Inspection on 05/10/05 for Morris House

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Morris House 26/01/09

Morris House 12/02/08

Morris House 04/10/07

Morris House 22/02/07

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 B38 8EJ Lead Inspector Joe OConnor Announced 05 October 2005 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 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 Stationary 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 E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Morris House Address Grange Farm Drive Kings Norton Birmingham West Midlands B38 8EJ 0121 459 1303 0121 459 1303 Telephone number Fax number Email 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 Ltd Ms Catherine Dowe Care Home 6 Category(ies) of Younger Adults, Learning disability [6] registration, with number of places Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 18 May 2005 Brief Description of the Service: Morris House is a detached house situated in a residential area of Kings Norton. The service is registered to provide personal care and support to six adults who have a learning disability. It is staffed twenty four hours a day including waking night and a sleep in member of staff. The service is situated close to the local shops of Kings Norton and West Heath and is also within short walking distance to local bus routes for Cotteridge, Northfield, Longbridge and Birmingham City Centre. The property comprises of six single bedrooms, five of which have en-suite facilities. Two of the bedrooms are on the ground floor, one of which is used as a sleep-in room. Four bedrooms are on the first floor. A bathroom is located on the ground and first floor. A shower cubicle is also on the first floor. There is a spacious lounge and conservatory that is used as a dining room. There is a kitchen and separate laundry facility. The property has a large garden that has a patio area and seating for service users. The garden benefits from outside lighting and a summerhouse. There is limited off road parking with additional parking available on the road. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out during the afternoon with the assistance of Stephen Ellis who is known as an Expert by Experience and his supporter Becky Ley from Sandwell People First Organisation. They spoke with three service users and had a look at one of the service user’s bedrooms. The Inspector spoke to three service users and two members of staff including the Team Leader. A tour of the premises was undertaken. Service users care plans and risk assessments were inspected. Staff recruitment and training records were inspected. A number of health and safety records were also sampled. Observations of care practices were also undertaken. Comments were received from relatives and professionals but none were received from the service users prior to the inspection. What the service does well: The expert by experience commented that he thought the home to be of good standard and that the residents seemed happy. He also commented the respect they have from the staff is good and the opportunity to have alternative therapies available in their own home works well. He found it to be a clean, well decorated tidy home with a relaxed atmosphere. The expert by experience and his supporter found the staff to be welcoming and friendly. There was a photo of the Inspector on the notice board. Two service users who spoke with the expert by experience spoke highly of the staff and another commented that the manager was very efficient at sorting things out if there were any problems. The service user also stated there were monthly meetings where they could discuss issues. Minutes of these meetings are held in the office. The expert by experience was pleased that one service user was confident in speaking up for himself. Staff stated they thought the manager was a good listener and very supportive. The service maintains appropriate numbers of staff on duty during the day, evening and at night. The expert by experience was pleased to find that people knew what they were having for tea and that they share in the responsibility of cooking and clearing up. Menus inspected were found to have a wide range of healthy foods and it was good to see that one service user had their own menu as part of their need to reduce weight. Service users were observed to have tea, which was well presented and they enjoyed eating. The service users have a range of daytime activities. One service user told the expert by experience she enjoyed going to work to earn money. She has a boyfriend who also lives in the home and they go out together. The expert by experience was pleased that staff are very supportive with their relationship. There is a member of staff who is a trained counsellor and is also qualified to Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 6 provide a number of alternative therapies such as Reiki and Tai Chi to assist with relaxation and reduce any anxieties. What has improved since the last inspection? What they could do better: Two service users informed the expert by experience, they were all going on holiday to Tenerife in November. He commented that although people were looking forward to their holiday, he was not sure they were given the option of not going together. The expert by experience thought that the two service users who are in a relationship might want to have an opportunity to have their own holiday. One service user told the expert by experience that she had a key worker and liked her. However, she stated that the key worker was on duty at night and felt she was not getting enough support like the other service users. The expert by experience feels this should be addressed. The expert by experience also thought that service users should be involved in the recruitment of staff during the interview process. One service user told the expert by experience she did not go shopping as staff did it because it was easier. He feels this should be encouraged as part of their daily living. The expert by experience was also concerned that staff were referring to the people living in the home as service users. This made him feel uncomfortable, and he feels that the staff should only refer to service users by their names. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 7 The emergency lighting was not tested every month. It was noted that staff had not completed manual handling and food hygiene training. This was a requirement from the previous inspection. Not all staff completed adult protection training. Each service user has a complaints procedure in their bedroom but the print was small and should be made larger. Two service users stated they did not have keys to the bedrooms and the manager must ensure their care plans and risk assessments justify why keys are not available to service users. The care plans must have detailed information regarding service users likes and dislikes. The expert by experience commented that he thought one of the service users’ bedrooms was in need of some painting. Service users bedrooms must have lockable facilities. The management of medication was in need of improvement. The Medicines Administration Records or MAR sheets they are known must indicate where any surplus medication is being carried over. Service users must not be charged separately for any petrol or parking fees and their individual contracts do not provide a breakdown of fees to be paid and if they have to contribute towards any transport costs. Two service users told the expert by experience there was one person who they did not get on well with because she was always shouting and swearing. The expert by experience was concerned that as the individual concerned is older than the other people and thought she might refer to live in a smaller home with people of a similar age. The manager must ensure that this issue is regularly monitored and reviewed, as this issue will be assessed at the next inspection. 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. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 Service users have information available to them about the service being provided. Service users have a statement of terms and conditions that does not adequately provide a breakdown of the fees being charged by the service. Service users have detailed assessments prior to admission and these are reviewed annually. The service has an admissions criteria that informs prospective service users and professionals who can be admitted to the service. EVIDENCE: There is a statement of purpose and it was found to be satisfactory. There is also a service user guide. Service users do have a contract but those viewed were found to require amending. There was no information to inform service users whether they had to pay for transport costs. There was no information for service users as to a breakdown of the fees to be paid and what were “extras”. There were new admissions to the service since the last inspection but from three service users files sampled there were detailed assessments completed by staff, shortly after the service users were first admitted. These had been reviewed. The service has an admissions criteria including one for emergency admissions. Service users needs were generally met at the time of this inspection. A sample of three care plans confirmed there were detailed records in place that Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 10 informed staff how the needs of each individual were to be met. There was evidence to confirm that good links are maintained with specialist services such as the Primary Care Learning Disability Trust. The service provides the opportunity for service users who participate in alternative therapies such as the use of Tai Chi and Reiki activities to assist in the management of their behaviour and reduce their anxieties so they have greater confidence in integrating in the community. Discussion with two members of staff confirmed they had a good understanding of the needs of the current group of service users, who appeared to be well cared for and dressed in clothing that was appropriate to their age. No comments were received from service users prior to this inspection and those that had been returned were from healthcare professionals and two relatives. One of the relatives stated, “My sister is very happy and appears to be very well cared for and nourished”. Comments received from one service user stated that he liked living in his accommodation and that staff were polite and helpful. Another service user stated that he liked where he was living but did not want to watch hospital soap dramas in the lounge with the other service users. The expert by experience spoke to three service users who stated they were happy with the staff. He asked one service user if there was anybody they lived with and did not get on well. Both replied there was one person, who is often in a bad mood and shouts and swears at people, which upset them. A member of staff said they have noted people’s complaints about this person but cannot do anything about the situation as she lives there too. The expert by experience thought this must be very difficult for people including the person being complained about. He commented that he would not like to live anywhere where he did not get on with the people he lived with, and thought this was unacceptable. How does the person concerned feel? Would she be happier in an alternative home? Maybe a smaller home or with other people similar ages, (as person concerned is in her early 60’s and people here seem quite a bit younger). At the time of this inspection it was observed that the service user concerned appeared to be bickering a great deal with other service users. It is recommended that the manager regularly reviews this individual’s placement to ensure that it continues to meet their needs. Despite these concerns the expert by experience stated, “Generally I felt this home to be of good standard. Residents seemed happy with the home, the respect they have from the staff is good and the opportunity to have alternative therapies available in their own home works well”. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Service users are encouraged to make decisions about their lives through service users meetings. Care plans while detailed require some improvement as to identifying individual service users likes and dislikes with regard to their daily routines. Service users have risk assessments in place concerning any limitations on their independence. EVIDENCE: Each service user has a care plan that covers all aspects of their daily living. Care plans sampled contained detailed information around specific therapeutic interventions to assist with those who have difficulties with their behaviour. A number of service users participate in Tai Chi and Reiki exercises to assist them in reducing their anxieties. Service users preferred form of address was documented. Each service user has a named member of staff who is a key worker and every three months or more frequently, the service user is involved in supervision with the key worker. Here the service user is able to discuss any changes regarding their care plan. There was evidence that service users had signed the care plans during their draft and review. Only one service user stated he knew about his care plan. While it was good to see detailed care plans for the service users there was little in the way of information concerning service users likes and dislikes. Two care plans examined found the likes and dislikes sheets blank. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 12 Risk assessments were in place that covered areas such as managing challenging behaviour, escorting service users in the community and manual handling requirements. Service users are encouraged to be independent and any limitations are recorded on individual risk assessments. There was documented evidence in place for service users to participate in service users meetings that are held every month. One service user told the expert by experience that he liked to discuss with staff in these meetings about which member of staff was on shift. The pre-inspection questionnaire stated that the manager was acting as appointee for one service user and that two handled their own finances. It also stated service users benefits were paid into individual bank accounts. Two service users told the expert by experience that they were saving up their money for their holiday in Tenerife later this year. The expert by experience asked one service user who did the shopping. In response the service user stated staff did the shopping, as it is easier that way. When asked if she would like to be involved in shopping the service user replied no. The expert by experience felt very strongly that people should be encouraged to do as many daily tasks as possible and that people need to realise that going shopping is part of daily living. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 Service users are given opportunities for personal development through the appropriate use of alternative therapies, encouraging integration into the community. Service users with staff support are able to access activities in the community, but the daily recording of how service users spend their leisure time requires improvement. Service users maintain good relationships with staff and have contacts from relatives. There are no unnecessary restrictions affecting service users routines but they should be given the opportunity to have a key to their bedroom. Service users have access to wholesome nutritious meals with a varied menu demonstrating choices available. Service users do not have a choice as to when they wish to go on holiday with other service users or not. EVIDENCE: Each service user has a timetable of activities during the week that includes planned activities such as day services and leisure activities including going out to pubs, restaurants, ten pin bowling, walks at the Lickey Hills and the cinema. A record is maintained of activities participated by service users. One service user stated that he went to college three days a week and he was doing pottery and creative art. Another service user said she went to a social Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 14 services day centre called Sparkbrook Resource Centre and she travelled independently by bus. Another service user attends a social daycentre in Harborne that is also run by Social Services. The expert by experience spoke to three service users about their lifestyles. One service user stated that he was interested in observing people and that he enjoyed doing Tai Chi exercises and gave a demonstration of different moves. The expert by experience then spoke with another service user who stated she worked five days a week and enjoyed earning money. At weekends she enjoyed spending time with her boyfriend who also lives in the home. They have been together for four years. Both of them use public transport and can come and go as they please. They are currently looking forward to their daytrip to Wales. The expert by experience was pleased He enjoys going on buses and visiting airfields. Both service users stated they were very happy. An examination of service users activity sheets found they were involved in domestic tasks such as doing their laundry and tidying their bedrooms. Some of the daily recording of service users activities was found to require some improvement. Some of the entries referred to service users going out on activities such as the cinema but there was no reference as to what film they had seen and whether they enjoyed watching it. The expert by experience spoke to service users about holidays and was told by two service users that all of them were going on holiday to Tenerife later this year. One service user was anxious about the sleeping arrangements and flying. The service user had asked the member of staff who was also a counsellor to do some Reiki exercises which she enjoyed doing as it helped her to relax when faced with situations that made her uneasy. The expert by experience commented that although everyone was looking forward to the holiday he was not sure they were given the option of going with all of the other service users and wonders whether the service users who are in a relationship would like a holiday of their own. Two service users stated they did not have a key to their bedroom door and an examination of their care plans did not state whether this had been offered and why. Service users records confirmed that they are encouraged to maintain contact with their families. Two service users have weekend visits to their parents. The expert by experience commented that there was good communication between one service user and his key worker and the understanding between them was great. He was also pleased that the two service users who are in a relationship had positive support from staff when they were discussing issues such as having children. Menus sampled found that service users had access to nutritious meals and a record was being maintained of what had been eaten. There was a separate menu for one service user who was on a vegetarian diet. Service users were Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 15 observed having tea that was cottage pie, and fresh vegetables while one service user had cheese and potato pie with vegetables. The meal looked well presented and the service users were observed to enjoy it a great deal. The atmosphere was relaxed. The expert by experience commented that with the cooking people share this responsibility and cleaning up which is really good. He was impressed with the way everyone knew what they were having to eat and were looking forward to it which is all very good practice. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 Service users receive support for personal care when they require assistance. Service users are able to access community and specialist primary healthcare services, but service users foot care requirements must be clearly stated. The recording of service users weight is not recorded appropriately. Medication management is in need of improving ensuring the good health of service users is promoted. Work is required to develop individual health action plans in line with the Valuing People White Paper. Service users are consulted regarding their final wishes in the event of their death. EVIDENCE: There is a mixed group of service users living in the service and there is a gender care policy in place. Each service user has a named key worker. At the time of this inspection service users were having a lie in and two service users stated they were able to go bed and get up when they wanted to. It was noted that a requirement from the previous inspection for the development of health action plans in line with the Valuing People white paper had yet to be addressed. A sample of service users daily recording referred to where service users had completed personal care tasks. There was evidence from a sample of service users records they have access to different professionals including a GP, dentist and optician. A number of service users were registered with different GP practices. There was no documented evidence to confirm as to how service users’ foot care was being managed. Good relationships are maintained with specialist services provided by the Primary Care Learning Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 17 Disability Trust. Comments received from three GP’s and a Consultant Psychiatrist expressed overall satisfaction with the care provided to service users at Morris House. Comments received from a Community Nurse stated, “The care staff at Morris House are very professional in their approach and have carried out any requests given and their interaction towards service users is appropriate”. Three files sampled found that one service user’s weight was being recorded every month. However, the other two had documentation headed with the year 2001 although staff stated that the records were current that the year on the heading had not been changed. Nevertheless care must be taken in ensuring there are clear up to date records for service users weight. Manual handling assessments were in place and these were due for review. The management of medication was found to be of a good standard. However, there were still a number of areas that the service had still not addressed since the last inspection. The Medicines Administration Records or MAR sheets were generally recorded appropriately. There were a number of gaps where medication had been administered but not signed for. One service user’s medication records examined found that staff had not booked in boxed medication received. There was also evidence that the number of tablets left in both boxes, including one for paracetamol sampled had not been carried over from the previous MAR chart cycle. This issue was also raised during a recent visit from the service’s supplying pharmacist. It was of concern to note that medication being booked in by staff is only undertaken by one non senior member of staff and the manager must ensure that medication received and booked in prior to dispensing is double checked by a senior staff member. The returns book was examined and this was found to be recorded satisfactorily. Written protocols were place for the use of PRN medication. The manager had taken to ensure that each service user had written agreements signed by their GP’s for the use of homely remedies medication. A member of staff was able to demonstrate her understanding around important issues for service users who are in their final days and what kind of support would be needed. The staff member stated that one service user had details of her funeral arrangements and when sampling service user’s record there were details of the hymns they wanted to have sung at their funeral. Morris House does not provide any nursing care. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Service users have access to a complaints procedure that informs them of the CSCI, but this must be available in a large print format. Service users feel staff listen to their concerns. Most staff have received appropriate training in the protection of vulnerable service users backed up by appropriate policies and procedure. Service users personal allowances need to be managed in a way that protects the interests of service users. EVIDENCE: Neither the CSCI nor the service has received any complaints since the last inspection. There is a complaints procedure, which the manager stated service users are able to understand with the support of staff to read through it. However, previous inspections required this to be available in an accessible format. One copy of the procedure viewed in one service user’s bedroom was found to have small print. One service user was asked by the expert by experience what he would do if he was unhappy about anything. The service user replied he would be able to raise any concerns with the manager who was very efficient at sorting things out. The expert was very pleased to hear that the service user was confident in speaking up for himself, when he is not happy about a situation. There was a picture of the inspector on the notice board and details about the CSCI in the hallway. Two staff interviewed provided satisfactory responses to questions with regard to protecting service users from abuse and how they would deal with any complaints and challenge poor practice. Most but not all staff had completed training in adult protection. There is an adult protection procedure in place along with an up to date copy of the Multi Agency Guidelines published by Birmingham Social Care & Health. There is a procedure for physical Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 19 intervention but a requirement for this to be amended to include contacting the CSCI where emergency restraint has been used; had not been addressed. Service users personal allowances were examined during this inspection and there were a number of matters regarding certain items of expenditure. It was noted that some entries referred to service users being charged for petrol and car parking charges. The statement of terms and conditions for the service does not make any references to charges towards transport costs. They should not be made to pay for parking tickets and petrol unless the costs are set against service users receiving DLA Mobility Component. A separate record for expenditure from service users DLA Mobility Component must be set up. It was also noted that one service user was charged for a duvet and another was charged for a waterproof mattress cover. One of the service user’s financial records examined did not have two signatures for all transactions. Each service user was found to have their own building society account. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29, 30 Service users live in a clean and homely property that is maintained to an acceptable standard with some minor improvements required. Service users bedrooms do not have lockable facilities and one is in need of renewed paintwork. There is adequate shared space that is available and comfortable for service users. Service users bathing and toilet facilities provide privacy but an assessment is required to ensure the bathroom on the first floor is suitably equipped for service users with mobility difficulties. EVIDENCE: A tour of the premises was undertaken at the time of inspection. The premises were generally clean tidy and smelled fresh. The expert by experience commented that he thought the building was clean and tidy. At the time of this inspection the ground floor bathroom was being re-furbished. The manager stated this was to make it more accessible and the lighting brighter. It was also stated that the kitchen would soon be re-fitted with new equipment including a new cooker that would provide service users wider opportunities to be involved in meal preparation. There is a comfortable lounge with a conservatory area that is used as a dining room. The garden was well maintained with a summerhouse. A bathroom is Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 21 located on the first floor with a separate shower cubicle. It was noted that the extractor fans in the bathroom and shower cubicle were in need of cleaning. The light fitting in the bathroom was broken and the non slip mat used in the shower was also in need of cleaning. There is a call alarm point in the bathroom and shower. It was noted that the bathroom did not have any rails to assist service users with mobility difficulties, as is the case for one service user. Two service users bedrooms were viewed at the time of this inspection. These had en-suite facilities consisting of a toilet and wash hand basin. One of the bedrooms viewed was found to require some re-decoration particularly on the doorframes and wardrobes. The expert by experience also commented that the bedroom was in need of re-decorating. It was noted the bedrooms did not have any lockable facilities for service users to store any valuables. Two service users stated they liked their bedrooms and had their own equipment including a TV, Video & DVD player. One service user had a Playstation console and games and a call alarm point. There is a separate laundry facility with a washing machine and tumble dryer. The manager stated there were no service users who had concerns around continence. There are appropriate facilities in place for the removal of clinical waste. The light pull cords in the shower and bathroom were found to be dirty and in need of replacing. There was no liquid soap dispenser in the upstairs bathroom. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 Service users are supported by staff who are competent and qualified to meet their needs as set out in their respective job descriptions. Current staffing levels meet the needs of service users providing adequate cover throughout the day with night wake and sleep in staff. The staff rota does not state the hours worked by staff and the manager. Staff recruitment records meet the requirements of the regulations ensuring protection for the service users. Service users do not have the opportunity to participate in the recruitment of staff. Staff have still not completed manual handling and up to date food hygiene training. Staff receive frequent supervision as part of their duties and development. EVIDENCE: Staff demonstrated an understanding around the needs of the current group of service users and provided positive and friendly interactions. One member of staff observed to praise one service user how nice she looked with her new hairstyle. During interviews with two members of staff one stated she was undertaking training towards The Learning Disability Award Framework and NVQ Level 2. Another member of staff who was the Team Leader stated he had NVQ Level 3 and evidence was seen of his certificate of qualification. The pre inspection questionnaire stated that out of a total of seven care staff 6 are qualified to NVQ Level 2 and above. The manager stated that two new staff had commenced training towards the Learning Disability Award Framework or Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 23 LDAF, as it is known. However, there was no documented evidence on staff training records to confirm this. An examination of staff rota found that apart from the manager there were three care staff on duty during the day with one providing sleep in duties. The shifts covered are from 08:00 hours - 20:00 hours. There is one night waking staff on duty. The staff rota needs to state the actual shifts covered by staff and the hours worked by the manager. The staff rota states there is one bank member of staff. Two members of staff had left since the last inspection and the posts had been recruited to. The expert by experience spoke to three service users who stated that they were happy with the staff and each one had a key worker. One service user commented she liked her key worker, but is often working at night and feels she is not receiving the same opportunity as with the other service users for support during the day. The other service users she stated get to go shopping with their key worker so why can’t she. The expert by experience feels very strongly that this service user should get consistent key worker support during the day. The expert by experience asked the same service user how new staff were employed. The service user stated that new staff are introduced to the service users during a residents meeting. The expert by experience feels very strongly that the service users should be involved in the interviews of new staff that will work in their home and not just meeting them in a residents meeting after they have got the job. The service user stated that she would like to be involved in the recruitment process of new staff. Three staff files were sampled and there was a job description, application form, interview assessment, CRB checks, two references, proof of ID, personal details, medical questionnaire and staff risk assessments. It was noted that none of the files sampled had statement of terms and conditions. A record of staff training was found and it was noted that staff had received training in areas such as first aid, fire safety, and safe handling of medicines. However, a requirement from the previous inspection for staff to have manual handling training and updated food hygiene training had not been addressed. The manager must be mindful that mandatory training topics must be updated every six months. The pre-inspection questionnaire stated that staff had completed Monitored Dosage System Training with Boots and dementia awareness but there was no documented evidence to confirm that dementia awareness training had taken place. It also stated future training was to include autism and ‘Aspergers’ Syndrome along with managing challenging behaviour but there were no dates set for these topics. The training record viewed also indicated that not all staff had received training in adult protection. Further sampling of staff records found that staff were receiving supervision every two months and there was evidence of induction records. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41, 42 There is a friendly atmosphere that service users are comfortable with. Records being maintained were generally up to date and held in locked facility for the protection of service users. A quality assurance system must be in full operation, in order service users, staff and relatives have confidence that their views will be included in the future development of the service. The health and safety of service users is maintained and promoted but some improvements are required. EVIDENCE: The manager was only present for part of this inspection as she had been hospitalised since the previous week and was not well enough to continue. She had addressed a number of requirements from the previous inspection and was keen to improve practice. The team leader and senior carer who were on duty were able to demonstrate their knowledge of the service users in their care. Staff described the manager as being supportive and a good listener to both staff and service users and that there was a good working relationship. The atmosphere overall was friendly and relaxed. The expert by experience thought Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 25 that staff and service users were very welcoming and offered him and his supporter drinks. He described the home as warm and friendly, like a persons home. Staff meetings do occur but not on a monthly basis. A representative visits from the organisation on a monthly basis and reports for these visits recording service users’ and staff views. The manager has partly addressed a requirement from the previous inspection for the implementation of a quality assurance audit. She provided some examples of satisfaction questionnaires for service users, relatives and professionals. These need to be available for staff and discussion followed with fine tuning the questions being used. A business plan was not available for inspection but an up to date Employers’ Public Liability insurance certificate was on display in the premises. Records being maintained were generally up to date and locked in a secure cupboard in the office. There service has a range of policies and procedures but many of these had not been signed and reviewed and action is needed to ensure the policies and procedures are still relevant to current practice and law. Health and safety records were examined and it was noted that there was record of hot water temperatures being completed every month. However, there was no documentation to confirm that water system had been treated for the prevention of Legionella. There were also daily temperatures in place for refrigerators and freezers. There was evidence of a fire drill completed prior to this inspection. There were names of service users and staff involved in the evacuation. It was noted that staff were due for an update in fire training the last one occurring in April this year. The fire alarms were being tested every week but it was noted that the emergency lighting was not being tested every month and this had not been picked up by the representative of the organisation during their monthly visits to the service. The accident book was examined but it was not clear how many accidents had occurred since the last inspection, as the counterfoil strips on the accident book did not have any dates. There was one incident that had not been notified to the CSCI under Regulation 37. This was when a service user had been left alone on the premises and was only discovered when a representative from the organisation was visiting the service. Staff on duty stated that the service user had hidden himself in his wardrobe and they assumed he had gone out, as he is very independent. As previously mentioned staff had yet to complete updated training in manual handling and food hygiene a requirement from the previous inspection. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 26 Since the last inspection the organisation has new vehicles, which the service users were very pleased with. An examination of the documentation found there was an up to date MOT certificate and copies of staff driving licences. However, there was no date to confirm when these had last been checked which should be undertaken annually. There was no evidence of an up to date insurance certificate. Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 2 4 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Morris House Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 3 2 x E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 28 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 5 Regulation 5(2)(b) Requirement The Registered Person must ensure that all service users have up to date statements of terms and conditions that also includes whether service users are to contribute the DLA Mobility Component for transport costs. It must also provide a breakdown of their fees. The Registered Person must ensure service users care plans clearly state service users likes, dislikes and daily routines. The Registered Person must ensure service users records demonstrate where service users have been encouraged to participate in activities such as shopping. The Registered Person must ensure daily recording clearly refer to how service users spend their leisure time. The Registered Person must ensure service users are given the opportunity to choose when or when not to go on future holidays as a group. The Registered Person must ensure service users are given the opportunity to have a key to Timescale for action 05 December 2005 2. 6 15(1) 05 December 2005 05 December 2005 3. 7 12(3) 4. 14 12(3) 05 November 2005 05 December 2005 05 December 2005 Page 29 5. 14 12(3) 16(2)(m) (n) 12(3) 6. 16 Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 7. 20 13(2) 8. 23 13(6) 9. 26 16(2)(c) 10. 35 &23 18(1)(c) 11. 39 24(1)(a) (b) 12. 40 17(3) 13. 14. 42 42 13(4) 23(4)(c) (v) 13(4) 23(4)(d) their bedroom. Any reasons why this cannot be provided must be documented on service users care plans and subject to any risk assessments. The Registered Person must ensure that all medicines administered to service users record quantities received and balances carried over. The Registered Person must ensure that the procedure for physical intervention is amended to state that when restraint is used in an emergency the CSCI is notified without delay. Outstanding Requirement. Timescale 18 June 2005 not met. The Registered Person must ensure service users are provided with lockable facilities in their bedrooms. The Registered Person must ensure all staff receive training in food hygiene, manual handling and adult protection. Outstanding Requirement. Timescale 18 July 2005 not met. The Registered Person must ensure its Quality Assurance format is fully implemented by the beginning of the next inspection year. Anonymous satisfaction surveys must be made available to staff. The Registered Person must ensure the organisations policies and procedures are reviewed, signed and dated so they reflect current practices and legislative changes. The Registered Person must ensure the emergency lighting is tested every month. The Registered Person must ensure staff receive up to date fire awareness training. 05 Novemeber 2005 05 Novemeber 2005 05 January 2006 05 December 2005 05 April 2006 05 January 2006 05 Novemeber 2005 05 December 2005 Page 30 Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 15. 42 13(4) 16. 42 13(4) 37(1)(e) 17. 18. 42 42 13(4) 13(4) 19. 22 22(1) The Registered Person must ensure evidence is provided that the water tanks have been tested for the prevention of Legionella. The Registered Person must ensure that any incident affecting the welfare of service users is reported to CSCI without delay. The Registered Person must ensure staff driving licences are updated every year. The Registered Person must ensure there are updated motor insurance certificates for the new vehicles. The Registered Person must ensure that the complaints procedure in service users bedrooms is available in large print format. 05 December 2005 06 October 2005 05 December 2005 05 December 2005 05 December 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 18 Good Practice Recommendations It is recommended that the Registered Person undertakes regular reviews of the older service user to ensure the placement still meets their needs. It is recommended that the Registered Person in line with the Valuing People White Paper, introduces Health Action Plans for service users. Outstanding Recommendation brought forward from 29 September 2004 & 15 May 2005 Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 Page 31 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morris House E54 S16892 Morris House V246397 051005 Stage 4.doc Version 1.40 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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