Inspection on 22/11/05 for Morton Close

This inspection was carried out on 22nd November 2005.

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 17/12/06

Morton Close 27/06/06

Morton Close 09/02/06

Morton Close 31/08/05

Morton Close 07/10/04

Morton Close 05/05/04

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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 Catherine Paling Unannounced Inspection 22nd November 2005 10.00 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.V265939.R01.S.doc Version 5.0 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.V265939.R01.S.doc Version 5.0 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 Mrs Linda Violet Mumbley Care Home 40 Category(ies) of Physical disability over 65 years of age (40) registration, with number of places Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Morton Close Care Home is a large detached property set in substantial grounds. The original building was a former mill owners house. The large extension is now the only part of the building in use, with the original building now closed. 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. Accomodation is on three floors with single and some double rooms available; the communal lounges and dining areas are all situated on the top floor. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has to carry out at least two inspections of care homes every year. The inspection year runs from April to March and this was the fourth inspection visit for 2005/2006. Two were carried out following the receipt of complaints made to the CSCI with one routine inspection visit. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk. The last inspection of the home was on 31st August 2005. This was an unannounced inspection carried out by two inspectors who were at the home from 10.00 until 15.15. The main purpose of this inspection was to make sure that the home provides a good standard of care for the service users and to assess progress on meeting any requirements or recommendations made at the last visit. The methods used at this inspection included looking at care records; observing working practices and talking to staff, service users and relatives. A tour of the building was also carried out. What the service does well: What has improved since the last inspection? The return of the manager to the home has provided stability for the residents and their relatives. There is an active and committed relatives group who have been successful in forging effective communications with the manager and the company operations director. The manager is working with this group to improve communications so that they can be assured that they are being listened to. Since her return to the home the manager has been working hard to improve the care records. The care plans seen at this inspection were an improvement on those seen previously. The refurbishment of the home has continued. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 7 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.V265939.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 is not applicable) All residents have their needs assessed before they are admitted to the home. EVIDENCE: The format used for the pre-admission assessment was detailed. Those seen had been completed to a reasonable standard and include detail of any specialist equipment needed to properly care for the resident. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Although improved, the lack of detail in the care plans continues to provide the opportunity for care needs to be overlooked by staff. Some medication practices are unsafe and create the opportunity for error. EVIDENCE: A sample of four care plans was looked at and overall there was an improvement in the standard of recording. It was clear that the manager has worked hard to try to improve the standard of record keeping. The format of the care plans was basic and somewhat restrictive in that the required intervention for the whole range of care needs was on one sheet. Although the information was limited there was some good personal detail which included rising and retiring times and how often a resident had a bath and how they got into the bath. Review was being done but changes in condition or treatment had not resulted in update or additions to the plans of care. In the current format of a single sheet for all care needs, update of one section would necessitate the re-writing of the entire care plan. Daily records were kept and there were some detailed and informative entries. In particular, some night entries gave a good picture of how one resident had Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 10 been overnight. Some acute problems were detailed in the daily records but had not generated a specific plan of care. There were some risk assessments carried out but these did not include nutritional risk assessment in one case. The sheet providing the key to the meaning of the scores did not always accompany the ‘Multiple risk assessment’ sheet. There was no risk assessment for the use of bed safety rails and identified risks had not always been addressed within the care plans. Some documents had not been signed and dated. It was difficult to assess how pertinent the assessments and care was without accurate dates. The records and care plans however have improved since the last visit. On arrival at the home the door to the medication room was unlocked with the drug keys left on top of the drugs trolley. A single tablet was on top of the drug trolley which the senior carer picked up and put in her pocket stating it was an aspirin that she had forgotten to give that morning. Communal creams were found in the shower and toilet areas. In one case a pot of Sudacrem had been prescribed for one resident but the name had been crossed out. This is poor practice. The policies and procedures were dated 2002 and were in need of update to reflect the current situation at the home. Nursing care is not provided and the policies and procedures make reference to the responsibilities of the first level trained nurse. Staff had access to up to date information about drugs in a MIMS dated April 2005. Drugs received into the home were recorded but did not include signatures. The senior carer said that drugs returned to the pharmacy were recorded but the returns book was kept by the pharmacist for part of the week. This record belongs to the home and should be kept at the home. On checking the medication it was found that the temazepam was overstocked. A count was done and was incorrect by one tablet. The manager was informed and asked to investigate the error and to inform the CSCI of the outcome. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15. There is no choice offered to residents but the food appeared to provide a nutritious diet. EVIDENCE: The dining tables were nicely set with place mats and flowers. The atmosphere throughout the meal was relaxed and unhurried. Staff talked to residents and gave general encouragement and assistance as needed. The meal at lunchtime was chicken pie, mashed potatoes and vegetables with a fruit crumble for desert. Liquidised meals were served to some residents. The components of the liquidised meals were mixed together which did not look appetising and does not allow the individual flavours to be experienced. Some residents remained in wheelchairs at the dining table. This meant that they were poorly positioned to eat comfortably. One resident in particular struggled to feed herself because of the position of the wheelchair and height of the table. It was noted that there was no choice of meal offered to the residents. The teatime meal was usually sandwiches with no hot choice available. The manager did say if anyone preferred hot food it would be provided. However Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 12 the kitchen was not manned after 16.00 and care staff serve the meal which has been prepared by the cook in advance. The manager advised that menus were under revision to improve the choice and variety available to the residents. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standards were assessed at this visit. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The home offers a reasonably well-maintained environment. Some work has taken place on the environment but further refurbishment is required. EVIDENCE: There is currently a re-decoration and refurbishment programme underway at the home. The completed works have been carried out to a good standard. There was a delay in gaining access to the home and the manager said that the doorbell could not be heard throughout the building. This had been identified at the previous inspection. The manager said that she understood that this problem was to be corrected as part of the ongoing refurbishment of the home. The grounds remain unkempt providing a poor outlook from many of the bedrooms. The manager advised that the company were in negotiations with the council to be able to lop some of the trees, to improve the light to bedrooms when the trees are in leaf. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 15 The main lounge for the home is situated on the second floor. The area is reasonably decorated. There was a significant dip in the floor which could pose a trip hazard for residents. There was only sufficient seating in the communal areas for the current number of residents at the home with twenty-three chairs counted in the lounges. The home is registered for up forty residents. All the armchairs in the main lounge were covered with plastic sheets or bags and draw sheets. This is undignified and considered poor practice. Bedrooms looked comfortable and had been personalised by residents. The bedroom furniture was badly worn and in need of replacement as part of the refurbishment programme. All areas of the home were clean and fresh smelling. Only personal laundry is done on site and there is a small laundry where this is done. This was clean and tidy. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. The numbers and skill mix of staff were not sufficient to meet the needs of the service users. EVIDENCE: There were three care staff on duty, including the manager. Two of these staff had started their shift at 08.00 with the third member of the care staff being rostered to start her shift at 09.00. This means that from 08.00 until 09.00 there was one carer and the manager when the peak time for support was before 9 a.m. This is not adequate and does not correspond with the provider’s own proposals to have four care staff on the morning shift. The duty rota indicated that this was a regular occurrence. Following the inspection in August the home had been instructed to provide additional staff. The CSCI agreed with the provider’s proposals for the number of care staff on the morning shift but this was not being adhered to. The manager acknowledged this was the case. The care staff were supported in their role by cleaning staff. There is a cook who works four days a week. Cover for the other three days is provided by the maintenance man. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 38. The manager provides stability at the home. The relatives are working with the manager to promote the interests of the residents. There are some practices that do not promote and safeguard the health safety and well being of the residents. EVIDENCE: The manager was away from the home over the summer months providing management support to one of the sister home. Her return to Morton Close has provided some stability for residents and staff. It was possible to talk to a relative who was visiting and was also a member of the active residents support group. She said that she felt that things had improved at the home and that the group felt that it was being listened to. The manager and operations director were addressing areas raised at previous meetings. An advocate is involved with the group providing support as they Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 18 continued to address issues at the home. This active group of relatives is also involved in fundraising at the home for the Christmas fair and raffle. During the course of the visit a number of health and safety issues were identified and these were shared with the manager at the visit. The emergency call was out of reach in the single toilet next to the main lounge. There was a cupboard in this area marked COSHH (Control of Substances Hazardous to Health) where chemicals were stored. It was unlocked and accessible to residents. Supplementary heating had been provided for one resident. The electric heater had not been secured to the wall and was leaning against the radiator guard. The guard was hot to the touch and was a potential hazard. The manager was asked to seek advice from the fire officer about the safe use of supplementary heaters. The new corridor carpets on the ground floor were ill fitting and posed a potential trip hazard. The manager was aware and was making arrangements for the carpet fitter to return and correct this. The ground floor fire exit under the stairs was not fitted with an appropriate lock. The Fire Officer had commented on this as requiring action in his recent safety inspection report. The report from the fire safety inspection has been sent to the manager and an action plan with timescales has been requested to address the issues raised within it. Some of the windows in the lounges opened too wide and should be further restricted to make sure that they only open to a safe distance. One resident had bed safety rails and an Alpha excel mattress supplied by the district nursing service. The safety rails were too low and needed replacement with higher rails. Concerns regarding the setting of the mattress were passed on to the manager to discuss with a district nurse. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 19 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X X X 2 Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4 Requirement Timescale for action 31/01/06 2 OP1 5 3 OP7 15 4 OP8 13(4) An up to date Statement of purpose must be provided for current and prospective service users. A copy must be forwarded to the CSCI. (carried forward from the previous inspection) An up to date Service User Guide 31/01/06 must be provided for both current and prospective service users. A copy must be forwarded to the CSCI. (carried forward from the previous inspection) Care plans must set out in detail 31/01/06 the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. The care plans must be drawn up in conjunction with the service user and/or their relatives. The provider must make sure 31/01/06 that any unnecessary risks to the health and safety of service users are identified and, as far as possible eliminated by means of detailed risk assessment DS0000029204.V265939.R01.S.doc Version 5.0 Morton Close Page 21 5 6 OP9 OP12 13(2) 16(2)(m) 7 8 OP16 OP27 22 18(1) 9 OP28 18 10 11 OP36 OP38 18(2) 23(4) together with a detailed plan of management where a risk is identified. Medication practices must be reviewed together with the policies and procedures. The provider must consult the service users about their social interests and make arrangements to enable them to engage in local, social and community activities. The complaints procedure must be made available to all service users and their families. The provider must make sure that there are adequate numbers of suitably qualified and competent staff on duty at all times. The provider must ensure that there is a minimum ratio of 50 trained care staff to NVQ level 2. (previous timescale of 01/04/05 not met) Staff must be properly supervised. (carried forward from the previous inspection) The manager and provider must produce an action plan with timescales for the issues raised within the fire safety report, as requested. 06/02/06 31/01/06 31/01/06 31/01/06 31/12/06 06/02/06 31/01/06 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 OP9 Good Practice Recommendations The medications ‘returns’ book should be signed by the pharmacist and remain at the home as part of the home’s medication records. DS0000029204.V265939.R01.S.doc Version 5.0 Page 22 Morton Close 2 3 OP15 OP15 4 OP19 Consideration should be given to providing a choice to service users at mealtimes and to making sure that service users are aware of the choice available. Consideration should be given to improving the presentation of the liquidised meals. The components should be served separated to allow the service users to experience all the flavours. The refurbishment programme should continue to make sure that the residents are provided with a safe and wellmaintained environment. This programme should also include access to the home and the maintenance of the grounds. The programme should be shared with the CSCI. Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton Close DS0000029204.V265939.R01.S.doc Version 5.0 Page 24 - 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. 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