Inspection on 04/10/07 for Morris House

This inspection was carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 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 12/02/08

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 Ann Farrell Key Unannounced Inspection 4th October 2007 08:00 Morris House DS0000016892.V347832.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.V347832.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.V347832.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.V347832.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 22nd February 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. No information was available on entering the home about the services; facilities, fees or what is included in the fees. Therefore residents and their representatives do not have information about the terms and conditions of their stay in the home. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 provision that needs further development. The inspection was over two days commencing at 8am and the home/provider did not know we were coming. This was the first key inspection for 2007/2008 and the manager was present for part of the inspection and the feedback. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection; on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home also conversation with managerial and care staff plus some residents. In addition, comment cards were received from residents, relatives and staff. Two residents 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 peoples care helps us understand the experiences of people who use the service. The inspector was assisted by an Expert by Experience (in this report known as the “Expert”). This is someone who has personal experience of using learning disability services and who has been trained to accompany inspectors during a visit to a home. Experts by experience observe what happens in the home and talks to residents, to get their view of the home. Any health and safety issues were discussed with the member of staff in charge prior to the expert speaking to residents. An easy read summary with pictures would normally be provided with the report. However, the home have written to the Commission since the inspection indicating that residents do not want documents in picture form and so this has been omitted. This expert talked with three residents and has provided a report of their findings, parts of which have been included in this report. The expert stated that, “Overall this is not somewhere I would wish to live as the choice is very limited and people are not encouraged to live as independent as they could be. I don’t think that the staff view the home as a person’s home but somewhere where they go to work”. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Some re-decoration of the home has taken place in the lounge, hallway, dining room, laundry, shed and summerhouse. In addition, some blinds have been Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 7 fitted to the windows in the conservatory so enhancing the environment for residents. What they could do better: Information available to residents to tell them about the home and what they can expect needs to be developed further and presented in a way that is accessible to them. Care plans and risk assessments process needs to be developed further to provide positive risk taking and provide staff with clear guidelines about how to meet resident’s specific needs and the action required to reduce any risks identified. Practices must be reviewed and a more person centred approach adopted to enhance resident’s life and enable them to achieve their aspirations. The medication system needs improving to ensure all residents receive the medication ordered by health professionals. Systems should be in place to support residents with elements of the self-medication process in order to enhance their independence. Systems need to be in place to ensure recommendations made by health professionals are included in resident’s daily care to ensure their well being. Residents need to be given support with raising complaints or concerns and they should be recorded in the appropriate folder, investigated fully and action taken to ensure there are no further incidents. This is so learning can take place and residents benefit from improved services. The arrangements in respect to safeguarding need to be developed further and action taken to ensure all staff are fully aware of the procedures, so that residents are protected from abuse. The arrangements for activities need to be reviewed and developed further. There was no evidence that residents got the opportunity to partake in independent living skills such as cooking and there was no evidence of community involvement. The expert stated, “There is nothing happening within the home and residents must become bored with just watching TV and doing very little in the home during the day or on an evening. The residents should be more involved in the running of the home. I think that the residents should be a part of their local community more”. The expert was disappointed to see that residents were not offered a choice of meal at lunchtime, they were not aware of what they were going to have for their evening meal and they did not get all their meals at week-ends. The arrangements for meals, snacks and recording need to be developed further to ensure residents receive an adequate nutritious diet of their choice at all times, including snacks. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 8 Although residents meetings are held each month it was stated they are over too quickly and residents don’t feel they can say what they want to say. The expert stated, “I don’t think anyone should be made to feel like this, it is their home and they should be able to say what they want, when they want!” Adequate staffing levels must be maintained at all times to ensure resident’s needs are met. Also a review of the hours worked by staff needs to be reviewed to ensure their health and safety and the well being of both staff and residents. Staff recruitment needs to be more robust to ensure residents are safeguarded by the employment of new staff. Staff training is required in a number of areas to ensure staff have the skills and knowledge to look after residents and ensure their needs are met. 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. Morris House DS0000016892.V347832.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.V347832.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): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information about the service and facilities needs development to enable prospective residents and their representatives to make an informed choice about moving into the home. There have been no new admissions to the home for a number of years. EVIDENCE: There is a static resident group in the home with all residents having lived in the home for a number of years. There were no vacancies and therefore the admission process could not be assessed. On entering the home there was no information available to inform visitors of the services and facilities. A copy of the service user guide was provided, but it was not complete with a contact of residence to indicate the terms and conditions of stay and it was not in a format suitable for residents to access. It is recommended that a service user guide be produced in a format that is accessible to resident’s e.g. large print, pictures, audio or video. The statement of purpose and the latest report from the Commission should also be made more accessible to anyone visiting the home. On inspecting a sample of resident’s files there was no evidence of contracts available for individuals. Without this information residents and their Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 11 representatives do not have information about the services included in the fees and therefore cannot make appropriate decisions. Morris House DS0000016892.V347832.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): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments need reviewing and updating to ensure all residents’ needs and risks are identified, known by all staff and met in a consistent and appropriate manner in line with resident’s preferences. Systems for supporting residents in making choices and having control over their lives is limited and needs to be developed further, so that residents can achieve their aspirations. EVIDENCE: Each resident had a care plan drawn up, which were stored in the manager’s office. This should be an individualised plan about what a resident is able to do independently and should state what help is needed from staff in order for the resident to have their needs met. On discussion with staff they stated all residents had a key worker and co worker who would be responsible for ensuring individual residents care plans were up to date, needs were met, monthly supervisions and three monthly reviews were undertaken. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 13 On inspection of a sample of care plans it was noted that they contained information about residents preferences regarding food and activities. There was also a range of risk assessments based on the risks identified by staff. The care plans had been reviewed in June 2007 with a review date of September 2007, but there was no evidence that they had been reviewed. Some of the care plans did not give detailed information e.g. in one file it stated that a resident displayed poor behaviour and gave vague details of the action required by staff to manage it. In some cases behaviour management guidelines were found later in the file, but the care plan had not been cross referenced to them so all staff may not be fully aware of them. In another care plan it stated that a resident would display facial/body language when there was a problem, but did not indicate what expressions or body language staff should be aware of. In one case the details of a residents diet and advice given from health professionals had not been included in the care plan. Also some areas described in care plans were not fully implemented e.g. it stated to keep a resident busy and to observe during the day, but this was not consistently completed. At the time of this visit there was no evidence that residents had been involved or consulted about what was in their care plan and it was not produced in a style that was accessible to them. At the last inspection the manager stated that she had just received information about person centred planning and would be starting to develop these with individual residents. A person centred plan is an individual plan, written by or with the person and includes information about their needs and aspirations. However, this has not been undertaken to date. Although there were risk assessments in place they did not cover all risks e.g. when a person goes out independently, accessing the home for those who go out independently, nutrition etc. Where risk assessments had been completed the actions required to reduce the risk had not been consistently included in the plan of care or cross-referenced to the element(s) of the care plan. Three residents can go out independently and when the manager was asked if they had a key the front door in order to access their home. She stated that no residents in other homes had keys to the front door. No resident had a key for the front door as they may return when there was no one there. It is concerning that risk assessments appear inconsistent and residents can go out independently, but they cannot have a key to access their home. This area must be reviewed under a risk management process and identify steps that can be taken to enable positive risk taking. The staff have one to one sessions with residents that they call supervision sessions and it was stated they were conducted monthly. On inspection it was found that they were not always undertaken each month and where records were available it was noted that areas in respect of activities, items of furniture etc. had been identified and there was no evidence that it had been followed or Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 14 actioned. Inspections of three monthly reviews were of a similar standard. Without comprehensive care plans and risk assessments it cannot be guaranteed that residents needs will be identified and met effectively. Also it is concerning that residents were identifying needs, aspirations, preferences etc. and staff were not supporting residents with actioning them. Staff completed records for each day indicating the activities or care provided. This was found to be task orientated and did not give any information about how the resident enjoyed their day or the activities undertaken, to determine if it was suitable or if changes were required. On discussion with some staff they were not aware of some aspects of residents care and they were reliant on the key worker for details. All staff should be aware of residents needs; care and interventions to ensure their needs are met at all times in a consistent manner. Residents meeting take place each month and records of the meetings were available for inspection. There was a list of items that were discussed at each meeting such as house rules, garden, recycling, chores, food and anything else that residents wished to raise. On inspection of records it was noted that meetings lasted between thirty and fifty minutes and they did not indicate how decisions were made. The expert who was visiting at the time of inspection spoke to residents about the meetings and was informed that meetings occurred each month, but they were over too quickly and some residents could not say what they wanted to say. This was also stated in the comment cards received by the Commission prior to the inspection. The expert by experience stated. “I do not think anyone should be made to feel like this, it is their home and they should be able to say what they want, when they want!” She felt that residents should be more involved in the running of the home. At the time of inspection it was observed that residents were not offered a choice of meal at lunchtime. They were given sandwiches and were not offered a choice of fillings. It was also noted during inspection that there was a lack of choice in respect of activities and when residents made certain requests there was no evidence to demonstrate that they had been actioned. The expert stated, “I do not feel that the residents have a lot of choice when it comes to what they want to do or what they want to eat.” Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 15 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, 15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for personal development and independence need developing further to ensure residents reach their potential, so enabling them to lead a meaningful and fulfilled lifestyle. Residents are supported to have personal, family and sexual relationships so that their self-esteem is enhanced. The arrangements for meals and snacks need developing to provide residents with adequate choice. EVIDENCE: Each resident has a weekly timetable of activities that included planned activities such as attending college and day centre, visits to family plus leisure activities such as swimming, relaxation, walk, shopping, and some domestic tasks, which were mainly during the day. It was observed that a resident was doing their own washing and hanging the clothes on the line at the time of inspection, which was positive. Two cars were available to residents to support them take part in activities, which was positive as it means that different Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 16 activities can be accessed at the same time. A record is made of the activities undertaken and on inspection it was noted that it was mainly around college and day centre visits and shopping etc. There was one record about a meal out and there was evidence of reiki sessions, but generally activities appeared limited and there was no indication how these activities were chosen. Residents who spoke with the expert stated there were generally few activities apart from college and the day centre. She found that two residents went out independently, which she thought was positive. One resident stated they went bowling occasionally and another went dancing. Other comments received included, “I don’t go shopping” and “I don’t go out”. Others stated they went out to day centres, but did nothing after they came back. Some residents stated they would like staff to take them to watch a football match. The expert stated, “I feel there needs to be more activities happening in the home. The residents don’t seem to do much apart from watch television”. Also there was no evidence from discussion with residents or records that there was any involvement with the local community. Leisure activities within the home included Sky television, DVD’s, videos, music and books. One resident said that he liked to watch sport but it depended on whether the staff likes it that are on shift. The expert stated, “This should not be the case, residents should be able to watch what they like, it is their home. Staff seem to dominate the home rather than the residents having ownership of their own home”. Residents were encouraged to take part in some domestic activities so that they can develop their independent living skills, which is positive. However, these need further development as some records and discussion with residents indicated that they would like to undertake some cooking. This issue was raised at the last inspection with a recommendation to make such opportunities available to residents, but it appears that no action had been taken to date. The home has gone ‘green’ and residents were involved with a recycling project, which is very positive. There was a small well-maintained garden and it was stated that residents are involved in gardening and each had an area with the support of a member of staff to maintain. There were two garden benches that required treatment and it was stated that a member of staff would be working on them with one of the residents. This is positive as it provided an opportunity for residents to get involved with activities and provides some ownership. A record is made of the activities individual residents take apart in. These records need to be further developed so they 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. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 17 Staff accompanied all residents on holiday to Ibiza earlier this year, which they enjoyed and this is very positive as it provides them with a range of experiences. Another holiday has been booked for all residents to go to Puerto Ventura in the near future. Although it is positive to see residents going on holiday it was not clear how the decision was made and if residents were given other opportunities such as separate holidays etc. Also they can be expensive and residents were funding both holidays themselves. This area needs to be reviewed, as funding for a holiday is often included in the fees paid on behalf of residents. Also records need to clearly demonstrate how individual residents make decisions. The expert stated, “There could be planned activities, which cater for people to do what they want to do. They could all have an activity plan which charts that each person gets to do an activity of their choice regularly and staffing levels should be able to accommodate this”. Records indicated that residents maintain contact with their families and some have weekend visits to their parents, which is facilities by staff and ensures contact is maintained. At the time of inspection a member of staff was supporting a resident with writing to a relative. The home now has two cats that sleep on their own beds in the lounge area. One of the staff employed in the home is a reiki therapist, so residents have regular access to alternative therapies, which are helpful in maintaining a sense of wellbeing and can provide great benefit to residents who wish to get involved. A menu of the week’s meals was available in the kitchen and it demonstrated a choice of various foods, but it was printed in small print and was not in a suitable format for residents. There was a good stock of food and a supply of fresh fruit and vegetables, so that healthy diet guidelines are followed. The menu indicated the main meal was served in the evening with a snack meal at lunchtime and a cooked breakfast on Saturday morning. On the day of inspection it was observed that residents were not offered a choice of lunch; sandwiches were served and they were not offered a choice of fillings. When the expert spoke with residents it was found that they were not aware of what was on the menu for the evening meal. Issues were raised about the meals at weekends e.g. after breakfast on Saturday it can be about 6 o’clock before residents have anything, as some staff say that residents have had a big breakfast also “Staff say we won’t give you a sweet after Sunday dinner because they say we would be too full after our dinner”. The expert asked if they could help themselves if they got hungry. The feedback was “Staff wouldn’t like it if we helped ourselves”. “Staff don’t like to many people in the kitchen at one time”. The expert was very concerned about these issues and raised them with the inspector. She stated, “I think that this is awful!!! Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 18 The record of food provided by the home only gave information about the main meal. In some cases it stated as per menu when there was a choice on the menu for the main meal and it indicated that a vegetarian resident had been given a meal with meat. This is not appropriate, as it does not provide adequate detail for the person inspecting to determine if residents were receiving a nutritious diet especially in light of the concerns raised around meals and it is unacceptable if residents are unable to have meals/snacks when they are hungry. Staff are required to provide a comprehensive record of food and review the arrangements for meals ensuring residents are offered all meals plus a choice and there are suitable arrangements for residents to access the kitchen for snacks etc. under a risk management process. The expert suggested that the menu be put in an alternative format to make it more accessible to residents e.g. large print, picture etc. She stated, “the menu is too hard for people who cannot read”. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate systems are in place to ensure resident’s health care needs are recognised and responded to ensuring that their health is promoted. The medication system needs to be further developed to ensure residents receive the medication prescribed by health professionals. EVIDENCE: There is a mixed group of residents in respect of age, gender and ability living in the home. Each has a key worker, who is responsible for ensuring residents needs are met. Care plans provided information about the support residents required with personal care and residents were dressed appropriately for their age, culture, gender and weather. The home employs a mix of staff that reflects the gender and culture of the people living in the home, so residents can chose who they want to support them with their personal care. At previous inspections it was identified that a health action plan (HAP) in line with the Valuing People white paper was required. This is a document that Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 20 outlines the care a person with learning disabilities requires to stay healthy. A document had been introduced, but was not available in all residents’ files. Where it was available it was noted that areas of need had been highlighted in respect of health care and in some cases the record indicated how the need was to be met, but the record did not consistently indicate what action was required to maintain residents health. It was noted that a resident with diabetes did attend regular health checks to ensure their condition was controlled and so reduce the risk of complications. However, it could not be evidenced that all residents received regular health checks in respect of other conditions e.g. asthma. Records showed that all residents with the exception of one (whose choice it was) had check ups with the dentist, chiropodist and optician and they were weighed on a regular basis, so monitoring their weight. Consideration should be given to making the HAP more accessible and easily understood by residents. 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 (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication it was found the monitored dose system was satisfactory and audits were correct. Audits in respect of some of the boxed medication were not accurate and it could not be guaranteed that residents were receiving the medication as prescribed by health professionals. Where staff had handwritten medication details on the MAR chart it had not been countersigned by two staff to ensure accuracy and the room where medication was stored was not locked. One resident was supported within a risk assessment framework to self-administer their own Insulin, which was positive. Other residents were called and lined up outside the room for staff to administer medication. This practice is institutionalised and does not reflect a person centred approach. Also some residents are independent and staff should be looking to support residents with elements of self-administration of medication. The practice needs to be reviewed and a more appropriate approach adopted. Homely remedies were available and it was pleasing that the resident’s doctor had confirmed that the medicine was safe for the resident to use. On discussion with a member of staff about the medication they did not have an adequate knowledge of the medication they were administering. It is recommended that information about the use of medication and common side effects is included in resident’s records, so that staff is made aware of the use of medication and its side effects in the event of any adverse reactions. During the inspection it was identified that staff undertaking blood glucose monitoring, but there was no evidence that they had been provided with training in this area, as it is classed as an invasive technique. In such cases Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 21 staff should be provided with training how to undertake the procedure, complications, indications etc. and evidence should be retained in the home. Interactions between staff and residents observed on the day were positive and staff were pleasant. The expert stated staff were friendly and residents seemed to get on well with them. The Commission had received a complaint alleging that staff used inappropriate language. On discussion it was stated it did occur in the form of “banter”. This is not appropriate and the manager will need to take action to ensure there are no further incidents in the future. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems in place are not sufficiently robust to ensure residents are safeguarded, or provide confidence that their views are listened to or acted upon. EVIDENCE: A written complaints procedure was available upon request and a copy was provided to the inspector. It was in very small print and it is suggested that this be reviewed to make it more accessible to residents. It stated that the Commission could be contacted with a complaint if they were dissatisfied with the response or if they were unhappy with the response at any stage of the complaint. This was identified at the last inspection and remains outstanding. It is recommended that this be reviewed to advise of their right to contact the Commission at any stage. The information provided by the home indicated that they had not received any complaints since the last inspection. However, on inspection of the complaints record there was evidence of one complaint in Mach 2007 from a relative about being unable to contact anyone in the home by telephone. It appears that the answer machine was not switched on when everyone was out of the home. On inspection of the staff daily diary it was found a resident had raised a concern about the serving of breakfast on Saturday morning. There was no evidence to indicate how this had been addressed and on discussion with the manager she stated that the residents had been informed that he could have a light breakfast earlier and have the cooked breakfast as well. It was Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 23 recommended that all concerns/complaints should be recorded in the complaint log, so that it could be demonstrated that all issues no matter how minor are addressed appropriately by staff and there is an open approach to concerns/complaints. On discussion with residents they stated they were aware of whom to go to if they had a complaint and they would be given a form. This is concerning as a residents may not be able to complete the form and this may inhibit them from raising concerns. This area needs to be reviewed and the policy updated to ensure the process is accessible and residents are supported in raising concerns. It is concerning that requirements regarding complaints have been made since October 2005 and remain outstanding. The Commission received a complaint about the inappropriate use of language by staff and residents returning to the home who were not able to gain access to their home. On discussion with staff they stated that residents did not have a key to the front door despite going out independently. The inspector was unable to determine if there was any substance to this element of the complaint, but as identified earlier there were times when there was no one in the home. The element is respect of inappropriate language is upheld as identified earlier in the report. The manager has been asked to follow up both elements, record the details in the complaint log with the outcome and action taken to ensure there are no further reoccurrences. The home had safeguarding policies and procedures and a copy of the local guidance. However, the policies and procedures indicated that an allegation of abuse would be investigated. However, guidance that should be followed states any allegation should be referred to the lead agency and they would make the decision as to the how the allegation should be followed up. The manager will need to ensure these are reviewed and updated inline with local guidance. The training matrix showed that five of the nine staff had completed training specifically in abuse in September 2004 or November 2005. Four staff still required specific training in this area. Records for new staff indicated that they had completed induction training and NVQ training, which should include issues in relation to abuse. On discussion with some staff they were not aware of the policies and procedure or the action to take in the event of abuse. It is concerning that staff have been provided with training in this area and were not aware of the corr4ect procedures to follow. This area will need to be addressed and further staff training provided to ensure residents are adequately protected. On inspection of staff files it was noted that references had not been obtained for a member of new staff until after they commenced employment, also a number of staff had not have a Criminal Record Bureau Check (CRB) completed by the organisation, as required in order to protect residents. Some newly employed staff did not have evidence of a work permit at the time Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 24 of inspection. This poor recruitment procedure puts residents at risk with the employment of staff. Policies and procedures were in place for managing resident’s money. On inspection of records, money and valuables it was found to be of a good standard with receipts for money spent on behalf of residents, so ensuring residents finances were protected. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 25 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): 24,26,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, tidy well personalised home that meets their needs and reflects their taste and interest. A number of areas of maintenance require attention to ensure the home provides a safe and homely environment EVIDENCE: The home is a domestic style property that provides six single bedrooms for the residents who live there. Consent was obtained from staff or residents before entering bedrooms and it was found that some of the bedrooms have an en-suite toilet and wash hand basin, whilst others have a wash hand basin in the room. All rooms have a call bell to summon assistance if required and all areas were clean and odour free. The ground floor accommodation consists of a staff office and sleep in room, two bedrooms for residents, 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 residents would Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 26 need to be mobile to access rooms on this floor. The only aids to assist with mobility are the handrails on the stairs. As residents needs change due 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. Communal areas and bedrooms sampled were well personalised and reflected the taste, interest and culture of the people living here. The manager stated that since the last inspection the lounge, dining room, hall, laundry, shed and summerhouse had been decorated. She had drawn up a record of all maintenance and repairs that were required and showed the inspector a cracked wash hand basin in one of the resident’s rooms. The following areas will need addressing to ensure that the home continues to provide a pleasant and safe environment for the people living here. • • • • • • • • • • • • The kitchen is in need of refurbishment as the worktops were chipped, units were worn and the extractor over the cooker was broken. The cooker is domestic in size, given that staff dine with residents to enhance the social aspects of mealtimes consideration should be given to providing a larger cooker. Food items and sauces had been opened and stored in the fridge, but they had not been dated to ensure they are used within specific timescales. Some of the chopping boards in the kitchen were worn and in need of replacement to ensure adequate hygiene standards in the kitchen. There was inadequate comfortable seating in the lounge for residents and staff to sit together. The conservatory needs blinds to the roof and it would benefit from a fan being installed so that a comfortable temperature can be maintained in hot weather. One of the tables in the conservatory was damaged and needs replacing or repairing. The stair carpet was beginning to wear and needs replacing to avoid the risk of trips. Two benches in the garden require treatment to ensure they are safe for use and prevent risk of injury to anyone using them. Some of the patio paving slabs were uneven and may pose a trip hazard. There was a bag of used tins of paint and decorating materials in the garden, which should be removed in order to reduce risks. The cupboard used for the storage of cleaning fluids etc was not locked and some cleaning items were found in the bathroom. These should be kept in a locked cupboard except when in use as they pose a risk to residents. The enamel on the ground floor bath was slightly damaged. • Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 27 • A double adaptor was in use. These are not suitable and should be replaced with a socket board, to ensure appropriate safety in respect of electrical items. Some of these areas remain outstanding from last year. The manager stated audits had been completed and some of the areas were in the process of being addressed. There was a separate laundry facility with a washing machine and tumble dryer. It was stated that there were no residents who had concerns around continence. Facilities were in place for the removal of clinical waste. There was no liquid soap dispenser in the upstairs bathroom for hand washing to ensure adequate infection control procedures within the home. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 28 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for the level of staffing the home was not clear and it could not be guaranteed at there were adequate staff at all times to meet residents needs. The recruitment practices and training need to improve further to ensure that residents remain safe at all times and their needs are met in an effective manner. EVIDENCE: There was a fairly stable staff group with all staff having worked in the home for over one year. The staff were friendly towards the residents and the residents seemed to respond well to staff. A key worker system was in operation, this is where a member of staff is allocated to support the resident and help them with specific activities such as personal shopping. Residents all knew who their key worker was and key workers were aware of resident’s needs, which was positive. However, not all staff were aware of certain aspects of residents care when they were not the key worker and this could lead to some inconsistencies in care and it is recommended that this area be reviewed. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 29 It was stated there were three members of staff on duty during the day. The planned rota indicated that there were three staff on duty at all times during the day with one awake and one sleep in member of staff at night. On the day of inspection there were only two care staff on duty plus a social worker student, who is supernumery. The manager and senior carer attended a training session. During a conversation with some of the residents it was stated that there were not as many staff on duty at the weekends. The expert was informed that other homes ring up for staff to cover shifts and there were two staff on duty at weekends. Time sheets were inspected to determine the shifts worked by staff, but they had not been completed from the beginning of October by any member of staff. On discussion with the manager she stated that staff should complete them when each shift is worked. Therefore, the staffing levels could not be confirmed at the inspection. This was discussed with the manager and systems will need to be put in place to ensure there is adequate staff on duty at all times to meet residents needs and records are retained of hours worked so that it can be verified. Whilst viewing the rotas it was noted that staff can work a 15-hour day, followed by a sleep in duty of 9 hours and followed by a further 12-hour day. In addition, staff were working overtime to cover a vacant shift. When this was discussed with the manager she stated that staff preferred the shifts together. However, this does not fall in line with the working time directive, which states that there must be an eleven-hour break between shifts. Also such shifts will have an impact on the health and safety of staff and may impinge on resident care. This area must be reviewed and appropriate action taken to ensure regulations are met and resident’s safety maintained. The manager maintains a matrix record of the training that staff had completed. This indicated that all staff had received fire training by the manager, who is a fire marshal, twice in the past year. However, on discussion with staff they were not able to indicate what action they would take if a resident did not respond to the fire alarm. It was appeared that fire drills had taken place and all residents had followed the procedure. The inspector was concerned to know staff’s response if a resident did not respond, as they would be responsible for the welfare of all residents in such an event. Three staff had completed health and safety training and some other areas of training were out of date e.g. infection control, managing challenging behaviour and food safety. Some staff had undertaken training in respect of risk assessment and dementia, but there was no evidence of training around areas of resident’s specialist needs e.g. Aspergers syndrome, epilepsy, diabetes etc. A review of all training should be undertaken and appropriate updated training provided to staff to ensure all staff has the skills and knowledge to care for residents. On inspection of staff recruitment files it was noted that the recruitment procedure was poor and so puts residents at risk. A number of new and existing staff did not have a Criminal Record Bureau (CRB) check completed by Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 30 the company prior to commencing employment. 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. When this was discussed with the manager she was aware that staff did not have CRB checks and stated that staff had to pay for them and what was she supposed to do when they told her they could not afford them. An audit of all staff files must be undertaken to ensure a current CRB is in place for all staff employed at the home. Also relevant documentation must be available to demonstrate that staff can legally work in this country. 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 residents in the home and ensure their needs are met. The manager stated that over 50 of staff were trained to NVQ level 2. However, evidence was not consistently available and the matrix for three staff did not provide a date that the qualification was obtained. Evidence must be available to demonstrate that staff have completed the training and have the appropriate knowledge and skills. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 31 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst there were management systems in place they were unable to show how they planned to improve the service for residents and protect residents effectively. EVIDENCE: The Registered 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. However, serious deficits were found in the home during inspection and poor response to previously made requirements does not provide confidence that the home is run in the residents interests. A quality assurance system had been implemented at the last inspection and it was noted that audits had been undertaken in respect of the building. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 32 Feedback had been sought from residents, relatives and staff. In addition there were regular meetings with residents and key workers had undertaken review/supervision sessions with individual residents to obtain feedback. Also staff meetings were held. However, evidence was not consistently available to demonstrate that areas had been addressed and there was no evidence of a development plan to demonstrate how the home was going to address the areas that would lead to improvements. Records of staff meeting, which were held approximately every three months, indicated that better team working was required. Feedback received from staff raised suggested that there was low staff morale, they did not feel appreciated by the organisation and were considering leaving due to the level of pay. Some residents were also aware of these issues. This is concerning as low morale and lack of team working may impinge on resident care. A representative from the organisation visits the home monthly and reports in writing on its conduct and no issues or concerns had been identified. A number of checks were undertaken in respect of equipment to ensure it was fit for use and the health and safety of residents was maintained. On the day of inspection it was observed that in house testing in respect of the fire systems and emergency lighting system had been completed. Testing of the electrical wiring system and electrical items had been completed. The manager stated testing had just been completed in respect of legionella and they were waiting for the certificate. There was no evidence of a company testing the fire, emergency lighting and fire extinguishers and there was no evidence of testing hot water temperatures to ensure residents are not at risk of scalding. Following the inspection the manager sent evidence of servicing of emergency lighting and fire extinguishers plus testing for legionella and insurance/Mot for one vehicle. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 33 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 1 2 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 1 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 2 X Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 34 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement All residents or their representatives must be provided with a contract of residence that outlines the terms and conditions of their stay in the home and a copy should be retained on their file in the home. Residents care plans require further development so that staff have specific guidance about how to meet individuals needs. Timescale of 1/4/07 not met. Systems must be in place to ensure all staff are aware of residents needs and their care plans to ensure residents needs are met in a consistent manner. Timescale of 15/3/07 not met. Risk assessments must include all areas of risk, be comprehensive and indicate the measures to minimise risk and ensure residents are adequately protected. There needs to be a positive risk taking strategy in place with Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 35 Timescale for action 30/10/07 2 YA6 YA19 15(1) 30/11/07 3. YA9 13(4) 15/11/07 4 YA17 16(2)(i) 17 suitable safeguards and boundaries where necessary to enable residents to achieve their aspirations. Residents should be offered 10/10/07 three meals each day, which are nutritious and meets their needs. A comprehensive record of food provided to residents must be maintained in the home to demonstrate residents are receiving a nutritious, balanced diet. Systems must be in place to ensure recommendations made by health professionals are implemented to ensure resident’s health care needs are met. Timescale of 1/5/07 not met. All staff who undertake blood glucose monitoring of residents must undertake training and be assessed as competent to undertake the procedure by a suitably qualified person. Written evidence must be retained in the home and this must be updated on a regular basis. This is so procedures are carried our correctly and residents are not put at risk. Robust systems for the administration of medication must be in place to ensure residents receive the medication prescribed by health professionals to include; • The accurate administration and recording of all medication. • Two staff must countersign any hand written medication details. • All staff should be aware DS0000016892.V347832.R01.S.doc 5 YA19 12(1) 30/10/07 6 YA19 12(1) 13(4) 30/10/07 7 YA20 13(2) 20/10/07 Morris House Version 5.2 Page 36 8. YA22 22(1) of the use and side effects of the medication they are administering. • The room where medication is stored should be locked when not in use. The Registered Person must 30/10/07 ensure any complaints received by the service are documented to state the nature of the complaint, the investigation, outcome action taken and resolution. This is to ensure all issues are addressed and learning takes place so that there are no re-occurrences. Timescale of 5/10/05 and 20/3/07 not met. The Complaints procedure should be amended to reflect that a complainant can contact the commission at any time. Timescale of 20/3/07 not met. The manager must undertake 30/10/07 an investigation into the complaint raised at the time of the inspection, put systems in place to ensure there are no occurrences and provide a copy of the report to the Commission. The safeguarding procedures 30/10/07 must be reviewed and amended to ensure they are in line with local guidance. All staff must be provided with training in the procedures so they can recognise any signs of abuse and aware of the action to take in the event of an allegation plus the whistle blowing procedures. There must be adequate staff on duty at all times to ensure resident’s needs are met. 9 YA22 22(2)(3) 10 YA23 13(6) 11 YA33 18(1) 17(2) 20/10/07 Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 37 12 YA33 18(1) Working time directive. 19, Sch 2 13 YA34 14 YA34 19, Sch2 15 YA35 16(1)(j) 17(2) 16 YA35 13(5) 17(2) 17 YA35 13(3) 17(2) A record of all hours worked by staff in the home must be retained. Staff should have an elevenhour break between shifts to ensure health and safety and residents needs are met consistently. Robust systems must be in place for the recruitment of new staff that includes all relevant checks prior to the person commencing employment to ensure residents are protected by the recruitment procedure. An audit of all staff files must be undertaken and where staff do not have a current CRB completed by the organisation a CRB must be obtained to ensure staff are fit to work in the home. All staff must undertake updated training in respect of basic food hygiene and records must be retained in the home to ensure staff have the appropriate knowledge and practice to maintain adequate hygiene standards in the kitchen and when handling food. All staff must undertake updated training in respect of moving and handling residents, systems must be in place to ensure good practice at all times to ensure residents safety and records must be kept in the home All staff must undertake updated training in respect of infection control and systems must be in place to reduce the risk of cross infection and. Records must be kept in the home 30/10/07 10/10/07 10/11/07 30/12/07 30/11/07 30/01/08 18 YA35 23(4)(d)(e) All staff must be fully aware of the fire procedure and the DS0000016892.V347832.R01.S.doc 30/10/07 Morris House Version 5.2 Page 38 19 YA35 20 YA42 21 YA42 action to take in the event of a fire to ensure residents safety in the event of a fire. 13(6)(7) All staff must undertake updated training in respect of managing challenging behaviour e.g. studio 3 to ensure staff have the skills to manage any incident and residents are not put at risk. 23(4)(a)(c) The fire system must be serviced on a regular basis to ensure residents safety in the home. 13(4) The hot water temperatures should be checked on a regular basis by staff to ensure appropriate water temperatures are maintained and residents are not put at risk of scalding. 30/11/07 30/10/07 30/10/07 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 YA1 Good Practice Recommendations The service user guide should be reviewed to ensure it is up to date and contain all the information outlined in the National Minimum Standards. It should be produced in a format that is accessible to residents so that they are aware of the services and facilities provided by the home. Systems must be in place to support residents to make decisions about their lives. Staff must be able to demonstrate how individual choices have been made and maintain a record. It is recommended that the home provides residents with comprehensive, accessible understandable information, in a suitable format about its policies, procedures, activities and services Information should be sought about local community activities and appropriate arrangement made for residents DS0000016892.V347832.R01.S.doc Version 5.2 Page 39 2 YA7 3 YA8 4 YA13 Morris House 5 YA14 6 7 YA16 YA17 8 9 10 11 12 YA17 YA19 YA20 YA22 YA24 13 14 15 YA26 YA27 YA28 16 YA28 17 YA28 involvement to enhance the quality of their lives. Appropriate arrangements must be made for all residents to undertake a range of activities (individually and in groups) that meets their preferences and aspirations so that they live a fulfilled life. Arrangements should be made for residents to be supported with additional daily living skills e.g. cooking so that they can maintain and develop their independence. Residents should be involved in the planning of meals and offered choices at all meals. The menu should be provided in an alternative format, so that it is accessible to residents. Residents nutritional needs should be assessed and regularly reviewed including risk factors to ensure residents receive a nutritious diet. Arrangement should be in place for all residents to have regular health checks to monitor their health and prevent complications arising. Residents should be supported to undertaken elements of self administration of medication within a risk assessment framework The complaints procedure should be produced in a format that is accessible to residents. The following areas need to be addressed in order to ensure adequate hygiene in the kitchen: • The kitchen worktops and units need replacing. • The cooker should be replaced and a suitable extractor fan provided. • The worn chopping worn should be replaced. Food items and sauces should be dated when opened and used within specified timescales The double adaptor should be replaced with a more suitable electrical appliance to meet regulations and ensure safety in the home. Repair the chipped enamel on the ground floor bath as it cannot be cleaned adequately and poses a risk of infection. • Treat or replace the garden benches so that they do not put people at risk of injury. • Ensure the paving slabs are even so the risk of tripping is reduced. • Remove decorating materials from the garden area. • Ensure there is adequate comfortable seating in the lounge for residents and staff to sit together. • Ensure blinds or alternative are fitted to conservatory roof. • Replace worn dining table in the conservatory Ensure there is adequate ventilation in the conservatory at all times so that a comfortable temperature can be DS0000016892.V347832.R01.S.doc Version 5.2 Page 40 Morris House 18 19 20 YA28 YA32 YA39 maintained in hot weather. Replace the stair carpet as it poses a trip hazard. At least 50 of care staff should be trained to NVQ level 2 to ensure they have the skills and knowledge to care for residents and meet their needs. The quality assurance system should be enhanced to include an annual development plan indicating outcomes for residents and improvements that are to be made to enhance resident’s quality of life. Morris House DS0000016892.V347832.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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