Inspection on 28/09/07 for Mornington Road

This inspection was carried out on 28th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mornington Road 16/02/07

Mornington Road 23/02/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Mornington Road 100 Mornington Road Leytonstone London E11 3DX Lead Inspector Jackie Date Unannounced Inspection 28 September to 9 October 2007 07:30 th th Mornington Road DS0000065856.V347299.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 Road DS0000065856.V347299.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 Road DS0000065856.V347299.R01.S.doc Version 5.2 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) johng@outlookcare.org.uk Outlook Care Mr John Barry Gleaves Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate 1 service user over the age of 65 with a learning disability 16th February 2007 Date of last inspection Brief Description of the Service: 100 Mornington Road is a residential care home registered to accommodate six adults aged 18 years and over who have a learning disability. The home is operated by the Outlook Care group, a ‘not for profit’ organisation which operates a number of similar registered services in North and East London and in Essex. The aims and objectives of the service are set out in the Statement of Purpose, which include that the service will promote the rights of service users through advocacy and involvement. People who live at Mornington Road are informed of the purpose of the home in its Statement of Purpose and the Service User Guide, which is also available in pictorial form in the home. Copies of these documents, and the last public inspection report were readily available in the home to staff, service users and visitors. The house is situated in a quiet residential street, within walking distance of Leytonstone town centre, and in close proximity to road and rail links to Stratford, Walthamstow, Woodford and Ilford. The building does not set users apart from the local community. The accommodation comprises 6 single bedrooms, a lounge and communal kitchen/dining room. There are sufficient and suitable bathrooms to meet the needs of the residents. There is a small garden to the rear of the property. Although the house is not fully accessible to people with physical disabilities, there are suitable facilities on the ground floor for people who have impaired mobility. At the time of the inspection, 3 men were accommodated, and a fourth person was being assessed prior to taking up residence. Fees for the service are £1008-18 per week. This information was obtained from the Services Users Guide. Two of the residents are funded and supported by the London Borough of Waltham Forest and the other resident by the London Borough of Redbridge. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took approximately 11 hours over two days, and was undertaken by two regulation inspectors and a regulation manager. The first day of the inspection was unannounced. The Service Manager from Outlook Care was available for part of the inspection on the first day, in the absence of the manager. A second arranged visit was made to examine staff records, which were not accessible on the first day of the inspection. The manager was available for this part of the inspection. The inspection on the first day commenced at 7.30 a.m., in order to observe the morning routine, prior to the residents leaving for the daytime activities. It ended at approximately 4 p.m. The process of the inspection comprised discussion with residents (although communication with one person was severely limited); observation of how residents were supported and assisted; discussion with care staff and the service manager; examination of records and inspection of the premises. In addition, a number of other people involved with residents were contacted by telephone after the site visit for their views of the service being provided by Outlook Care. These included relatives, the independent advocate for all three residents, social and health care professionals, volunteers and the local vicar. Questionnaires were left for residents and staff to complete. The independent advocate was to be asked to complete the questionnaires with residents. Additional information about the service was obtained from the Annual Quality Assurance Assessment (AQAA), completed by the registered manager prior to the inspection, and from other documents submitted to the Commission for Social Care Inspection since the last inspection, including the reports of the organisation’s own internal monitoring visits under Regulation 26 of the Care Homes Regulations 2001, reports of serious incidents and the comments/action plan relating to the last inspection. The Regulation Manager enquired what name should be used to describe the people who lived in the service in the report, and the term residents or residents was their preferred terminology. The inspectors would like to thank the residents, staff and the service manager, for their co-operation and contribution to this inspection. The inspectors acknowledge the considerable delay in the service receiving the report of the previous inspection of February 2007, and the adverse impact that this report has had on those involved in delivering a service to the people who live at 100 Mornington Road. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 5 requirements have been made following this inspection, relating to further development of risk assessments; finances and health & safety. A lot of systems and safeguards are already in place but some areas need to be more robust to better safeguard residents. It is also recommended that the registered provider, manager and staff team consider the statements set out in the Commission’s Key Lines of Regulatory Assessment, (KLORA) to consider how they may further enhance the overall Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 7 quality of care in the home and achieve a quality rating of excellent, in each outcome group of standards. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 8 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.V347299.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives/representative are able to obtain the information that they need in order to be able to make an informed choice about moving into the home. Information is available in a format which helps people with limited communication and literacy skills to be able to understand about living at the home. The staff in the home understand the importance of gathering detailed information about prospective residents, to assist them in providing a service which will identify and meet the individual needs of the resident. EVIDENCE: There is a Statement of Purpose and a Service Users’ Guide which detail the aim and philosophy of the service, and which contains relevant information to assist someone considering moving into the home, or local authorities who wish to commission the service. The Statement of Purpose is currently being reviewed and updated. The Service Users’ Guide has been produced in a pictorial format, which can be understood by some of the people who currently live at Mornington Road. This information enables a prospective resident to Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 10 know what the home is like, and to be involved in the decision-making process. The three people who currently live at Mornington Road were unable to remember or describe what it felt like to move into the home. However, one prospective resident is in the process of being assessed for admission, and one of the current residents stated that the new resident had been to visit earlier in the week, to meet the other residents and staff, and to get to know people. This corroborates the statement in the Annual Quality Assurance Assessment that a prospective resident would be offered the opportunity to visit and have a meal, to help all parties in making the decision as to the suitability of the placement. Information from the Independent Advocate also corroborated that the admission of the prospective resident had been robust and had enabled him to visit the home prior to any decisions being made. Outlook Care has a comprehensive admission policy and procedure. The admission policy stated ‘that all prospective residents’ needs would be assessed prior to them moving into the home’. The current residents have lived in the home for a number of years and their admission assessment has been reviewed and updated since the previous admissions. The prospective resident’s admission process has been designed around his needs and from this a strategy plan has been developed, which identifies short –term, medium-term and long-term goals. The manager has spent time in the establishment where he currently lives; talking to the resident, care staff and health professionals, looking at records and observing care practices. Health professionals have visited Mornington Road and have made suggestions on some practical alterations to the home; these are currently being carried out. The prospective resident has visited Mornington Road on three occasions, on two of these visits he was accompanied by staff from his current placement and on the last visit he stayed enjoyed a meal with the other residents. The prospective resident’s brother has also visited the home and spent some time touring the building and talking to the manager. Health professionals are also meeting with the staff team and arranging relevant training. If and when the prospective resident moves to Mornington Road some staff from his previous placement will also be transferring. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The staff team encourage people who live at Mornington Road to be involved in decisions about their lives, and ensure that their changing needs are reflected in their individual care plans and risk assessments. People living in the home benefit from being supported to take appropriate risks but the service must ensure that risk assessments cover all areas of perceived risk and are updated as circumstances change. EVIDENCE: The Statement of Purpose states that a key working system is used to focus on individual residents’ needs. Two of the people who live at the home knew who their keyworker was. Each resident has a person-centred care plan, with associated assessments of risk. One resident was able to show his pictorial care plan to the inspector, evidencing his particular abilities and his preferences. Two care plans were examined and these contained appropriate and detailed information to enable staff to meet residents’ needs. Reviews are Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 12 held twice yearly and relatives, the advocate, social workers and other professionals are invited. All three residents have had reviews in the last couple of months. There was evidence in the file of a recently deceased resident, as to how the changing and deteriorating needs of this person were kept under constant review, and amended according to his terminal condition. (See also Section 4 on Personal & Healthcare Support.) Staff on duty demonstrated a good understanding of the different needs and abilities of each resident and were observed to interact with the residents in a calm, respectful and caring manner, demonstrating an appropriate balance between friendliness and professionalism. Staff were observed to explain actions and decisions to residents in an adult manner, relevant to each person’s particular needs and abilities. There was also evidence of the flexibility of daily routines, to take into account the preferences of each resident. Information was displayed in the home about recreational activities in the home and in the community. An Independent Advocate supports each of the residents. The advocate contributed to the inspection, stating that he was satisfied that the staff team work effectively to promote choices for the diverse needs of the people who live in the home, and to enable them to lead fulfilling lives. All three of the residents have complex needs, resulting in some restrictions to their liberty, in order to safeguard them. Restrictions were appropriate and reasonable. Risk assessments were in place and these were linked to individual need. Risk assessments seen were appropriate and had been reviewed. However risk assessments for one individual dated August 2007 stated that he should never leave the house without staff. However this resident travels to and from college in a taxi without staff support. Staff said that the college booked the cab and had carried out the risk assessments. This resident also has epilepsy and there was no information in relation to risk assessments about this and travelling independently. This resident is obviously being encouraged to be as independent as possible but it is important that comprehensive and up to date risk assessments are in place to cover this. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13, 14, 15 , 16 & 17 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use the service are encouraged to make choices about their lives and are supported to develop life skills. Social, educational and recreational activities are tailored to meet the preferences and abilities of the residents. Residents benefit from the efforts made by staff to maintain contact with relatives. EVIDENCE: The staff team demonstrated a strong commitment to encouraging the people who use the service to develop their skills and interests, both in the home and in the community, whilst recognising that residents had differing interests and abilities. One resident was able to describe his college-based activities, and there was evidence of his achievements in the certificates and medals displayed in his Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 14 bedroom, including achievements in a community drama group. He was clearly very proud of his achievements. This resident was also able to show the inspector a pictorial communication aid which assisted people in the community to understand what he needed, for example when out shopping, as he had a speech impediment. He spoke with enthusiasm about his family, and showed the inspectors photographs of a recent holiday in Switzerland with them. He also spoke about his girlfriend at college, although it did not appear that she came to visit him at his home, or that he saw her other than at college. He also spoke about having his own washing day, and subsequently a notice seen in the laundry room confirmed this information for each resident. He had a lockable facility in his room for his money and was able to take out the money that he needed for his day at college, describing what he would be using it for. Another resident was supported to enjoy activities in the community on a regular basis, from an outreach worker employed by Mencap in order to provide 1:1 care. This worker was also able to comment positively on the care provided by the staff in the home, and to note the improvement in the resident’s abilities in the time that she has been supporting him. This gentleman, when asked if he would show the inspector his bedroom, stated: “No, I’m doing the post.” He had heard the postman at the front door and collected the mail, taking it to the kitchen, and then informing a member of staff that there had been a delivery. He appeared pleased to have achieved this task. The advocate also confirmed that each of the residents had tasks in the home, such as making cups of tea, emptying bins and doing their laundry, which they enjoyed and seemed proud to complete. The third resident had fewer activities in the community, as a result of his deteriorating condition, but activities that he had previously gone out into the community to enjoy, such as music and drumming and music therapy, were now being brought into the home, so that he was still able to enjoy them. The independent music therapist confirmed how they now came to support this gentleman to continue his interests, as his frailty prevented him for leaving the home in the way that he had been used to. One resident also enjoys art work and working on a community farm. The people running these services spoke very positively about the support being provided by the staff team, in order that the resident can enjoy the activities. The art therapist commented on how the staff have promoted the independence of the resident, so that he can undertake part of the travelling independently. There was evidence of regular visits from the independent advocate, to support the rights of the people who use the service. Residents were also involved in the Outlook Care Westminster and Waltham Forest Forum, which meets 2 or 3 times a year. A summary of the minutes of the last meeting of April 2007 had been produced in a pictorial form and clearly evidenced the input from one of Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 15 the people who live at Mornington Road. One of his concerns was about receiving his medication on time, and the action to address this was evidenced in how the staff had re-assured him of the reasons for him having his medication earlier than usual on the day of the inspection. Residents’ views are sought in relation to menu planning. One resident was able to get his own breakfast, and chose from a range of cereals. Another required some assistance, but was asked his preference. Care staff were sensitive to the needs of another of the residents, who was finding it more difficult to eat solid foods. Staff were aware of his preference, although no choice was offered for his breakfast. Food stocks were adequate on the day of the inspection, and included a small selection of fresh fruit and vegetables. A shopping list was available on the kitchen notice board, and one staff member went shopping on the day of the inspection. Food in the fridge and freezer was appropriately stored, and included the date of opening as well as the use by date. The independent advocate confirmed that residents were encouraged and assisted to make choices regarding meals, television programmes, activities etc. The resident group is all white British. However, the community in which the home is situated is multi-racial. The ethnicity of the staff team reflects the local community. A multi-faith calendar was displayed in the corridor, enabling staff to identify different religious holidays and events. The registered manager has stated in the AQAA that the home had an African experience day at an ‘Aklowa’, a replicated African village in Hertfordshire. This enabled residents and staff to experience different aspects of the African culture, including dance, drumming, costumes and story telling. The AQAA also stated that Outlook Care have two diversity work groups looking at workforce issues and practice issues. Scores of 4 for this group of standards have been awarded in recognition of the high standard of care being provided, to ensure that the people who live at Mornington Road receive a fulfilling lifestyle. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 & 21 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home receive appropriate personal support and health care based on their individual needs and their preferences. The principles of respect, dignity and privacy are observed in the practice of the staff team. There was evidence that the terminal illness and death of a resident was managed sensitively. EVIDENCE: Information on residents’ files, and specifically their care plans, identified their health and personal care needs, and the way in which they preferred to be supported by staff. One resident was independent of staff in relation to intimate personal care, and one required minimal support. The third required a higher level of support, including two staff for some of the time. The staff demonstrated a good understanding of how each person liked to be assisted in personal care tasks and were flexible in the routines of daily living. There was evidence from discussion with staff and two of the residents, and from examination of records, that a range of social and health care Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 17 professionals are involved with residents’ personal or health care, including the Community Learning Disability Team, MacMillan nurses, the district nurse, the chiropodist and the Royal Society for Epilepsy. Some of the social and health care professionals were invited to contribute their views of the care of the residents. Without exception, they have praised the staff team for their commitment to the residents, and particularly for the manner in which the terminal illness and the death of one resident was managed. Each person has a health care plan; subject to review as needs change. The health care action plan for the recently deceased resident covered the key areas of his specific health care needs, although the date of the action plan and the review date were the same. None of the people who currently live in the home would be able to take control of their own medication. The home has a satisfactory medication administration system. The administration of the morning medication for one resident was observed. The system involved two staff in administering the medication, with good checks and safeguards. The administration system allowed for flexibility to meet the needs of the resident, who was leaving the home earlier than usual, in order to attend a college function. The resident was also aware of the medication system, and the reasons for the change in his usual routine. Staff were knowledgeable about the prescribed medication and the contra-effects. They were also able to show the inspector written guidance for staff, setting out what each medication was for, its positive effects and any possible side effects. The staff were also aware that the training that they have had in the administration of insulin for a resident who has recently died, would need to be updated if they were to have to administer insulin to a new resident. The pharmacist provided positive feedback on the ability of the staff team to understand the medication that they were administering, and was satisfied, through the quality checks that he makes, that residents were protected from harm by staff competence in this area. Medication is appropriately stored in a locked metal medicines cabinet attached to the wall in the kitchen. The medication file contained photographs of each individual and a record of any allergies. There was also a list of staff that are able to administer medication and also their signatures. All of the residents have had medication reviews. This is good practice. Examination of the MAR (Medication Administration Record) found that these had been appropriately completed. However there were some hand written entries. Entries made by staff on residents’ medicines administration record (MAR) charts require their signature or signed initials and the date of the entry. If appropriate include brief details or reference to another document containing details about the medication. This provides accountability for the entry and continuity of the audit trail. Monthly medication audits are carried out and the service manager checks medication as part of the monthly monitoring visits. Staff are assessed each year in relation to their competency to administer medication. The medication file contained lots of paperwork and spare record sheets to cover Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 18 various areas in medication administration even if they were not required. For example, staff said that they do not have any homely remedies and do not administer these. However homely record sheets are in the file as are staff assessment records. It is recommended that the actual medication file that is used each day be streamlined to contain only the records and information that staff need on a daily basis. Other information can be filed and stored separately. This will ensure that staff have easier and quicker access to information that they require to safely and appropriately administer medication. It is acknowledged by the Commission that a reference made in the previous inspection report to the risk to residents as a result in mal-administration of a prescribed medication, may have been erroneous. Documents relating to the end of life care of a recently deceased resident were examined, and feedback sought from social and health care professionals involved in his care. The registered manager had developed guidance on palliative care. There was evidence that the staff team were aware of the changing and deteriorating needs of the resident and provided a very sensitive and caring end of life experience for the gentleman, enabling him to die in the home with people who knew him well. Staff and residents were enabled to attend the funeral. The Consultant Kidney Specialist described the staff team as ‘exemplary’ and that the staff team had worked very hard to understand the illness and treatment, and asked the correct questions in order to provide person-centred care. A member of the palliative care team described the staff as treating the dying resident, and the other residents, with dignity and respect, and provided a high commitment to maintaining the resident in the home, until his death, treating him as if he was a member of their family. She stated that all of the residents were enabled to understand the process of dying and death, because of the actions of the staff team. She stated that the staff team had been very good at making referrals when his needs changed, and that there was always someone on duty who understood the needs of the resident when she visited. She particularly praised the registered manager, stating: “ John was very good. He knew the patient very well indeed.” The consultant psychiatrist was also very complimentary, stating that the staff team had tried to maintain care at the highest possible level, and that the resident’s nourishment and skin care was maintained well to the end. The consultant psychiatrist also spoke positively about the care provided by the staff team to the other residents. The vicar said that he was ‘deeply moved’ by the care provided by the staff team, and that he was impressed with the support provided by all staff, not only to the dying resident, but to others in the home. A score of 4 has been awared in recognition of the high standard of care in relation to Standard 21. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The people who use this service are encouraged to express their views and are protected by the policies and procedures and monitoring systems of the home. None of the resident would be able to make a formal complaint, without the support of another individual, such as an independent advocate or relative. EVIDENCE: The service has a satisfactory complaints procedure, which includes referring complaints and allegations of abuse to the appropriate authorities, including the Commission for Social Care Inspection. The complaints procedure is available in a pictorial format, which is more user-friendly for residents who may have poor literacy skills. The views of residents are also ascertained in residents’ meetings, and through an independent advocate from the North East London Advocacy Service. There were several eye-catching leaflets and posters on the kitchen notice boards which enabled the people who live in the service, visitors to the home and staff responsible for caring for the residents to know what action to take if there were concerns, including alerting to concerns about adult abuse. Two of the residents were able to name people to whom they would go if they had any worries. These people included named staff working in the home and also relatives or advocates. One person had dementia and would not have been able to either understand the process of making a complaint or make use of written or pictorial information, but did have an advocate. One person was Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 20 able to turn to the complaints section in the pictorial Residents’ Guide, which referred to the Commission for Social Care Inspection, pointing to the inspector and then to the section, indicating an awareness of the Commission’s role if he was unhappy. The home has comprehensive ‘Safeguarding Adults’ policies and procedures as well as the local authority policies. The manager was clear in that incidents needed to be reported to the local authority (London Borough of Waltham Forest) as part of the local safeguarding procedures. Staff files indicated that staff had training in the protection of vulnerable adults and refresher courses have also been booked. Staff members that were spoken to were very clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. Residents’ finances were checked and cash amounts held agreed with records. Receipts were on file. The finances for two of the residents are managed by the organisation that act as a corporate appointee. The other resident has a bank account and staff support him to draw out his money using a debit card. Staff spoken to said that only the resident knows the PIN number. He has a lockable tin in his room and he keeps the key to this. However it was noted that this account is not reconciled or checked. A system needs to be in place to reconcile and monitor residents’ bank accounts and to robustly safeguard their finances. Unannounced visits are also made to the home, as part of the organisation’s own internal quality monitoring procedures and copies of these comprehensive reports are available to the Commission. The Commission for Social Care Inspection has received no complaints about the service since the last inspection. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 & 30 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The design, layout and maintenance of the home enables the people who live at Mornington Road to live in a clean, safe, comfortable, and well-maintained environment, which provides privacy and encourages them to be independent. EVIDENCE: The service provider and the staff team have ensured that the physical environment is appropriate for the needs and lifestyles of the people who live at the home. The premises are clean, well decorated and well maintained. There were no unpleasant odours in the home, even in the early morning, when residents were getting up. Furniture is of a good quality, and is in line with current trends in interior decoration. The ground floor is accessible to people with impaired mobility, although currently none of the residents is wheelchair dependent. Two of the three bedrooms in occupation were seen. The residents’ bedrooms were suitably furnished and decorated, and personalised with photographs, Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 22 certificates of achievement, weekly programmes of social events, music equipment and televisions. The bedrooms afford the residents with private space, and bedroom doors are lockable from within, with an override for staff to access in the event of an emergency. The kitchen and laundry areas promote the involvement of the people who live in the service to acquire or develop skills of daily living, where they have the capacity to do so. The kitchen/diner appears to be the main centre of the home, as with many families, with residents, staff and visitors congregating around the large dining table. The design of the room allows space for staff and residents to eat together, or socialise, and also allows staff to discreetly supervise residents who may be involved in independent tasks in the kitchen or dining area. A range of information is available in the kitchen, including information for staff and for residents. One resident was able to identify a range of information for the inspector, including the pictorial Service User Guide, his own profile, which helped people who did not know him to understand his particular needs, likes and dislikes, and the daily communication book and diary. Kitchen cupboards were well stocked, tidy and hygienic. The laundry is very small, but provides adequate equipment to meet the needs of the service. The lounge has a spacious, whilst homely atmosphere, and interconnecting doors to the dining area provides both private space for receiving visitors or for quiet and ‘noisy’ pursuits, as well as a larger area for social events. Alternative styles of seating were available to meet different needs. Bathrooms and shower facilities were appropriate to meet the needs of the people who lived in the home, had soap and towels and ensured privacy. A small, safe garden area provides residents with a lawn and patio area, with a garden shed and swing seat. Substances hazardous to health were securely locked away. Scores of 4 have been awarded in recognition of the efforts made by the staff team to ensure a comfortable, safe and home-like environment, for the people who live at Mornington Road. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are supported by staff who are suitable trained and in sufficient numbers to meet their current needs. Staff are being regularly supervised and annual appraisals have taken place. A risk assessment ensures that residents and staff are protected, when staff work alone. EVIDENCE: The home is not fully staffed, however the agency/bank staff are known to the residents and are therefore able to offer continuity of care. Duty rotas were inspected and they correlated with the staff members on duty and on the days of the inspection there were sufficient staff on duty to meet the needs of the residents. During the day there are at least two support workers (depending on the needs of the residents) and one waking night staff, this staffing ratio will increase with the admission of more residents. Outlook Care has thorough recruitment policies and procedures. Staff files are kept at the home and the inspector was able to examine three of the staff files. These files showed that robust recruitment procedures had taken place; a Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 24 completed application form, three written references, copies of qualifications, driving licence, passports and work permit visas. All staff have a current Criminal Records Bureau (CRB) check. Equality and diversity is monitored through the recruitment and selection procedure. There was also evidence on files that all new members of staff undertook an induction programme and were subject to a satisfactory probation period. The majority of the staff are from diverse cultures and backgrounds, which are different from the people living in the home. However, staff have undertaken training in ‘valuing people’ and this ensures that the cultural, spiritual and other diverse needs of the residents are understood and met. There was evidence on staff files that as well as an induction programme other training such as, food & hygiene, manual handling, first aid, administration of medication, infection control and fire training. Further training has been booked on the Mental Health Capacity Act, mental health & learning disability, epilepsy refresher, dementia awareness, safeguarding adults, basic first aid and moving & handling. There was also evidence of a work alone policy and an associated risk assessment that had been completed and signed by the manager and the member of staff. Staff files indicated that staff are receiving supervision in line with the National Minimum Standards, which states ‘at least six times a year’. There was also written evidence that staff have received annual appraisals and that staff meetings are held regularly. Staff that were spoken to confirmed that supervision and staff meetings were taking place. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents benefit from a home that is run with their best interests at the heart of what is done for them. EVIDENCE: In August the registered manager was seconded to another Outlook Care service. Therefore there is an acting manager in post. She has a lot of experience of working with people with learning disabilities and also of mental health issues and she has achieved NVQ level 4. The acting manager has the necessary qualification and experience to manage this service. The service manager said that this was not a long-term arrangement and that she has and will continue to liaise with the allocated inspector regarding the management of the home. Feedback from the advocate was that there was no disruption as Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 26 a result of the recent change of management, and that the transition was very smooth. The quality of the service provided to the residents is monitored by the manager and by the organisation. The service manager carries out monthly monitoring visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports are written. These indicate the action to be taken when deficiencies are identified. Copies of these reports were available in the home. The staff team carries all of the necessary health and safety checks out regularly. For example fridge and freezer temperatures are tested daily and hot water temperatures monthly. Hot water temperatures need to be tested on a weekly basis to ensure that they do not exceed the prescribed safe temperature. This lessens the risk of scalding. Monthly overall health and safety checks take place. Fire call points are tested weekly and regular fire drills take place and are recorded. Fire drills have been recorded on different documents and these require different information. Fire drill records should include the names of the staff and residents present, the date and time and any comments or action needed as a result of the drill. It is recommended that the fire drill record contains all of this information and that other recording sheets or books are no longer used. This will ensure that the necessary information is recorded. There is a fire procedure but these does not cover the procedure in the event of a fire at night when only one staff is on duty and a night time fire procedure is needed. This will ensure that staff are aware of the action to be taken in the event of a fire at night. Appropriate servicing is carried out on the fire system and fire equipment. Overall a safe environment is maintained for residents and addressing the requirements and recommendations above will make this more robust. Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 27 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 3 3 3 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 2 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 4 3 X 3 X X 2 x Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 13 Requirement To minimise risks to residents appropriate risk assessments and strategies must be in place for when they are travelling or undertaking activities without staff support. Entries made by staff on residents’ medicines administration record (MAR) charts require their signature or signed initials and the date of the entry. If appropriate include brief details or reference to another document containing details about the medication. This provides accountability for the entry and continuity of the audit trail. A system must be in place to reconcile and monitor residents’ bank accounts and to robustly safeguard their finances. Hot water temperatures need to be tested on a weekly basis to ensure that they do not exceed the prescribed safe temperature. This lessens the risk of scalding. A nighttime fire procedure is needed to ensure that staff are aware of the action to be taken DS0000065856.V347299.R01.S.doc Timescale for action 30/11/07 2 YA20 13 30/11/07 3 YA23 13 31/12/07 4 YA42 13 30/11/07 5 YA42 23 30/11/07 Mornington Road Version 5.2 Page 29 in the event of a fire at night. 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 Refer to Standard YA20 Good Practice Recommendations It is recommended that the actual medication file that is used each day be streamlined to contain only the records and information that staff need on a daily basis. This will ensure that staff have easier and quicker access to information that they require to safely and appropriately administer medication. It is recommended that the fire drill record contains all of the required information and that other recording sheets or books are no longer used, to avoid duplication or miscommunication. 2 YA42 Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mornington Road DS0000065856.V347299.R01.S.doc Version 5.2 Page 31 - 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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