Inspection on 12/02/08 for Morris House

This inspection was carried out on 12th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morris House 26/01/09

Morris House 04/10/07

Morris House 22/02/07

Morris House 05/10/05

Morris House 18/05/05

Morris House 29/09/04

Morris House 22/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Morris House Grange Farm Drive Kings Norton Birmingham West Midlands B38 8EJ Lead Inspector Kerry Coulter Unannounced Inspection 12th February 2008 09:45 Morris House DS0000016892.V359798.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 Morris House DS0000016892.V359798.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. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morris House Address Grange Farm Drive Kings Norton Birmingham West Midlands B38 8EJ 0121 459 1303 F/P 0121 459 1303 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) Morris House Limited Catherine Dowe Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 4th October 2007 Brief Description of the Service: Morris House is a modern two storey detached building situated in a residential area of Kings Norton. The home is registered to provide personal care and support to six adults who have a learning disability. The home is situated close to the local shops of Kings Norton and West Heath and is also within short walking distance to local bus routes. The home comprises of six single bedrooms, five of which have en-suite facilities consisting of toilet and wash hand basin. Two of the bedrooms are situated on the ground floor and the remaining four bedrooms are on the first floor. The home offers a choice of bathroom or shower room. There is level access to the building, which is suitable for people with mobility problems. There is a garden with patio area and seating for residents to use when the weather permits. The garden benefits from outside lighting and a summerhouse also, so enhancing the facilities for residents. There is limited off road parking to the front of the building with additional parking available on the road. CSCI inspection reports are available on the home’s notice board and as part of the service user guide located in the lounge. The service users guide stated that the fees charged each week to live there range from £1,200 to £1,500. The information included in this report applied at the time of inspection and the reader may want to obtain more up to date information from the care service. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection took place over two days by one inspector and the first day was unannounced. This was the homes second key inspection in the year 2007-08. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Health and safety records and staffing records were also assessed. The people living there and their relatives were not asked to complete the Commissions ‘Have your say’ survey that asks for their views on the home as these surveys had recently been used, prior to the key inspection in October 2007. What the service does well: Residents meetings take place monthly so that they have the opportunity to comment on what they want to do. People are supported to go on holiday to places they want to visit. Two cars were provided which were used for taking people to activities such as day centre, college etc., so they have opportunities for education and development. One of the staff in the home is trained in Raiki and people benefit from this therapy, so enhancing their well being. The people living there are helped to keep in touch with their family and friends and the people that are important to them. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 6 Each person had their own bedroom and these contain the things that are important to each of them. The garden was well maintained and provided a pleasant area for people to sit when the weather permits. The garden also benefited from outside lighting, a summerhouse and barbeque, so enhancing the facilities. Many staff have worked at the home for several years so that they know people who live at the home well. Senior managers from the company visit the home and write a report about this. This shows that they are aware of their responsibilities and take them seriously. The manager’s office was situated close to the entrance of the home, so providing easy access to the manager enabling anyone to speak to her. What has improved since the last inspection? The service user guide is written in a way that makes it easier to understand so the people living there know what is provided for them at the home. Each person now has a copy of their contract with the home so they are aware of their rights and responsibilities. There are lots of activities offered to people so that they can take part in things they enjoy doing. The arrangements for meals have been developed to ensure people receive an adequate nutritious diet of their choice. Improvements had been made to the medication procedure so that it protects people and ensures medication is given out safely. The complaint procedure has been reviewed so that people know how to make a complaint and be sure that they will be listened to. New furniture had been bought for communal areas. This had made the home more comfortable for the people living there. The carpet has been replaced on the stairs so that it is not a tripping hazard to people. A new cooker has been purchased that is larger than the old one, this makes it easier to cook meals for the people at the home. There are enough staff on duty to meet peoples needs. Staff do not work very long hours so that they are not to tired to meet people’s needs. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 7 Staff had received more training so they know how to meet the needs of the people living there. 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 Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 9 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 Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 10 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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have available to them information about the home that would enable to make an informed choice about whether they wanted to live there. EVIDENCE: The service user guide for the home was readily available to people in the lounge. The guide has been updated since the last inspection in October and is in a laminated format that includes some pictures making it more accessible to people. The guide includes information about the home, the complaints procedure, a copy of a standard contract and a copy of the Commission’s last report. It was observed that the guide did not include information about the range of fees but this was added by the Manager when brought to her attention. There have not been any new admissions to the home for a number of years and currently there are no vacancies at the home therefore admission standards were not fully assessed. There is an admission procedure available to enable staff to assess any future prospective resident to see if the home would be able to meet their needs and aspirations and this includes trial visits. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 11 As required from the last inspection each person now has a copy of their contract with the home so they are aware of their rights and responsibilities. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans need to include specific information to guide staff to meet people’s needs consistently. Risk assessments need further development to ensure that risks to people are managed in a safe and responsible manner and that staff have enough information to manage these risks. People are supported to make decisions about their own lives to enhance their independence. EVIDENCE: Each person who lives at the home had a care plan drawn up, which were stored in the manager’s office. This should be an individualised plan about what a person is able to do independently and should state what help is needed from staff in order for them to have their needs met. The care plan for one person was looked at in detail and the care plans for two people were sampled in part. Care plans were observed to cover areas such as health, personal hygiene, communication, mobility, behaviour, meal times, community access and activities. Some of the plans sampled lacked detail about the exact type of Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 13 support needed. Following the inspection the Manager sent evidence to the Commission that the plans sampled had been updated, however the home will need to ensure that all care plans are sufficiently detailed so that peoples needs are met consistently and in the way they prefer. People had been consulted about their care plans as part of their annual review. A record of one review was sampled and found to include comments from the person and had been signed by them. However since the annual review had taken place staff had again reviewed the care plans. When a care plan review occurs the files sampled just recorded the date and signature of the staff and typically the comment “ongoing”. This does not demonstrate that the person and others who know the person well have been involved in the review and that a full evaluation has occurred. At the last two inspections the Manager had stated that the home would be starting to do person centred plans. A person centred plan is an individual plan, written by or with the person and includes information about their needs and aspirations. Evidence was seen at this inspection that this process has now started. People are supported to make decisions about their lives. A monthly residents meeting takes place. Records of these meetings show that people are consulted on the food they eat, activities they take part in and choosing holiday destinations. It is recommended that a system is introduced that tracks the outcome of people’s requests at the meetings to make sure things get done. Staff were observed taking time to talk to people about what was available and their preferences for the day to include what people wanted for lunch and what film they wanted to see at the cinema. Records sampled included individual risk assessments. These stated how staff are to support the person to minimise the risks from things such as diabetes, manual handling, accessing the kitchen, falls, community access and travelling in vehicles. At the last inspection it was identified that some areas of risk assessment needed improvement, to include completing assessments for people who go out independently. At this inspection an assessment had been completed for one person but was not available for another. The Manager forwarded a new assessment for this person shortly after the inspection. The assessment was observed to focus on the person’s behaviours and did not fully assess whether the person was safe without staff support. For example if the individual has good road crossing skills, do they take a mobile phone with them and is there is an increased risk if the person is out late at night. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to have opportunities for leisure and personal development so that they live fulfilling lives outside of and within the home. People are offered a varied and healthy diet that meets their needs. EVIDENCE: Each person has a weekly timetable of activities that includes planned activities such as attending college, employment preparation units and leisure activities such as going out to pubs, restaurants, shopping, ten pin bowling and the cinema. Two cars are available to support people to take part in activities, which was positive as it means that different activities can be accessed at the same time. Evening activities were usually scheduled at home with only a minority scheduled away from the home. One person spoken with said they preferred to stay at home in the evenings as they were too tired to go out after a busy day. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 15 At the time of the inspection some people were not attending college due to the half term. It was good therefore that alternative activities such as going to the cinema and bowling had been organised by staff. One member of staff is a qualified Reiki therapist and they were observed to undertake Reiki with people on a one to one basis, people who live at the home appeared to enjoy this activity. One person said they were going out later that day to a garden centre where they did some voluntary work which they enjoyed doing. One person was observed to be vacuuming and dusting their bedroom, they said they liked to keep their room clean and tidy. There are a number of leisure activities also available within the home including television, DVD’s, videos, music and books. There is a pet cat, which sleeps in its own bed within the lounge area. People are also encouraged to take part in domestic activities so that they can develop their independent living skills. The Manager said that as a result of recommendations made at the last inspection people are being encouraged to participate more in cooking activities. During the visit people were observed being supported to make their own drinks and become involved in lunch preparation. Records and discussions with staff show that people are supported to go on holiday, since the last inspection people have been away to Fuerteventura. There was a small well-maintained garden and it was stated that people are involved in gardening and each had an area with the support of a member of staff to maintain. A record is made of the activities people take apart in. These records now include details of whether the activity was enjoyed, what was successful or not so successful about the activity, so that future activity planning is informed. Records indicated that people maintain contact with their families and some have weekend visits to their parents, which is facilities by staff and ensures contact is maintained. One person said that their family had come to the home for a ‘pre Christmas’ lunch. The Manager explained that all relatives had been invited to this. One person has had a recent close family bereavement and the Manager said that staff were now supporting this person to have more contact with other family members. Menus were observed to meet healthy eating guidelines, offer variety and meet people’s special dietary needs, to include vegetarian options. There was a good stock of food and a supply of fresh fruit and vegetables, so that healthy diet guidelines are followed. On the day of inspection it was observed that people were offered a choice of lunch and that staff ate with people making a pleasant sociable atmosphere. Staff said that people at the home are supported by staff to do the food shopping. People were observed being able to access the kitchen. One person said ‘staff don’t let me go in the kitchen’, the staff with them explained to them that they could go into the kitchen they just needed Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 16 staff support to make sure they were safe. This was supported by the person’s risk assessment. It was identified at the last inspection that the records of food provided to people needed to improve, this has now been done so that staff know what people are having a healthy diet. It was also suggested at the last inspection that the menu should be put in a picture format. People who live at the home were asked at a meeting if they would like this to happen but have said no. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place so that people’s health care needs are recognised and responded to. People receive their medication safely and as prescribed by the GP so that they get the medication they need. EVIDENCE: Most people who live at the home manage their own personal care, where people need support this is indicated in their care plan. It was evident that people are able to dress, use cosmetics and have hairstyles that are individual and of their own personal choice. One person said that their key worker supports them to go to the hairdressers. The home employs a mix of staff that reflects the gender and culture of the people living in the home so people can chose who they want to support them with their personal care. Interactions between staff and people who live at the home observed on the day were entirely positive and respectful. People are supported to access health care professionals to meet their individual needs. Where people refuse to attend appointments then a record Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 18 that the opportunity was offered and refused has been made. Records do indicate that people generally access dentist and opticians regularly, however the recording systems sometimes made it time consuming to locate the date and outcome from when people last attended a health appointment. It was recommended during the inspection that it would be useful if a form was developed where at a glance staff could see when people last attended a specific health appointment. Following the inspection the Manager forwarded evidence that this had been developed. One person at the home has diabetes and there was some good information in their care plan about how this is managed. Another person has recently been assessed by the Speech and Language Therapist (SALT)as having dysphagia. This is a swallowing difficulty and puts people at risk of choking. The home has a basic care plan and risk assessment in place for this, this guides staff to read the guidelines from SALT. These guidelines record that toast is a high risk food, yet records for the individual showed they had toast. The Manager said this was safe as the bread was only put in the toaster for a short time and it was not ‘crunchy’. Guidance for this practice was not observed in the care plan during the inspection but was forwarded to the Commission shortly afterwards. It is advisable that this practice is checked with SALT to ensure it is safe. Medication is stored in a locked cupboard in the staff sleeping in room and staff retain the keys to the cupboard. The cupboards were observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a monitored dose and box system with Medication Administration Record (MAR) sheets. The home had copies of the original prescription for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. Audits of medication were accurate so that it appears people were receiving the medication as prescribed by health professionals. As required at the last inspection when hand written amendments are made to the MAR these are signed by two staff to make sure they are accurate. One person is supported within a risk assessment framework to self-administer their own Insulin, which is positive. The Insulin is stored in a locked container in the fridge in the kitchen. Consideration should be given to purchasing a separate medication fridge of a type that can be kept locked, this is good practice as recommended by the Royal Pharmaceutical Society. At the last inspection it was identified that a member of staff did not have an adequate knowledge of the medication they were administering. To make sure staff know about the medication they are giving the Manager has developed a list of what people are prescribed and why, this is kept next to their MAR for easy reference. Morris House DS0000016892.V359798.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for making complaints have improved to show that the views of the people living there are listened to and acted on. Arrangements need to improve to ensure that the people living there are protected from abuse. EVIDENCE: Previous inspections have identified that improvements are needed to the complaint procedures. Since the last inspection a new complaint format has been developed for people who live at the home. This includes some pictures so that it is easier for people who have difficulty in reading. Picture cards have also been developed to assist people to express what they want to complain about. The homes record of complaint showed that the complaint raised at the time of the last inspection had been investigated by the Manager. As a result people who live at the home had been offered keys to the front door of the home but declined. One further complaint had been made by someone who lives at the home about staff leaving the conservatory light on at night. The record indicated that this had been resolved and the person who made the complaint was happy with the outcome. The Commission has not received any complaints about this home since its last inspection. The home had safeguarding policies and procedures and a copy of the local guidance. However the home was observed to have two different procedures regarding adult protection, neither was dated. One was observed to be very out of date as it referred to the Registered Homes Act which is no longer Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 20 current legislation. Having two different versions of a procedure could be confusing to staff. The Manager removed the old procedure from the file when this was brought to her attention. At the homes last inspection it was identified that although staff had some training in protecting people from abuse some staff spoken with were not aware of the policies and procedure or the action to take in the event of abuse. It was required that further staff training is provided to ensure people are adequately protected. The Manager said that this had not yet taken place but that the Care Director would be organising this training. At the last inspection in October 2007 policies and procedures were seen to be in place for managing people’s money. At this inspection, reports from the Care Director’s visits to the home show that people’s money is regularly checked to ensure it is being well looked after. The last inspection identified that a number of staff had not had a Criminal Record Bureau (CRB) check completed by the Organisation, as required in order to protect people. Evidence was seen that the home has since applied for, or obtained CRB’s for staff. An areas of poor practice was identified with regards to CRB checks and this is further detailed within the staffing section of this report. Morris House DS0000016892.V359798.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, 26, 27, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that people live in a homely, clean, comfortable and safe environment. EVIDENCE: The home is a domestic style property that provides six single bedrooms for the people who live there. The home was clean and free from offensive odours throughout. The ground floor accommodation consists of a staff office and sleep in room, two bedrooms, a bathroom, kitchen, lounge and conservatory, which is used as a dining area. The first floor comprises of four bedrooms, a bathroom with toilet and a shower room. The first floor is accessed via a stairway with handrails and people need to be mobile to access rooms on this floor. The only aids to assist with mobility are the handrails on the stairs. As people’s needs change due to the aging process this will need to be kept under review. There is a well-maintained and secure garden to the rear of the property with a patio that has a table and chairs for use when the weather permits. As Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 22 identified at the last inspection two garden benches need re-varnishing. The Manager said this would be done after the winter. Only one bedroom was observed at this inspection, this was seen to be well decorated and furnished. There were photographs of people important to the person and pictures and ornaments that reflected their interests The lounge was observed to be in good decorative order and was homely in style. The Manager said that since the last inspection a new carpet had been fitted and that the settees were new. One person who lived at the home said that they liked the new settees as they were comfortable. Staff said they were better as there was now enough seating for everyone to sit together. New carpet has been fitted to the stairs as this was previously identified as a trip hazard. New dining tables and chairs have been purchased for the conservatory and new window and roof blinds have been installed. The blinds should help to ensure that the conservatory remains at a more comfortable temperature in hot weather. It was identified at the last inspection that refurbishment of the kitchen was needed. It was observed that a new fridge freezer and oven has now been purchased. The oven is a large range type and is more suitable for cooking meals for the numbers of people at the home than the small oven the home previously had. The kitchen unit doors were observed to still be worn and the work surfaces were chipped. The Manager said these would be replaced soon as new doors and work tops had been ordered. The 1st floor shower room had some mould growth to the ceiling, this will need to be addressed so that the room is in good decorative order. The ground floor bathroom was observed to be tired in appearance. Grouting around the bath was discoloured and as identified in the last report the enamel on the bath was slightly chipped. The Manager said that work had not been undertaken to this area as the Provider was seeking planning permission to extend the home and if granted the bathroom would be converted into an en-suite bathroom for one person who lives at the home. Morris House DS0000016892.V359798.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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements generally ensure that the people living there are supported by a trained staff team who can meet their individual needs. Arrangements to make sure that staff have had the right checks need to improve to ensure people are not supported by unsuitable staff. EVIDENCE: There was a fairly stable staff group with most staff having worked at the home for several years. The staff were friendly towards people at the home and they seemed to respond well to staff. Staff records showed that most staff have completed an NVQ in care so that people are supported by qualified staff. The staff rota showed that the gender of the staff team is balanced and is reflective of people who live at the home. The Manager said that usually staff meetings are held monthly but that a meeting had not been held recently due to all the staff training that had been going on. Minutes of meetings showed that the last meeting had been held in September 2007. Meetings need to be held regularly to ensure that staff are Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 24 kept updated with ‘best practice’ and the changing needs of the people living there. There were enough staff on duty on the days of the inspection to meet the needs of people living at the home. Observation of the rota shows that there are usually three staff on duty during the day, the Manager when on duty is usually extra to the staffing numbers. It was identified at the last inspection that staff were sometimes working long shifts followed by a sleep in and then another long shift. Staff working arrangements have since been reviewed to make sure staff have appropriate rest periods between shifts so that they do not become too tired which could impact on people’s care. Recruitment practice at the last inspection was observed to be poor, a number of new and existing staff did not have Criminal Record Bureau (CRB) checks undertaken by the organisation. Also references for a new member of staff had not been obtained until after they had commenced employment and there was not adequate evidence available for overseas staff to determine if they could legally work in this country. Some improvement has taken place and evidence is now available to determine if staff can legally work in this country. Recruitment records were sampled for a new member of staff and these showed that a robust recruitment procedure had been followed. CRB checks have been applied for or received for existing staff who previously did not have checks. It was of concern that for one staff although a CRB had been applied for there was no completed check that they were not on the list that prevents them from working with vulnerable adults (POVA). This member of staff was continuing to work waking nights without satisfactory supervision as the other staff on duty worked sleep in shifts. This means that people at the home were not being fully safeguarded from the risk of unsuitable people working with them. An immediate requirement was made to assess the risk to people at the home. This was completed by the Manager who decided that to fully protect people the member of staff would not work until a satisfactory POVA check was received. The POVA check was received the day after the inspection and evidence of this was sent to the Commission. New staff receive an induction so that they have the basic skills needed to do their job. In addition, staff have the opportunity to train towards completing the Learning Disability Award Framework, (LDAF) so that they have the necessary knowledge to work with people in the home and ensure their needs are met. At the last inspection it was identified that some staff needed additional training. Since the last inspection training has been undertaken by staff in monitoring blood glucose levels (re diabetes), manual handling, health and safety, infection control, first aid and physical intervention. Some staff have also recently completed mental health training. Morris House DS0000016892.V359798.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, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements at this service are improving so that people will benefit from a service that is run in their best interest. EVIDENCE: The Manager has been working in the home since 2003 and has completed the Registered Managers Award. There is also a Deputy Manager in post, so providing an adequate management presence in the home. At the last inspection some serious deficits were found in the home during inspection and poor response to previously made requirements did not provide confidence that the home was being run in people’s interests. However, many areas have now improved and where issues were identified during the inspection the Manager has sent evidence to show that some things have already been actioned. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 26 The Provider’s representative visits the home monthly and writes a report of their visit. These reports showed that the views of the people living there had been asked for. People living there had also completed ‘Comment Cards’ that asked for their views about the home. Maintenance and environment audits are regularly completed to ensure that the home is maintained and decorated so that it is comfortable and safe for the people who live there. The Care Director also completed quality checks this covers areas such as records, fire precautions, care plans, meetings, medication, menus, environment and arrangements for looking after peoples money. Prior to the home’s key inspection in October 2007 the Manager completed the Commission’s Annual Quality Assurance Assessment. This did not fully detail areas where the home needed to improve. It was recommended at the last inspection that a development plan was needed to demonstrate how the home was going to address the areas that would lead to improvements. Whilst some improvements have taken place the home does not yet have a development plan, this should be completed so that there is a plan to make sure outcomes for people continue to improve. As identified earlier in this report there were two versions of the adult protection procedure in the home’s procedure file. Both versions were undated making it difficult for staff to know which was the most up to date copy. To make sure that all the homes policies and procedures are up to date an audit should be done to make sure there is only one version of each policy and procedure and that these are dated on completion and review. Regular fire drills are held. This ensures that the people who live there know what to do if there was a fire. Staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to make sure it is working and well maintained. It was identified at the last inspection that some staff were not able to indicate what action they would take if people who lived at the home did not respond to the fire alarm. The Manager said she had since spoken with staff and they were all aware of what to do. However there was no record available for this and staff training records showed that it was over seven months since staff had received fire training. The Manager will therefore need to arrange refresher training for staff. Staff test the water temperatures weekly to make sure they are not too hot or cold, which could put the people living there at risk of harm. Staff test the fridge and freezer temperatures each day and keep a record of these. They showed that they are within the safe limits for safe food storage to ensure that the people living there are not at risk of food poisoning. Morris House DS0000016892.V359798.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 X 4 X 5 3 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 2 25 X 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 2 X 3 X Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 28 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(4) Timescale for action Risk assessments must include 30/04/08 all areas of risk, be comprehensive and indicate the measures to minimise risk and ensure people are adequately protected. Previous unmet requirement from 15/11/07. The practice of offering toast 30/03/08 to one person assessed as having dysphagia needs to be discussed with the Speech and Language Therapist to make sure it does not put the person at risk of choking. All staff must be provided with 30/05/08 training so they can recognise any signs of abuse and are aware of the action to take in the event of an allegation so that people living at the home are protected from abuse. Previous unmet requirement from 30/10/07. Ensure that all staff who work 30/03/08 at the home have had the right checks to make sure people are not put at risk of having unsuitable staff working with them. DS0000016892.V359798.R01.S.doc Version 5.2 Page 29 Requirement 2. YA19 12(1) 3. YA23 13(6) 4. YA34 13(6) Morris House 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 3 4 Refer to Standard YA6 YA6 YA7 YA20 Good Practice Recommendations All care plans should be sufficiently detailed so that people’s needs are met consistently and in the way they prefer. Records for the review of care plans should be more detailed to include evidence of evaluation and how the individual was involved in the review of their plan. It is recommended that a system is introduced that tracks the outcome of people’s requests at residents meetings to make sure things get done. Consideration should be given to purchasing a separate medication fridge of a type that can be kept locked for the storage of insulin, this is good practice as recommended by the Royal Pharmaceutical Society. The following areas need to be addressed in order to ensure adequate hygiene in the kitchen: The kitchen worktops and units need replacing. The 1st floor shower room has some mould growth to the ceiling, this should be addressed so that the room is in good decorative order. Minor repairs and minor refurbishment should be carried out in the ground floor bathroom if the proposed alteration of this room to become an en-suite does not go ahead in the near future. Treat or replace the garden benches so that they do not put people at risk of injury. Staff meetings should be held at least every other month to ensure that staff are kept updated with ‘best practice’ and the changing needs of the people living there. The quality assurance system should be enhanced to include an annual development plan indicating outcomes for people and improvements that are to be made to enhance people’s quality of life. To make sure that all the homes policies and procedures are up to date an audit should be done to make sure there is only one version of each policy and procedure and that these are dated on completion and review. Staff should receive fire training at least six monthly to DS0000016892.V359798.R01.S.doc Version 5.2 Page 30 5 6 7 YA24 YA27 YA27 8 9 10 YA28 YA33 YA39 11 YA40 12 YA42 Morris House make sure they are aware of what to do if a fire occurs to keep people safe. Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Morris House DS0000016892.V359798.R01.S.doc Version 5.2 Page 32 - 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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