Inspection on 01/11/07 for Morton Close

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Morton Close 22/08/09

Morton Close 16/10/08

Morton Close 17/12/06

Morton Close 27/06/06

Morton Close 09/02/06

Morton Close 22/11/05

Morton Close 31/08/05

Morton Close 07/10/04

Morton Close 05/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Morton Close Morton Lane East Morton Keighley BD20 5RP Lead Inspector Nadia Jejna Key Unannounced Inspection 10:30a 1st November 2007 X10015.doc Version 1.40 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 Morton Close DS0000029204.V342581.R03.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 Older People. 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. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton Close Address Morton Lane East Morton Keighley BD20 5RP 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) 01274 565955 01274 510392 Barleyglow Limited c/o ADL plc vacant post Care Home 40 Category(ies) of Physical disability over 65 years of age (40) registration, with number of places Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th December 2006 Brief Description of the Service: Morton Close Care Home is a large detached property set in substantial grounds. The home is situated in the Cross Flats area of Bingley, approximately two miles from the town centre. The home is registered to provide personal care only for up to 40 service users with physical disabilities over the age of 65 years. Accommodation is on three floors with single and some double rooms available; two communal lounges and dining room are situated on the top floor. There is level access into the home and one passenger lift. There are mature garden areas around the home. Information about the services provided by the home and the organisation that owns the home is available on request and kept in a file in the main entrance of the home. Information specific to the home has been added to this and the manager is updating the Statement of Purpose and Service User Guide. Weekly charges for care and accommodation vary from £365 to £400 per week. This information was provided in November 2007. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first visit was made on 1st November 2007. The manager did not know that this was going to happen. The visit was completed on 6th November 2007 and feedback was given to the manager during and at the end of the visit. The purpose of this visit was to make sure that the home was being managed for the benefit and well being of the people using the service. People living in the home, their visitors and staff were spoken to. Records were looked at such as staff files, complaints and accidents records. Before the visit was planned the provider was asked to carry out a quality assessment of the service stating what they did well, what was in place to prove this, what improvements had been made over the last twelve months and what was planned for the year ahead. This document is called the Annual Quality Assurance Assessment and will be referred to in the report as the AQAA. Other information asked for included what policies and procedures are in place, when they were last reviewed and when maintenance and safety checks were carried out. The AQAA had not been completed well. The last CSCI report had been used as evidence rather than looking at what improvements had been made since the last inspection, what the home was doing well and what plans they have in place to make changes and improvments. Statements referring to the CSCI report suggest that it was used as part of their quality monitoring tool rather than putting their own systems in place to monitor and audit the quality of services provided in the home. Questionnaires were sent to people living in the home, their relatives and healthcare professionals before the visit took place. These people were selected using information provided in the AQAA. When the visit took place surveys had been returned by four people who live in the home, four relatives/visitors, one care manager and two healthcare professionals and one member of staff. The information from these was used to inform the visit and is referred to throughout the report. What the service does well: Care and support is provided to people in a clean and tidy home. People said that their rooms are always clean and that they can bring in their own belongings to personalise the rooms, making them ‘theirs’. Information from people said that: • They had received enough information about the home, either verbally or written. • Contracts for services provided were in place. • People’s needs were usually met. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 6 • One said that ‘the staff were communicative and helpful.’ • The staff were nice. • People were generally satisfied with the home and services provided. • One person said ‘the staff have helped my relative to adjust to living in a care home and to stay as independent as possible which they were very happy about’. • One person said ‘The staff are marvellous and I cannot fault what they do.’ • Visitors can call at any time and are made to feel welcome. • People said that they enjoyed the meals. What has improved since the last inspection? What they could do better: The provider has not met all the dates given in their improvement plan dated March 2007. There are still many areas where improvements need to be made to make the experience of living in the home better for people. These are: • The information from pre admission assessments should be used to make sure the individuals needs can be met by the skill mix of staff working in the home and that their needs are included in the home’s conditions of registration with CSCI. • Making sure that there are enough trained, skilled and competent staff on duty at all times so that peoples needs will be met. • Making sure that safe practices are followed when helping people with their medication to reduce the risk of mistakes being made. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 7 • Making sure that people and their representatives are involved with the care planning process. The care plans could be more individual and detailed about the person and give staff enough guidance about their needs and how to help them. • The provider could look at making sure the home has a support worker as stated in the Statement of Purpose and improvement plan dated March 2007. This will help to make sure that people’s social, leisure, emotional and spiritual needs are identified and appropriate activities provided to meet them. • The problems with the heating must be dealt with so that people can be sure they will be kept warm by a reliable, safe central heating system. Requirements and recommendations of good practice have been made and can be found at the end of this report. The organisation has been asked to provide an improvement plan to the CSCI. This will tell us how and when they will make the changes that will make the services provided by the home better for people living there. 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. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have access to information about services provided by the organisation but it would be better if it was more specific to the home. People’s needs are assessed and identified before they move into the home but the information is not always used to make sure that the knowledge and skill mix of the staff team can meet them. EVIDENCE: There is an information file about services provided by the home in the main entrance. There were three different documents in use as the Statement of Purpose and Service User Guide. They did not contain all the information a person would need to have to help them decide if the home would be suitable for them or not. It was not clear if they were about the home or about the organisation. Additional information was needed about the services provided Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 10 and the admission process. The manager said she would review them to make sure that they had all the information a person need and were reader friendly. The completed pre admission assessments do provide enough information about a person’s needs for the manager to decide if they can be met by the home. But they are not always being used to identify when the home cannot meet their needs. The pre admission assessment for somebody who had recently been admitted showed that their main reason for needing residential care is because they have dementia. The home is registered to provide care to people over the age of 65 with physical disabilities. The manager was told that this must be looked at and an application made to vary the conditions of registration so that they truly reflect the needs of people that can be met by the home. If the home wants to include people with dementia appropriate training must be provided to make sure that staff understand their needs and how to meet them. Information from people said that: • They had received enough information about the home, either verbally or in writing. • Contracts were in place. • People’s needs were usually met. • One said that ‘the staff were communicative and helpful.’ Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made around identifying and meeting people’s needs. But practices around dealing with medication are not always safe and could put people at risk of errors being made. EVIDENCE: The manager has given staff some guidance about care planning, but the last time she had any training on this subject was some time ago. She agreed to access more training on this topic. Four care plans were looked at. These have improved since the last inspection and it is clear a lot of work has gone into making sure all people living in the home have got care plans that provide staff with guidance about how to meet their needs. There is still work to do to make sure they are detailed and individual to the person. The documents used have been provided by the organisation and are pre printed. They are based on ‘activities of daily living’ and for an identified area of need there is a tick box list for possible problems and again for action to be followed. This prevents the plans from being Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 12 individual and person centred. For example the plans about eating and drinking for people at risk of losing weight did not: • Say what the outcome of the nutritional risk assessment was. • What the person’s admission weight was. • What their dietary likes, dislikes and preferences were. • How their meals would be enriched to help them gain weight. • Whether or not their food and fluid intake was going to be monitored. The plans for two people with dementia said nothing about how it affected them and what staff could do to help them. The plans did not show that the person and or their relatives/representatives had been involved. The pre printed care plan titled ‘Breathing’ had a tick box for leaving the bedroom door open to make observing the person when in their room easier. This affects the person’s privacy and there was nothing to say if the person had been asked about this and consented to it. The care plans looked at showed that appropriate healthcare assessments were being carried out around the risks of: • Developing pressure sores • Losing weight • Falling • Moving and handling needs. The links between the outcomes of these assessments and the care plans were not always made when a risk was identified. In one case where somebody was losing weight the GP had been contacted about a referral to the dietician; this had been recorded in the care plan evaluation section but the guidance in the care plan itself had not been altered. The care plan for a person at risk of falling did not say how this was going to be managed apart from the use of bedrails when they were in bed. The manager has tried to contact the falls prevention team without success and worked with the district nurses instead. She will try again and will also try to get some training around falls prevention for staff. Information from healthcare professionals said that: • People’s health care needs were identified and advice/support was asked for when needed. • Staff acted on advice given to them. • People’s privacy and dignity was respected. The care plan for somebody with a pressure sore showed that the district nurses were looking after the wound and supplied specialist pressure relieving equipment. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 13 Information from surveys and talking to people and visitors during the visit said that: • The staff were nice. • People were generally satisfied with the home and services provided. • People on the ground floor felt a bit isolated when they were in their rooms as staff would then be on the third floor where the lounges and dining room are. But they did say that they didn’t wait long for ‘buzzers’ to be answered – if they were left somewhere where they could reach them. • There have been improvements since the new manager started – but when she wasn’t on duty some staff ‘did their own thing’ and it wasn’t as well organised. On the day of the visit a senior carer had been giving people their morning medication. They were in the dining room with the trolley and had a pot of tablets ready to take to somebody. The medication administration records were nowhere to be seen. When asked how many people still needed their morning tablets, they replied ‘nobody, just doing the last one’ and confirmed they had done all of them without the charts because they could not find them. This is not safe practice and puts people at risk of errors being made. The manager said that this was not the way medications were usually dealt with and that appropriate action would be taken. She said all staff who dealt with medications had received certificated training and knew what the proper and safe procedures were. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People exercise choice and control over their lives and maintain contact with family and friends. They are happy with the meals provided. Increasing the provision of social and leisure activities would make peoples experience of life in the home better. EVIDENCE: There have been ongoing issues in the home about poor provision of social and leisure activities for people and about meals. In the improvement plan dated March 2007 the operations manager said that: • They would make sure an appropriate programme of activities was planned. • The ‘support worker’ will speak to residents to determine their likes and dislikes. This information will be used to plan activities according to their needs. • The support worker will receive training around activities for the elderly. • Menu choices are to be reviewed and discussed with residents. • Resident’s pureed meals will be served appropriately – in separate parts. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 15 The Statement of Purpose says that the home has a support worker to ‘work with people to meet their social, recreational, emotional and spiritual needs’. During the visit I found that the home does not have a ‘support worker’ to talk people about what they would like to do or plan and ‘do’ activity sessions. There is a weekly plan of activity sessions for each afternoon that individual members of staff are allocated to do. But this relies on staff being free to do it. It did happen on the day of the visit but people said this was not a regular occurrence; it was dependant on how busy staff were and sometimes who was on duty, as not all staff were as keen as others to provide recreational and social stimulation. A notice board in the main entrance showed that: • People were planning a trip out to a famous fish and chip restaurant, • There was going to be a seasonal fayre to raise funds, • External entertainers are brought in at regular intervals. • A musical show is going to be held at the beginning of December. • The next in house worship session was planned for mid November. The care plans looked at contained very little information about people’s life and social histories and how they used to spend their time and what they would like to do. The manager said that this information is kept in the ‘lifestyle’ plans that are separate from the care plan. After talking about this ‘separation’ of care from social care the manager said she would look at putting these together so that the plans provide a picture of the ‘whole person’. Not everybody has one of these ‘lifestyle’ plans yet because there is no support worker to do them. Care staff are doing them when they have the time. New menus have produced by the organisation. The manager said that advice from a dietician was asked for when they were being done. It provides choices at all mealtimes and is being used in the home. The manager said that it would be talked about at the next residents meeting to see if people want to change or add to it. Lunch was served just after midday. Most people had it in the dining room but some chose to stay in their own rooms. The tables were nicely set and people were asked which of the two choices they wanted for their main course. The meals looked appetising and were nicely served. People who needed help to eat were given it in a respectful way. Some people needed soft/pureed meals and they were served in their separate parts so people would get the different tastes of the food. The kitchens were clean, tidy, well organised and well stocked. A new cook started in June 2007. She has done some training in the past but not around nutrition for the frail elderly and enriching meals; this would be helpful to her. She holds a current food hygiene certificate. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 16 Information from surveys and people said that: • They liked the meals. • The home could look at changing the mealtimes. Some people have their breakfast at 9.30 am and then lunch is served at 12 midday and they are not always hungry then. But next meal at teatime is a light one and people can be hungry. – This was talked about with the manager and the home could look at more flexibility about how meals are served to people and when. • Sometimes there was enough to do but not always. • Sometimes staff did not ‘mingle with residents enough, appear when visitors arrive’. • More social activities and stimulation would be appreciated. • One person said ‘the staff have helped my relative to adjust to living in a care home and to stay as independent as possible which they were very happy about’. • One person said ‘The staff are marvellous and I cannot fault what they do.’ • Visitors can call at any time and are made to feel welcome. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know who to speak to if they are unhappy and now feel confident that their concerns will be listened to and acted upon. EVIDENCE: The provider’s improvement plan March 2007 said that: • A complaints file will be kept in the home. • Training in adult protection to be arranged for all staff Information provided in the AQAA said that there have thirteen complaints over the last twelve months and seven of these were substantiated; three of these were referred to the provider by CSCI. Two further complaints have been investigated since then. Records of complaints received and looked into have been kept since February 2007. The manager is now investigating and responding to them. She has received training in previous employment about dealing with complaints. The complaints have been about poor standards of personal care, items going missing, heating and plumbing and poor staffing levels. One of the complaints was about whether or not staff escorted to people to hospital. They had contacted head office who said it was company policy to send an escort but their relative had been to hospital appointments alone on two occasions. The manager said that at times there were not enough staff on duty to send Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 18 escorts with people. The home’s policy about staff escorts is something that should be made clear to people and could be included in the Statement of Purpose. Many of the complaints were made before the manager was employed and now they are not being received as regularly as they were. The complaints records used summarise action taken, lessons learned and if any preventative action was needed. This has not been followed in all cases. One incident identified that staff needed training about how to deal with challenging behaviour in July 2007 but it still has not been provided. Information from surveys and talking to people and visitors said that: • They knew who to talk to if they were unhappy. • They knew how to make a complaint if they needed to. • In most cases, if they had raised a concern, the responses had been appropriate. Some people said this was better since the new manager started. • One person said that they had told staff about concerns in the past but they had not always ‘been filtered up’ to the management. • One person felt that their concern about an item that had gone missing had not been taken seriously because they did not know exactly when it had gone missing. This information was given to the manager and she said action would be taken where appropriate. Most staff had received training around adult protection from the organisation’s trainer who has completed a ‘train the trainer’ course. Staff said that they would report suspected or actual abuse to the person in charge or the manager. The manager has done abuse and adult protection training before but not with the local authority she now works with. She said she would look at doing the local authority adult protection unit two-day managers course. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean and tidy home but there are areas for improvement, especially around making sure that the heating systems are safe and work efficiently. EVIDENCE: The provider’s improvement plan from March 2007 said that: • They would make sure the home is well maintained and safe. • A handyman would be employed and regular maintenance checks carried out. • A portakabin would be used to provide storage space to free up space in the home. A handyman has been employed and does regular safety checks of some equipment in the home as well as minor repairs and decorating. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 20 A portakabin has not been provided yet. But the manager said that a lot of surplus and damaged equipment has been returned or disposed of that has ‘freed’ up space in the home. The last visit by the fire safety officer was in March 2007 and the provider agreed to make sure all required work was done over the next six months. In May 2007 information was received that staff have been turning the heating off because they were too hot and they did not think that radiators in rooms could be individually controlled. The manager said that there was a problem with the heating system in that the top floor was much warmer than the ground floor. An engineer checked the system in April 2007 who said that repairs and parts were needed. This work has not been done yet and the heating system is still not working properly and the CORGI safety certificate has not been issued. The manager said that quotes for the parts had been received and had to be sent to head office for approval. I spoke to the operations manager when she rang the home and told her that this needed to be dealt with as a priority and to tell me when the work had been done. The kitchenette in the dining room is due to be refurbished and the hot water boiler and dishwasher are out of order. At mealtimes staff said most of the washing up goes down to the kitchen and they get hot water for drinks from there. Sometimes staff were seen washing up by hand and boiling kettles of water to make drinks for people. This is unchanged from the last inspection in December 2006. The nurse call system is one that can be silenced at certain points. A carer silenced it without going to the person who had used it and told me it would come back on as it had to be properly turned off at the activation point. The manager said that an infection control policy was in place and that she would look at the Department of Health guidance ‘infection control for care homes’. The home was clean and tidy and there were no smells. Information from surveys and talking to people in the home said that: • The home was always fresh and clean. • They could bring their own things in to personalise their rooms and make them more homely and ‘theirs’. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not enough appropriately trained staff on duty to adequately meet the needs of people living in the home. The recruitment procedures are not robust and do not protect people. EVIDENCE: The provider’s improvement plan March 2007 said that they would: • Review staffing taking into account the resident numbers and their dependency. • Make sure care staff do not do catering duties. • Review routines in the home and alter them accordingly. • Provide staff training according to the needs of the home, the company trainer will be responsible. It was found that the staffing levels had not been changed. There were twentyfour people living in the home on the day of the visit. There were four care staff on duty in the morning, including the manager. The manager said that in the afternoon/evenings there were three staff and at night two. Staff rotas confirmed that this was the case Monday to Friday. At weekends there still only three staff on duty all through the day, despite the fact there are still the same number of people with the same levels of need. Staff are still responsible for catering duties at teatime as the cook finishes at 2pm. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 22 Information from surveys and people said that sometimes there were not enough staff available and people had to wait for staff to attend to them, especially at weekends. People said that the staff were very caring. The manager is aware that there are large gaps in the training provided to staff even though there has been a lot provided since July 2007. She has identified who needs to do what and requests will be made to head office for it to be provided. Staff have not had fire safety training since October 2006 even though the organisation has somebody qualified to provide this specialist training. Many people in the home have some from of dementia and some staff have attended a dementia awareness course, all staff need this training as well some in dealing with challenging behaviour. One of the returned surveys said that ‘the home seemed to be getting more people with Alzheimer’s and not sure if staff are fully trained to look after these people.’ Eight staff have achieved National Vocational Qualification level 2 or higher and more staff are working towards it. Three staff files were looked at. All three people were employed after July 2007. These showed that one person had been employed before their second reference was received. Two people had gaps in their employment history that had not been explored. And the third person had started working in the home before their Criminal Records Bureau disclosure had been received. The files did not show that safe recruitment procedures were being followed. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The leadership and management arrangements in place have led to improvements being made, but there is still a lot of work to do to continue improving outcomes for people living in the home. EVIDENCE: The provider’s improvement plan from March 2007 said that: • The operations manager would to write to CSCI in April 2007 about the management arrangements. • The results of last quality assurance survey would be displayed on the notice board. • No monies are kept by the home for residents. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 24 • • Lockable facilities will be provided for those residents who wish to have them. Staff providing staff supervision will have training. A new manager was appointed and started at the home in June 2007. She is an experienced social care manager and has completed the registered managers award and National Vocational Qualification in care at level 4. She has not yet applied to be registered with the CSCI. People said that they had seen improvements in the way the home is being run and managed since she started and there have been fewer complaints about standards of care. The manager has altered working routines, which has caused some conflict with staff who are resistant to change. At the last staff meeting they talked about: • The different working routines that should make outcomes better for people and staff, • All staff being involved with writing the care plans • Plans for a training programme. Information from staff said that: • The manager was approachable and supportive, • They had seen changes for the better and things seemed to be more organised. • There was more teamwork but they knew there were some who were resistant to changes and wanted to do things ‘their way’. A quality assurance survey was carried out by the home in August 2007 to see if there were any areas of concern that could be dealt with straight away. The information received has not been collated or made available to people. The responses told the manager that people thought there not enough staff, not enough to do and concerns about the heating. She has done what she can to increase activities. But she cannot alter staffing levels and or authorise repairs to the heating system, these issues have to be dealt with by head office. The manager said she would be doing another survey before the end of the year. She will make sure that the information from it is collated, an action plan put in place – if needed – and the outcome made available to people in a way that can be easily understood. Last years survey results have been produced in a graph that older people might not understand. The organisation’s survey document is in small print and might not be the easiest document for older people to fill in. The manager said she would look at producing a ‘user friendly’ survey. The manager said that the home does not act as appointee for any residents and do not look after money for people. If people want lockable facilities in their room they can be provided on request. Part of the admission process for Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 25 new people to the home includes asking them if they want this and a dated, signed record is kept of the decision made. The AQAA said that all safety and maintenance checks apart from the gas and heating were up to date. The issues with the heating systems have been discussed in the section about the environment. Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 3 1 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14(1) Requirement The provider must be able to demonstrate that the home can meet the needs of the residents living in the home. This must include: • Looking at the homes conditions of registration and making an application for a variation in registration if needed. • Making sure there are enough appropriately trained, competent staff on duty to meet peoples needs. • Making sure that information from the pre admission assessment is used when deciding if the home will be able to meet the person’s needs. Previous timescales of 08/09/06, 11/12/06 and 31/03/07 not met. The care plans must be detailed and individual to the needs of the person, providing staff with clear guidance about how they can meet the person’s needs. The individual and/or their relatives must be involved with this process. DS0000029204.V342581.R03.S.doc Timescale for action 31/01/08 2. OP7 15 31/03/08 Morton Close Version 5.2 Page 28 3. OP8 13(1)(b) (4)(c) 4. OP9 13(2) The care plans must show clearly 31/01/08 what action has been taken to reduce risk where one has been identified through the specialist healthcare assessments and that appropriate specialist advice has been asked for, especially with regard to the risk for falling. This will help to make sure that peoples specialist healthcare needs are identified and met. Medication practices must be 05/12/07 urgently reviewed in order to make sure that practices are safe and people receive their medication as prescribed by their doctors. As discussed with the manager during feedback. Timescale of 22/11/05, 11/12/06 and 30/03/07 not met. The provider must make sure the 30/11/07 home is well maintained and safe. This must include making sure that: • The problems with the central heating system are dealt with so that people are kept warm safely. • The home has an up to date fire safety risk assessment. As discussed with the manager during feedback. The provider must make sure 31/12/07 that there are adequate numbers of suitably qualified and competent staff on duty at all times to meet peoples needs. Care staff must not be taken away from caring duties to carry out domestic tasks. There must be sufficient ancillary staff on duty at key times for example, for all meal times. Previous timescales of 06/01/06, 5. OP20 OP25 OP38 23 6. OP27 18(1) Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 29 7. OP29 19 8. OP30 18 11/12/06 and 31/03/07 have not been met. The manager must make sure 30/11/07 that recruitment procedures are safe and protect people living in the home. Employment must not be offered to people before the required pre employment checks have been received. This must include exploring the reasons for gaps in employment. As discussed with the manager during feedback. The provider must make sure 31/03/08 there that training programme provided to staff makes sure that they all have the necessary skills to care for and meet peoples health, personal, social and specialist care needs. Particular attention must be paid to making sure fire safety training is given to all staff. Previous timescales of 08/09/06, 11/12/06 and 30/04/07 not met. The manager must make 31/12/07 application to become registered with the CSCI. This will help people to be sure that the home is being managed by someone who is qualified and competent to do so. The results of the quality 31/01/08 assurance surveys should be collated and made available to all interested parties so that they can be reassured their views are being taken seriously. The provider must produce an 31/01/08 improvement plan setting out the methods and timetable of how they intend to improve the services provided at the home. 9. OP31 9 10. OP33 24 11. OP33 24(a) Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The provider should make sure that the information in the Statement of Purpose and Service User Guide is relevant to the home and the services it provides. The documents should be reader friendly. If care plans are in place for people’s bedroom doors to be left open they should show that the individual has been involved and agreed for this to happen. The manager should continue to consult and involve people living in the home and their relatives about their social interests and make arrangements to increase provision of activities in the home as well as helping people to engage in local, social and community activities. To make sure that all staff are aware of adult protection policies and procedures and the different forms of abuse the manager should make sure appropriate training is given to staff who have not had it yet. To help with this the manager should attend the local authority adult protection unit training course for managers. The provider should review the call bell system to make sure that it can only be cancelled at source. The provider should make sure there is sufficient storage space available. 2. 3. OP10 OP12 4. OP18 5. OP22 Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton Close DS0000029204.V342581.R03.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!