Inspection on 17/12/06 for Morton Close

This inspection was carried out on 17th December 2006.

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 01/11/07

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 Unannounced Inspection 17th December 2006 09:30 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.V321135.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V321135.R01.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 Care Home 40 Category(ies) of Physical disability over 65 years of age (40) registration, with number of places Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Morton Close Care Home is a large detached property set in substantial grounds. It is situated in the Cross Flats area in between Bingley and Keighley. The home is not far from main bus routes and the local shops. Morton Close is registered to provide personal care only for up to 40 residents with physical disabilities over the age of 65. Accommodation is provided over three floors with a passenger lift connecting each floor. There are single and some double bedrooms, some of which have en suite facilities. Communal toilets and bathrooms can be found on each floor. There are two lounges and a dining room on the top floor. There are mature garden areas around the home that are not used by residents. There is a patio area by the dining room that can be used when weather permits. Information about the fees and any additional charges was not available at the time of writing this report. The Statement of Purpose and Service User Guide providing information about the service have been updated and can be requested from the acting manager. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two visits were made on 17th and 21st December 2006. The home did not know that this was going to happen. Feedback was given to the manager at the end of the visits. This was the third visit since 1st April 2006. Inspections carried out in June and September 2006 highlighted serious concerns that residents’ needs were not being met. The main problems were around: * No clear leadership and management in the home. * Not enough staff on duty to meet the needs of residents’ living in the home. * Staff had not been given appropriate training to properly understand and meet residents’ health and specialist care needs, for example dementia. * Not enough written information for staff about residents care needs and how to meet them. The providers were made aware of these concerns and that the CSCI had included the home in a regional improvement plan in a letter dated 5th October 2006. They were told to forward an improvement plan showing how they would meet the thirty-one requirements that had been made. It was made clear that if improvements were not made further action would be taken which could include legal action. The directors of the home met with the CSCI in November 2006 and gave reassurances that action had been taken and that improvements had been made. The purpose of this visit was to look at what improvements had been made and make sure that the home was being managed for the benefit and well being of the residents. Information had been asked for before and after the last two inspections about what policies and procedures are in place, when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, and staff details and training provided. This has not been provided. During the visit residents’ visitors and staff were spoken to. Other records in the home were looked at such as staff files, complaints and accidents records. What the service does well: Residents’ were happy with their rooms. They and their visitors said that they were nicely decorated and furnished and that the home was clean, tidy and did not smell. Visitors are welcomed at the home at any time. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 6 Residents’ and visitors said that the staff were kind, friendly and caring. It was clear that there were good relationships in place. Residents’ said they enjoyed the meals provided even though a choice of main course is not offered at lunchtime. What has improved since the last inspection? What they could do better: Residents’ are still at risk of their needs not being met because there are not enough staff available at key times of the day. Examples are given throughout the report. The provider must look at residents’ physical, health and social care needs taking the size and layout of the building into account, in order to make sure that enough staff are duty at all times in order to meet residents needs. The management team have identified what training needs for staff are. They must make sure that the training provided properly equips staff to carry out the roles they have been employed to fill, and to meet the needs of residents living in the home. This must include training on maintaining the health, safety and well being of residents’ and themselves, and about specialist care needs of residents such as dementia and dealing with challenging behaviour. Training Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 7 for staff must be provided by people who are qualified and competent to do so, and records kept of the session/course content so that this can be checked. The provider must make sure that the remaining sixteen requirements are met within the given timescales. These can be found at the end of this report. An updated improvement plan detailing how and when the requirements made in this report will be met must be put in place, and a copy sent to the CSCI. 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.V321135.R01.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.V321135.R01.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, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ and their relatives can get information about the services provided in the home and decide if it will be suitable for them. Residents’ needs are identified before they move into the home but not all staff have received appropriate training and there is a risk that they will be overlooked. EVIDENCE: The Statement of Purpose and Service User Guide have been revised and provide information about services provided at the home. It can be provided in large print on request. It was looked at and found to contain a lot of technical terms and jargon and not reader friendly to the older person. The acting manager was advised to make sure that it is produced in plain English and that it is reader friendly. A copy of CSCI guidance about producing this document was given to her. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 10 Most residents’ in the home are funded in some way by the local authority and three way contracts are in place between them, the home and the resident. If residents are paying privately the home has got contracts detailing the terms and conditions of residence. Visitor’s said that contracts were in place. A copy was seen and some of the information was unclear. For example there was nothing about who would be liable if there was a breach of contract and in one section it called the home a nursing home. The acting manager said she would speak to head office about it. The acting manager has revised the pre admission assessment form. A completed pre admission was looked at for a resident who had come to live at the home in November 2006. It was very detailed and provided good information about the resident and their needs. The home provides care to people with dementia. Care plans seen showed that for some, it is their main reason for needing twenty-four hour care and support. The homes agreed registration categories are for providing care to people over the age of 65 with physical disabilities. Staff said they had not yet received appropriate training about dementia and dealing with challenging behaviour. When talking to them it was clear that their understanding of these subjects was not enough to help them properly meet the needs of these residents’. Morton Close DS0000029204.V321135.R01.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. Care plans are in place but more detail is needed to make sure that care needs are not overlooked. EVIDENCE: Since the last inspection in September 2006 all residents’ who were in the home at that time have had their care needs reassessed by the local authority, in order to make sure that they had been identified and were being met. Information from the monthly regulation 26 visits said that all care plans been reviewed and rewritten where necessary. Four care plans were looked at. It was clear that the acting manager has reviewed and renewed care plans. Plans were in place for most identified needs but did not give a picture of the individual, their strengths, weaknesses, likes, dislikes and preferences. For example: • The plans about personal care for a resident who had had a stroke did not say what they could do themselves, which limbs had a weakness and Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 12 • • • • • • • how to help the person taking this into account, it did not say which day or what time they preferred to have a bath. The pre admission assessment for one resident showed that they liked one or two baths a week, but the care plan for personal care did not show this. The care plan for a resident who was incontinent said that they wore pads and needed to be taken to the toilet two hourly, but it did not say what type of pads they wore. Some of the residents who could not walk or ask to go were not taken to the toilet during the visit. A resident identified as being at high risk of falls had a care plan in place which referred to other care plans about mobility but there was nothing about the falls prevention team being contacted for advice and support. Information about a resident being non-compliant with medication was added to a general care plan about safety. This should have been done as an individual care plan to provide staff with clear guidance on how to approach the resident, observing and making sure tablets had been taken and what to do if they were not taken. There was a statement that the GP be asked to provide liquid medication, but there was no follow up saying if this had happened or not. Two residents’ were seen self-propelling in their wheelchairs without footrests. Staff said this was their choice. There was no clear information in the care plans about maintaining safety when self propelling. Care plans for people with dementia did not identify how the dementia affected them or what staff could do to help them. The daily record/report sheets were not being completed on a daily basis. On the day of the visit staff were proactive in asking district nurses to attend to a resident with blisters that had appeared on their arm, and later they rang the on call GP service for advice when the redness and swelling increased. The nurse said that she was able to see residents in the privacy of their own rooms. The staff were kind and friendly with the residents, and it was clear that good relationships had been established. The morning medication round did not start until after 10am because there were only three staff on duty and they were attending to residents care needs and making sure they were all up, and had had their breakfast first. Residents’ were asked to stay at the table until they had been given their tablets. Four ladies in wheelchairs had been sat at the table at 09.45 were still sat there at 11am waiting for their tablets and to then be moved into the lounge. The carer dealing with medications worked one day a week and was not familiar with the new medication system being used. On checking the medication records some mistakes were found where tablets that should be given weekly on Sundays had been given on another day. Eye drops that Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 13 should have been given at night only were being given twice a day, and a night time tablet had not been signed as given to a resident the night before. The medication policies have been revised but would benefit from being looked at again as they are not to the Royal Pharmaceutical Society Guidelines. There are still areas of information and guidance for staff missing. For example there was nothing about dealing with oxygen and one resident was using oxygen in their room. Some of the ‘well meaning’ practices seen during the visit did not respect resident’s dignity. For example residents who need help to eat were referred to as ‘feeders’. A member of staff sat between 2 residents and helped one and then the other to eat, alternating between the two. This also reflects on the number of staff that were on duty who were working hard, and their intention was to make sure that residents had eaten. This was discussed with the staff involved at the time and the acting manager at the second visit. Morton Close DS0000029204.V321135.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ are being helped to exercise choice and control over their lives and can maintain links with family and friends. EVIDENCE: The night staff communication reports showed that often ten or more residents were up and dressed by 8am. The acting manager said that this was by choice. When the care plans were reviewed preferred getting up and going to bed times had been discussed, agreed and included in the ‘sleeping/night’ care plans. She said that twenty residents had said they would like to be up before 8am if possible. One resident said they had to wait a long time for their breakfast. They were up early and did not get a drink until breakfast. She said staff did their best but were always busy. Because there were only three staff on duty residents’ did not get another drink after breakfast until 11.45 when the senior carer had time to give out cold drinks of water and flavoured cordials. Lunch was served at 12.30. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 15 The meal served at lunchtime looked and smelled appetising. Residents’ were given portion sizes according to their appetite. At this time carers sat alongside residents who needed help to eat and there were lively conversations and chat going on in the room. Five men sit together on one table. There was a lot of fun and banter from this table and staff made a point of joining in. Residents’ and visitors said that the meals were good. The soft/liquidised meals were poorly served. Residents’ were given what looked like a brown/green soup. This did not look appetising. The meal had blended together rather than served in its separate parts. There is still only one choice of main course at lunchtime. Residents’ have not been included in planning menus, but the acting manager said she would discuss meals with them at a residents’ meeting. A review of one resident’s needs by the social worker had shown that there were some concerns about the resident’s intake of food and drink and their low weight. The resident had dementia and would get up and walk away from the table before they had finished eating. Staff said they were eating and drinking well but records of what was actually eaten are not kept so there was nothing to prove this. The GP had been contacted for advice but said that nutritional supplement drinks were not needed. The acting manager said that full fat milk was used and that cream and butter were used to enrich foods. When asked about nourishing snacks she said she was talking to the cook about providing these for all residents at risk of losing weight. She also said that the cook would be getting training about nutrition for the frail elderly in the New Year. She was clear that advice would be sought from the GP and requests made for referral to the dietician for residents who were low weight or at risk of losing weight. Visitors were coming in throughout the morning and said they could visit at any time. A new intercom system has been installed on the front door which means people do not have to wait as long to be let in. They said that the changes in the entrance hall were welcomed and the provision of mince pies and sherry were a nice touch. A Christmas party was taking place later in the afternoon for residents’ and their relatives and there have been some other festive celebrations taking place. Generally there were concerns from visitors about the lack of stimulation and social activities for residents’ generally. They said they are often left sat in the lounge with the TV on and no staff with them because they do not have the time. They were not sure if there was an activities person working at the home. The acting manager said that they were advertising for somebody to fill this role, but in the meantime one of the carers was doing ten hours a week. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 16 This carer had completed individual lifestyle diaries for residents’ and done some group activities with residents’ as well as spending time with individuals. Some of the residents’ have been taken out to the local pub for a drink and they have made links with a local school for the children to come and visit the home. The lifestyle diaries are kept separate from the care plans. When talking to the acting manager it was suggested that these be put in front of the care plans so that staff will see them and get a picture of the resident as an individual. Morton Close DS0000029204.V321135.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ and their relatives now have confidence that their concerns will be listened to. Staff understanding of abuse and how to protect residents will be better when they have received appropriate training. EVIDENCE: After the last inspection in September 2006 and as a result of a complaint received by CSCI there were concerns that residents needs might not be met. The local authority adult protection unit was involved. The areas of concern where residents’ may be at risk are around management and leadership of the home and not enough skilled, trained staff on duty to meet residents’ needs. There has been one meeting with representatives from the home, adult protection, social services and CSCI to discuss issues and plan a way forward that will eliminate these concerns. A follow up meeting was arranged but representatives from the home were unable to attend, as matters in the home required their attention. Some positive changes have been made which are referred to in the relevant sections of this report. When feedback was given at the end of the visit the acting manager was very positive and committed to making sure that improvements continue to be made. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 18 The complaint referred to above has been given to the provider so that they can respond using their complaints procedures. Details of this complaint were not in the home but were faxed through from head office when asked for. Visitors said that over the last few months their ‘moans and groans’ were being listened to, and that they were confident in approaching the acting manager or person in charge. The acting manager said that verbal concerns that could be dealt with quickly were not recorded. She was advised to keep records of all concerns or complaints dealt with, as this would give information that could be used as part of the quality assurance systems. Not all staff have received training around abuse and adult protection yet. The training that has been given was from one of the company directors. There was no information outlining what was covered in the training session and the acting manager was not sure if they had done an adult protection and abuse ‘train the trainers ’ course. People who are qualified and competent to do so must provide training and a record outlining what was covered in training sessions kept. Morton Close DS0000029204.V321135.R01.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, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ live in a clean home that suits their needs but improvements still need to be made. EVIDENCE: The home was clean and tidy and there were no smells. Information from the provider said that the home was in the process of recruiting a new maintenance person, and that the maintenance file needed attention. They said that a contractor had done electrical checks. The acting manager said appropriate contractors were carrying out repairs as needed. The provider wrote and told the CSCI that the gate in the fence at the side of the building would have a push pad opener and that agreements had been Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 20 made with the owners of the property it opens into for it to be used as a fire escape route. Visitors said they had noticed new fire exit signs and emergency lights had been fitted over the last few weeks. Information from the provider since the last inspection said that some of the bedroom carpets have been replaced and that work on some of the plumbing systems was due to start in December. The acting manager confirmed that work had started on making sure that hot water outlets were regulated to safe temperatures. Work on providing a car parking area had almost been completed. The dining room has been refurbished and small lounge type area made onto the side of room that gives views of the garden. Some visitors said this was an improvement because it would give them somewhere private to sit for a visit other than their relative’s bedroom. The boiler in the kitchenette has been condemned. Staff are boiling kettles to make hot drinks. The acting manager said that a request for a replacement hot water boiler had been made to head office. All bathrooms ad toilet areas were free from clutter and accessible to residents’. Supplies of liquid soap and disposable paper towels were in communal toilets and bathrooms. The manager said that resident’s ointments and creams were named and kept in their rooms. Plans are in place to provide more storage space. Morton Close DS0000029204.V321135.R01.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 staff on duty to adequately meet the needs of residents’. EVIDENCE: There were three care staff on duty, a senior carer in charge and two care assistants. There was also the cook and a domestic. Copies of duty rotas were taken which show that staffing levels dropping to three at weekends is a usual occurrence. Information from residents’ and visitors was that the staff were nice, kind and caring but at weekends especially, the home was often short staffed. This meant that care needs were not being met – for example during the visit residents’ who needed help from staff to go to the toilet were not taken after they had been got up and had their breakfast. They were taken straight to the lounge and were not taken to the toilet before being taken back to the dining room for lunch. Staff were still getting people up for breakfast at 9.30. There is no kitchen assistant and staff are still doing washing up in the kitchenette. They were washing up by hand and then putting crockery into a machine that sterilised. Information from the provider in October 2006 had said that catering staff washed up after meals. This was not the case during the visit. The cook had given breakfast to some of the residents’ and one of the carers went to the dining room to help the ‘feeders’. There were at least four Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 22 residents’ who needed help to eat. There were also some residents’ who preferred to stay in their room and staff took meals to them. It has been mentioned in other sections of this report that the number of staff on duty was not enough to meet the needs of residents. The provider must review staffing numbers in line with the needs and dependency levels of residents as a matter of importance. The size and layout of the building must also be taken into account. The senior had been at the home a few months, their previous experience was in home care, they were doing NVQ level 3 training, they did not have the level 2 qualification. Another carer had been at the home a few months and was qualified to NVQ 4. Two staff files were looked at. The administrator deals with checking references and said that two are always asked for but there are problems getting them back. In these cases she will ring the referee and take notes of verbal references. Enhanced CRB (Criminal Records Bureau) checks were in place before employment was offered along with proof of identity. In one file there was a long gap in employment and there were no reasons recorded for this. The acting manager has looked at training records and identified where there are gaps in training given to staff. She said that new staff are enrolled on a Skills For Care induction training course if they have not done it before. All new staff do an in house induction introducing them to the home, its routines and policies and procedures. She said that it is intended for staff to do training about dementia and infection control in the New Year. The training plan showed that some of the training sessions were to be provided in house. There were no training outlines seen for what was going to be covered in these sessions. The manager was advised that training for staff must be provided by people who are qualified and competent to do so, and records kept of the course/session content. Morton Close DS0000029204.V321135.R01.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, 33, 35, 36, 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 now are leading to improvements but a permanent management structure is needed. EVIDENCE: The home does not have a registered manager at present. The role of manager has been taken on by one of the homes directors since the last inspection. They have provided managerial support to the staff and residents. They have appointed an acting manager and an administrator. Together they are working towards meeting requirements made at the last inspection and to get things right at the home. Notification of the appointment of an acting manager must be made in writing to the CSCI. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 24 In October quality questionnaires were sent out to relatives with the invoices. Questionnaires were also sent to some of the residents’. Some have been returned and the results need to be collated and made available to interested parties. The acting manager and the administrator said they had started to do a series of quality audits in order to identify where further changes and improvements needed to be made. The acting manager said that residents’ and relatives meetings had been held to find out what their views of the home were. The most recent had been a week ago. Some of the visitors seen said that they had attended the meting and been able to talk about issues such as social activities. They were very positive about changes that had taken place in the home over the last few months and felt that things were improving. The administrator said that the home does not act as appointee for any residents but that they will look after small amounts of money for residents. Records of monies received and returned were not being kept. The administrator was advised on the records that should be kept, in order to safeguard residents and the home. Information from the provider said that staff supervisions were almost up to date. The acting manager said that they were up to date and she was doing them monthly. She has not had training in order to do this. She was using the organisations forms and observing staff at work, meeting to discuss afterwards and then identifying training needs or if the individual had any other issues. Records are kept. Information about maintenance and servicing of equipment as well policies and procedures that was requested before the inspection in June 2006 still has not been received. The acting manager said that she would make sure this information was sent to the CSCI if new documents were sent to her. Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 25 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 8 9 10 11 3 X X 2 X X 3 3 2 2 2 2 X STAFFING Standard No Score 27 1 28 3 29 3 30 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 2 Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 26 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 15(2) 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 making sure that there are enough staff on duty and that they have received appropriate training which will help them to meet residents specialist care needs, for example dementia and dealing with challenging behaviour. The provider must look at the homes agreed registration categories and consider if they need to be changed and make appropriate application for a variation in registration. Timescale of 08/09/06 not met 2. OP7 15 The manager must make sure that the care plans are individual to residents and provide staff with detailed guidance about how to meet residents’ health, personal and social care needs. Where risk assessments identify DS0000029204.V321135.R01.S.doc Timescale for action 31/03/07 30/04/07 3. OP8 13(4) 30/03/07 Page 27 Morton Close Version 5.2 that a residents is at risk, for example of falling, losing weight or developing pressure sores. Appropriate detailed care plans are put in place providing staff with guidance about how to manage and reduce the risk. Advice and support must be sought from relevant healthcare professional such as the falls prevention team. 4. OP9 13(2) Medication practices must be urgently reviewed together with the policies and procedures. Timescale of 22/11/05 and 11/12/06 not met. 5. OP10 12 The provider must make sure that staff recognise residents’ rights as individuals and treat them with respect. The provider must make sure that a regular programme of appropriate social and leisure activities are made available to residents. Records of complaints received, investigated and responded to must be kept in the home. The provider must make sure all staff have received appropriate training in relation to complaints and adult protection from people who are qualified and competent to do so. Timescale of 11/12/06 not met. 9. OP20 23 The provider must make sure the 31/03/07 home is well maintained and safe. Carried forward from September Morton Close DS0000029204.V321135.R01.S.doc Version 5.2 Page 28 30/03/07 30/03/07 6. OP12 16(2)(m) 30/04/07 7. OP16 22 30/03/07 8. OP18 12(1)(a)1 3(6) 31/03/07 2006. 10. OP22 23 The provider must make sure there is sufficient storage space available. Carried forward from September 2006. 11. OP27 18(1) The provider must make sure that there are enough suitably qualified and competent staff on duty to meet the needs and numbers of residents in the home. The size and lay out of the building must be taken into consideration. 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, at meal times. Timescales of 06/01/06 and 11/12/06 not met 12. OP30 19 30/04/07 The provider must make sure that training is provided to staff that makes sure they have the necessary skills to care for the residents health, personal, social and specialist care needs. Details about training given to staff and the training providers must be kept in order to make sure that they are appropriately qualified to do so. Timescale of 08/09/06 and 11/12/06 not met. 13. OP31 9 The provider must forward written notification about who is managing the home and make sure that an application is made to the CSCI for them become DS0000029204.V321135.R01.S.doc 31/03/07 31/03/07 31/03/07 Morton Close Version 5.2 Page 29 registered. The acting manager must achieve a care and management qualification equivalent to NVQ 4. 14. OP33 24 The provider must make sure 30/04/07 that the results of the quality assurance surveys are made available to all interested parties. The provider must forward an updated improvement plan setting out what improvements have been made since the last inspection and how they intend to continue to improve the services provided at the home. An action plan with timescales for the issues raised within the fire safety report must be forwarded to the CSCI. The acting manager must complete and return the pre inspection questionnaire to the CSCI. Carried forward from September 2006. 31/03/07 15. OP33 24A 16. OP38 23(4) 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 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 in plain English and reader friendly. DS0000029204.V321135.R01.S.doc Version 5.2 Page 30 Morton Close 2. OP15 The presentation of pureed/liquidised meals should be improved. The components should be served separately to allow residents to experience all the flavours. Two choices should be provided at mealtimes and residents should be involved with menu planning. This recommendation was first made in June 2006. 3. OP22 The provider should review the call bell system to make sure that it can only be cancelled at source. Carried forward from September 2006 4. OP24 Lockable facilities should be provided in every room. Carried forward from September 2006 5. OP29 The acting manager should make sure that interview records are kept which show that gaps in employment are identified and records kept. The acting manager should make sure that clear and detailed records are kept of residents personal monies that are held in safekeeping by the home. Staff providing formal supervision should receive training around providing supervision and carrying out staff appraisals. 6. OP35 7. OP36 Morton Close DS0000029204.V321135.R01.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. 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