt the present staffing levels were adequate. Although the service users presently accommodated were all male, the staff team was female, with the exception of a worker from one of the other homes, who did some shifts at Mornington House. The manager was aware of the gender inbalance and said she would like to recruit more male workers, but that very few applied for such posts. There were no ethnic staff on the team, but this reflected the all white client group. Other than the manager, only one of the newer support workers had completed her NVQ level 2 training. The manager said such training would be arranged but that funding needed to be sorted out. The home had a training and development programme which included all mandatory training as well as challenging behaviour/intervention techniques. From talking to staff and checking the training file, it was identified that the more recently employed staff had not yet done their Learning Disability Award Framework (LDAF) training, which is an excellent induction course and one which all new staff must attend and complete within 6 months of starting work. The manager said that names had been submitted to the Health Trust but that dates for the training had not been received. Both the owners had completed their LDAF Level 4 in challenging behaviour and would be able to pass some of their knowledge on to the staff team. In July 2005, they had completed their LDAF Assessors course. Regular staff meetings took place and minutes of the meeting were seen. The home had its own induction training programme and this was completed in one of the files inspected. One file did not contain any induction training record. The other was incomplete. The continuation of induction record showed gaps i.e. shadowing staff, confidentiality, fire evacuation procedures, privacy and respect etc. Several health and safety areas had not been covered. Clearly all documentation must be completed during the induction training process in order to ensure that all new staff were aware of policies/procedures, service users preferred routines and support needs etc. The in-house induction training included first aid, food hygiene, fire, infection control and health and safety but it was the deputy manager who had inducted the newest support worker and she was not qualified to offer training in any of these areas except for the fact she had done the relevant external training courses. The owners had recently ordered a new DVD induction pack and fire training had been booked for the week following the inspection. The Tuesday following the inspection, the manager had planned to go through the induction training, using the new pack, for 8 staff. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 23 Three staff files were checked to see if the correct documents were in place. One file for the most recently recruited staff did not contain any references. The Criminal Record Bureau check had been transported from her previous employer and not even a Pova First check had been obtained before she had started work. This is unsafe practice and could place service users at risk. Another file only contained one reference but a Pova First check had been done and the CRB check was in the process of being obtained. Two of the files did not contain a photograph of the employee and action must be taken to address this. The manager said the managers and deputy managers of all 3 homes had recently held a meeting to look at staff recruitment and selection and that all the requirements made at this inspection would be addressed. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area was adequate. This judgment has been made using available evidence including a visit to this service. The manager was experienced and qualified and was committed to ensuring that the service was meeting the needs of the service users. EVIDENCE: The manager was experienced and had completed her NVQ level 4/Registered Managers Award. She had also undertaken refresher training in food hygiene infection control and first aid and done training on epilepsy and protection of vulnerable adults. The knowledge she had acquired from the epilepsy training had been cascaded to the staff team. She had transferred from another of the providers’ homes when Mornington House was bought in November 2005 as it was felt that her experience would benefit the service users and staff. It was clear that she and the team had needed to do a lot of work on the record keeping side, transferring and updating all the home’s systems, policies and procedures to reflect the new Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 25 ownership. The manager was aware there was still a lot of work to be done but due to the turnover of staff, some of her time had been spent covering the staff rota and working alongside the less experienced staff. When the 2 vacancies are covered, this will mean she will be able to prioritise the remaining paperwork, which is still outstanding. Staff said they felt the manager gave them good support and that she was always willing to discuss any matters with them. Due to the staff changes in the team, the manager had written informative guidelines, setting out basic duties on each shift and giving a brief overview of the special needs of each of the service users until their full care plans were read. A new quality assurance file was in the process of being compiled. Monthly visits by one of the providers were taking place and copies of the reports were sent to the Commission for Social Care Inspection. Since new service users had come to live at the home, monthly meetings had commenced in May 2006 and the minutes from the last meeting was seen. The manager was in the process of writing her end of year report on the home and as part of this process, she had sent out feedback questionnaires to purchasers and colleges, day centres etc. Service user questionnaires had been completed in March 2006. When the service user guide is next reviewed, the outcome of the service users questionnaires should be included. The providers have always co-operated with the CSCI in progressing any requirements within the agreed implementation timescales and had already made improvements to the environment. Information from the pre-inspection questionnaire showed that all the necessary maintenance checks had been undertaken. Random samples of records relating to the lift, fire alarm system and electrical appliances were all found to be up to date. As identified in the staffing and training section above, not all staff had completed all the necessary mandatory health and safety training and this must be addressed. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 27 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. 2. 3. Standard YA1 YA6 YA9 Regulation 5 15 13 Requirement A copy of the service user guide must be given to each service user. Care plans must be fully completed for each service user. Risk assessments must be written and implemented wherever risk areas are identified. Staff responsible for handling medication, must receive accredited medication training. All complaints must be recorded in the complaints book, together with action taken to address them and each service user must be given a copy of the complaints procedure. At least 50 of the staff team must attain NVQ level 2 training. Staff must not start to work within the home until all necessary checks have been obtained i.e. a Pova First/Criminal Record Bureau check, 2 satisfactory references. All staff must receive in-house induction training and all health and safety mandatory training including i.e. first aid, food DS0000066122.V291503.R01.S.doc Timescale for action 31/07/06 31/07/06 31/07/06 4. 5. YA20 YA22 18 22 31/08/06 31/07/06 6. 7. YA32 YA34 18 19 31/12/06 30/06/06 8. YA35 18 31/07/06 Mornington House Version 5.2 Page 28 9. YA35 18 hygiene, infection control, moving/handling etc. All staff must receive Learning Disability Award Framework training. 30/09/06 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 YA22 YA39 Good Practice Recommendations The manager should ensure that all staff are given protection of vulnerable adult training. When service user feedback is collated, it should be included in the service user guide. Mornington House DS0000066122.V291503.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 House DS0000066122.V291503.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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