CARE HOME ADULTS 18-65
Mornington Road 100 Mornington Road Leytonstone London E11 3DX Lead Inspector
Kristen Judd Unannounced Inspection 23 February 2006 1:30
rd Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 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 Road DS0000065856.V277104.R01.S.doc Version 5.1 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 Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Mornington Road Address 100 Mornington Road Leytonstone London E11 3DX 020 8518 7515 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) Outlook Care Evangelina Begley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: 100 Mornington Road is a Victorian style building accommodating adults with learning difficulties. The house comprises 6 single bedrooms, a bathroom, two shower rooms and 3 toilets. There is an open plan kitchen to the dining area, a separate laundry room and a lounge. The home aims to provided care and support in daily activities and in accessing the community. At the time of the inspection, there were 6 service users occupying the home. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced which started at 1.30pm. This inspection followed up the requirements made at the unannounced visit held on 7th June 2005. The inspector spoke with service users, staff and the newly registered manager during the inspection. A tour of the environment was undertaken and samples of records were examined. An immediate requirement was issued at the time of inspection additionally there have been a further ten requirements made following this inspection. Verbal feedback was given to the registered manager. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection and actively contributing to the regulatory process. What the service does well: 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 Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 6 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 Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 7 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 & 4 The service must be able to evidence that the needs of all service users can be met inline with the current registration caterory. EVIDENCE: Service users are provided with a statement of purpose and service users guide, which provides all the relevant information. Pictorial information is provided to enable service users who cannot read to have some understanding of what is being provided. There have been two new admissions into the home since the previous inspection. Evidence showed that the service users had visited the home prior to admission. Assessments were undertaken prior to admission and included input from other social care and health professionals. Through discussions with staff and observations made during the inspection confirmed that staff were aware of the individual needs. The inspector was however concerned as the manager was unable to demonstrate that the home has the capacity to meet one particular service users needs. Staff also confirmed that concerns have been raised regarding needs of the service user and this was supported by the increase in recorded incidents in the home. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 8 The pre admission documentation highlighted that ‘ any violent outburst directed at other service users could have a devastating outcome’. There was no clear evidence of how the service users complex and individual needs were to be met. The inspector has raised concern as the service user has documented Mental Health issues; the home does not have this category of registration. The registered manager must clarify the service users needs and submit a variation application if deemed appropriate. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 9 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 Service users needs must be reflected in the individual service users plans and be supported by comprehensive risk assessments to ensure that service users and staff are not put at undue risk. EVIDENCE: Service user plans examined contained some information about the service users daily routines, personal care and daily living issues. However there was no evidence to show that service users plans of care had been amended since the previous inspection. For example one service user who health has deteriorated has evidence on file of liaison with relevant health professionals and advice given however the care plan has not been updated. Given the frailty of the service user it is important that all of the individual needs are clearly recorded. When service users needs change, individual service user plans must be reviewed and evaluated in order to evidence how the changing needs of individual service users are being met. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 10 Additionally the inspector noted that care plans had not been completed for one service user admitted on 13/9/05 and another admitted on 8/6/05. This is essential to describe the service users needs and to evidence how services will meet current and changing needs. An immediate requirement was issued for care plans to be implemented for the two service users at the time of inspection. Through the tracking of care the inspector was not satisfied that the all risks had been comprehensively assessed this was in particular to risk to others both inside and outside the home. One service user has displayed challenging behaviour to others. There are guidelines in place, which indicate techniques to remove the service user from the situation however there is a lack of evidence to show how and if these guidelines are followed. As previously stated the registered manager must liaise closely with outside professionals to reassess the service user accordingly to ensure their needs can be met by the home and to ensure that clear strategies are in place for staff when incidents occur. Further documentation is required to evidence that the risk assessment is comprehensive. This must be reviewed continually following incidents. The registered manager must ensure that all unnecessary risks to health and safety of service users are identified and so far as possible eliminated. The inspector was satisfied that service users are involved in the day to day running of the care home where possible given the dependency of each service user. It was evident from observations made during the inspection that service users have choice and control over their daily lives. Service users are encouraged to maintain their personal space, preparation of drinks and snacks dependent on their ability. Service users are free to come and go from the house as they choose in line with their dependancy. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 11 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): 11,13,15,16&17 The inspector observed and was satisfied that staff provide service users with support to make choices and provide them the opportunity to access the community and take part in suitable activities. EVIDENCE: The inspector was satisfied through observations made during the inspection and from records seen that staff encourage service users to be involved with many activities and organisations outside the home dependant on their ability. Service users also attend day care services. Evidence was seen on service user individual plans of attending a local farm and luncheon clubs. One service user continues to attend a ‘drumming’ when well enough. Two activities coordinators attend the home weekly and work with two of the service users. Additionally the mobile library calls regularly. The inspector was informed that holidays are arranged for service users annually. All of the service users have ‘ Freedom Passes’ to enable easy access to the local community.
Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 12 Staff were observed interacting with all of the service users throughout the inspection. Service users were seen to move around the home without any restrictions. Residents’ family and friends can visit anytime of the day. Residents are encouraged to go out with their families and develop personal relationships. The inspector saw the food storage facilities; dry, frozen and fresh food stocks were appropriately stored. There was plenty of food available on the day of inspection. Staff provide meals within the home, menus seen reflected that the breakfast and evening meals provided were healthy and appetising. One service user is supported to plan and record his own meal choices on a daily basis. A daily log of nutritional intake for one individual service user is kept. However through cross-tracking it was not clear whether it was being accurately maintained. This is a requirement under standard 41. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 13 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): 19 ,&20 It was the inspectors view was that medication was not being accurately administered; this must be addressed as a matter of urgency. EVIDENCE: Service users’ require a range of support with personal care from prompting supervision to assistance with regards to bathing and assistance with toileting. The ethos of the home and through observation during the inspection the inspector was satisfied that the service users are supported to maintain their personal identity and choice. The inspector observed the staff team assisting service users sensitively throughout the inspection. Service users were not restricted as to when they got up and staff were observed as being flexible regarding daily routines. Two health action plans were seen during the inspection which provide an over view of service users health and needs. One service user who is particularly frail was used as part of case tracking, the health action plan was not up to date. The service user has complex health needs, which need to be clearly monitored. Forms that are used to record appointments indicating what the health care appointment are for and
Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 14 outcomes of the appointment were seen however some were part completed. The inspector also raised concern with regard to the service users feet, as there was a need to be seen by the chiropodist. The registered manager must ensure that service users health needs are accurately monitored and input from relevant health professional sought when necessary. Policies and procedures were available for guidance on the administration of medication. Medication is provided by the chemist in doset boxes all of which were correct. Spot checks that were made on additional medications stored, two of which were incorrect at the time of inspection. There was concern as one medication was out by ten tablets, staff cross-referenced a monitoring sheet that reflected the actual amount however another medication was out by one. The third medication was an ‘when required’, the packaging reflected two tablets to be taken however the MAR sheets indicated to be taken. This is an outstanding requirement and must be addressed as a matter of urgency. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 15 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 The home provides a satisfactory complaints system, which has clear timescale for investigating. EVIDENCE: The home has a comprehensive complaints policy and procedure. The inspector noted that the service users complaints format was in pictorial format, which was very user friendly. The homes complaints logbook was seen; one complaint had been logged since the previous inspection, which had been responded to promptly and outcome recorded. The inspector was informed that staff also carry cards when accessing the community with service users who may behave inappropriately while in the community. The cards provide information about Outlook Care and a contact number in case of a complaint being made. The inspector was informed of a recent incident where the card was given out. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 16 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): 24,29 &30 It is the inspector’s view that at present the environment is suitable for purpose. EVIDENCE: The home is situated in a quiet residential area of Waltham Forest and is within easy access of transport links and the local community. The home is within walking distance of some local amenities; there is a garden area and parking available. Further parking on the road is restricted. A tour of the premises was conducted. The office is situated on the first floor. There is no separate visitors room available. Individual rooms seen had been personalised and were comfortable. All of the communal areas and service users bedrooms were of adequate cleanliness and hygiene. There is a small laundry facility. The inspector raised concern as a staff member was observed carrying a used incontinence pad through the home to the external bin outside. The registered manager must ensure that such
Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 17 practise ceases and appropriate facilities in place for staff to dispose of such items is provided. There was evidence of appropriate aids and adaptations available for service users including mobility aids .The bathrooms have suitable equipment to meet the need of service users. One service users has had suitable adaptations to the bedroom to meet individual needs. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 18 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 &36 Staff induction training must be completed within timescales to ensure care provision to service users is of the highest standard. EVIDENCE: The inspector was satisfied through discussions and observations made during the inspection that the registered manager and staff are aware of their own roles and responsibilities and have developed good relationships with service users and are fully aware of service users needs. The staff present appeared confident in their duties and conducted themselves in a professional and courteous manner. Rotas indicate that staffing levels are satisfactory. There are two members of staff on duty throughout the waking day and one waking night. There are currently thirty extra hours allocated for one service user who has particular needs. The staff team is stable and there is one vacancy at present, which is covered by Agency staff. Three staff files were viewed during the inspection with all relevant checks required by the regulations required by the regulations. Supervision records were seen which indicated that staff had been supervised at least six times a year. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 19 Staff receive a comprehensive induction programme and attend comprehensive mandatory training organised by the home. The newly recruited staff member files was examined that evidenced the induction programme however the inspector raised concern with regard to the timescales. The staff member started in June 2005 and did not complete the first week of induction until October 2005, the one month induction was completed in month fifth month and the three and six month induction was finally completed in February 2006 eight months after starting employment. Training is organised for all staff on an on-going basis. Training certificates staff had attained were seen to evidence this. Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 20 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 41,&42 The registered manager must ensure that all of the relevant documentation is in place to be able to evidence the current care provision provided to service users. EVIDENCE: The registered manager confirmed that he had completed the registration process. The inspector is satisfied that the registered manager who is newly recruited has a knowledge of the National Minimum Standards however there were serious concerns with regard to two service users not having individual care plans in place who were placed prior to the managers appointment. The inspector acknowledges that the manager the immediate requirement was responded to within timescale. The monthly-unannounced monthly monitoring visits were seen however it was noted that there was no report for December 2005. The responsible individual Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 21 must ensure that visits under regulation 26 be completed and recorded monthly. The reports must be available for inspection. Records were seen during the inspection in relation to Schedules 2, 3 and 4 of the Care Homes Regulations. This standard scored ‘2’ because, as identified in relevant standards, not all records were in place or deemed accurate. For example through the tracking of care it was noted that one service user had sustained a graze and cut after slipping on the homes stairs. Although an incident form had been completed there was no entry in the accident book. The homes policy on accidents and incidents also indicates that accident records must be completed. Some requirements have been made against individual standards. Further improvements are required in the following areas to keep records up to date and valid: Risk assessments. Care plans. Regulation 26 (monthly visits) Health Action Plans and monitoring. Medication Accident records The registered manager must that all records detailed in The Care Homes Regulations 2001 and accompanying Schedules. Through the tracking of care the inspector noted several concerning incidents with regard to one particular service user. The manager is maintaining a log of events; the inspector was informed that the information would be used at the review of the service users care. However the inspector noted that there have been incidents that have not been notified to the Commission for Social Care Inspection. The following health and safety checks have been evidenced: The last recorded fire drill is recorded as 14/11/05 Emergency lighting checked 18/10/05 Gas certificates were seen dated 22/08/05 valid for one year. The electric certificate 08/03 valid for 5 years. Portable Appliance Test were completed 25/05/05 Fire extinguishers were last checked 18/10/05 Insurance certificate valid until 31/03/06 COSHH was stored incorrectly at the time of inspection. Fire alarm was last serviced 18/10/05 Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 22 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 3 2 2 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 2 x LIFESTYLES Standard No Score 11 3 12 x 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 2 x 3 x 2 x 2 3 x Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 23 yes 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 YA2 Regulation 14.1 Requirement The registered manager must identify any service user who fall outside the registration category of the home. Service users must be re-assessed and, if necessary, a variation of registration obtained. The registered manager must ensure that all service users are assessed and a written plan is in place as to how those needs are to be met in respect of Health and welfare. The registered manager must ensure that the service users indivdual plans are reviewed and and outcomes are evaluated.(Timescale 31/07/05 not met) The registered manager must ensure that all unnecessary risks to health and safety of service users are identified and so far as possible eliminated.(Timescale 31/07/05 not met) The registered manager must ensure that service users health needs are accurately monitored and input from relevant health professional sought when
DS0000065856.V277104.R01.S.doc Timescale for action 30/04/06 2 YA6 15.1 24/02/06 3 YA6 15.2 30/04/06 4 YA9 13.4 30/04/06 5 YA19 13.1 30/04/06 Mornington Road Version 5.1 Page 24 necessary. 6 YA20 13.2 The registered manager must ensure that medications administered are recorded accurately. (Timescale 31/07/05 not met) The registered manager must ensure that appropriate facilities in place for staff to dispose of clinical waste. The registered manager must ensure that all staff receive induction training with specified timescales. The responsible individual must ensure that the monthly visits under regulation 26 be conducted and a report is made available for inspection. The registered manager must ensure that all records detailed in The Care Homes Regulations 2001 and accompanying Schedules. The registered manager must ensure that notifications are made to the Commission without delay. 30/04/06 7 YA30 23.2 30/04/06 8 YA35 18.1 30/04/06 9 YA39 26 30/04/06 10 YA41 17 30/04/06 11 YA41 37 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mornington Road DS0000065856.V277104.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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