Inspection on 27/06/06 for Morton Close

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 Karen Westhead Key Unannounced Inspection 09:40a 27th June 2006 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.V297336.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.V297336.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.V297336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 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 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. Accommodation is on three floors with single and some double rooms available; the communal lounges and dining areas are all situated on the top floor. The home is well served by public transport. There is level access into the home and one passenger lift. There are mature garden areas around the home; these are not used by residents. 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 are not readily available. The pre-inspection questionnaire had not been returned to the office in time to allow the information requested to be used. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between 1st April 2006 and 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. All of the core National Minimum Standards are assessed and this forms the evidence of the outcomes experienced by residents. On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific area and are known as random inspections. The visit was unannounced. Two inspectors were present and the visit started at 9.40am and finished at 5.20pm. Feedback was given at the close of the visit. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at the number of reported incidents and accidents, the action plan submitted following the previous inspection and reports from other agencies such as the fire safety officer’s report. This information was used to plan the inspection visit. A number of documents were inspected during the visit; some areas of the home were seen, such as bedrooms and communal areas. Inspectors also spent a good proportion of their time talking to residents, staff and visitors. Residents who were unable to comment on their experiences were observed. CSCI comment cards and post-paid envelopes were left, to be distributed to residents and their relatives. One comment card asks questions about the inspection process and the way the inspectors carried out their duties. After completion these are returned to the CSCI. At the time of writing this report no responses had been received. What the service does well: Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 6 Staff were described as being kind and patient by residents and visitors. The home promotes contact with relatives and friends of residents. Visitors are welcomed at the home at any time. Food provision is satisfactory, despite the lack of choice. Residents were happy with their rooms. They and their visitors said that they were nicely decorated and furnished and that the home was always clean, tidy and did not smell. What has improved since the last inspection? What they could do better: The information available to residents and other interested parties could be better presented and should accurately reflect what the home offers. This information must be readily available to current and prospective residents and the families. Residents must have a statement of residency/contract that clearly sets out what they can expect for the fees they pay. Residents out of the registered category must not be admitted to the home. Those residents coming to the home must be properly assessed and have a care plan which is devised by the home and properly reflects the care they require and how this is to be provided. Risk assessments must also be completed and appropriate steps taken to follow risk assessments through. The practices around the administration of medication are unsafe. Staff must respect the privacy and dignity needs of the residents at all times. The home must provide suitable leisure activities for the needs of residents. Residents and visitors were not aware of the complaints procedure and complaints brochures were not available. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 7 Residents are not always supported in having choice and control over their lives. Routines are present for the convenience of staff. The lack of guidance for care staff and the poor staffing levels make the situation worse. Appropriate staff training must be provided. The provider must review the staffing levels, including the provision of a suitably qualified and experienced manager. Recruitment practices must be reviewed to make sure people are correctly vetted before working with residents. Maintenance and fire safety issues must be addressed to make sure the home is kept safe and provides appropriate facilities for residents and staff. Further detail on the findings of the visit can be found in the body of the report. Requirements and recommendations appear at the back of the report and include a requirement of the provider to produce an improvement plan to state how they intend to improve the service for the residents. 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.V297336.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.V297336.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 does not apply to this home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have sufficient, up to date information to help them make an informed choice about Morton Close. Residents’ needs are not being properly identified. This means that care needs can be overlooked and that residents are being admitted when needs cannot be met by the staff team. EVIDENCE: The Statement of Purpose and Service User Guide are not readily available to prospective residents or interested parties. The information provided during the visit was not up to date and is in need of review. The home is registered to take care of residents who have a physical disability and are over the age of 65. It was clear that residents are admitted outside of this registration category. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 10 The provider must urgently review the needs of residents in the home and look at the homes registration categories. Once an audit has been completed the registered provider must take the necessary steps to resolve the current situation. The most recently admitted resident clearly had dementia and was presenting a challenge to staff and residents because they liked to walk, especially at night. From talking to residents, visitors, staff and looking at records it was clear that a number of residents had dementia and that this was the reason why they needed 24 hour care and support. Staff and residents said there was a confused resident who constantly walked in and out of people’s rooms. The resident had been at the home a few weeks after moving from outside the area. A pre admission assessment was not in place and information had been received via telephone calls and relatives. Another resident who had been at the home a few months said that they had settled in ‘champion’ and that the staff were so kind and patient, especially with what they had to put up with, the resident referred to another resident who was very confused, walked around a lot and went in and out of other people’s rooms. Morton Close DS0000029204.V297336.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not provide clear and detailed instructions for staff to follow. This means that care needs could be overlooked. Residents’ privacy and dignity is not always respected. Medication practices are unsafe and put residents at potential risk. EVIDENCE: One resident, who had been in the home for a few weeks, only had daily records to look at to review the care she was receiving. There was no care plan or assessment in place. The manager said they had only just received a copy of the care plan, which had been drawn up by the placing authority. This situation is of serious concern and the manager was informed of the responsibility and duty of care to make sure the correct documentation is in place and make sure staff are aware of the individual needs of residents. The care plans of five residents were reviewed in detail. The standard of information was variable. Risk assessment had not always been carried out Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 12 even when risk had been identified. Those risk assessments that had been completed did not contain sufficient information for staff on how to minimise or manage the risk. For example, one file contained a moving and handling assessment, which had been carried out on 17 October 2005. This had been subsequently reviewed on 31 January 2006 and again on 6 June 2006. However the information recorded did not provide instructions or detail of what type of equipment to use and how to safely move the resident. The manager explained the lack of information by saying that some forms had been taken out of files, because staff did not understand them. No other system had been introduced or training given to overcome this shortfall. One file showed that a resident was at high risk of falling and that bedrails had been provided when in bed. This resident also used a lap strap when in a wheelchair. The reason the lap strap was in place was as the resident was ‘always wriggling’. From the daily records it was clear that this resident spent a large proportion of their time sitting in the wheelchair. However, the use of a lap strap had not been risk assessed and there was no evidence to show that this restriction in movement had been reviewed or whether there was a danger of the resident developing pressure sores from sitting in one position for lengthy periods. Again this is an example of residents not being correctly assessed. Bedrails were fitted to some beds. There was no written evidence to show that these were being maintained or checked. One resident was described as being at medium risk from not receiving enough nutrition. There was no explanation on file to show how this decision had been reached. When asked, one carer said the resident had been eating well until the last few days, when their intake had been very little. No records were being kept of dietary and fluid intake. The reasons for these documents were discussed with the manager who said they would start using the record immediately. The inspectors checked the record relating to this resident’s weight. The only weight recorded referred to April 2006. The weight was 61.6kg but the resident looked to have lost weight since that date and could be described as very frail. Care plans were found to be prescriptive and the information was based on eight activities of daily living. There was nothing to show if the resident or their relatives had been involved. Dates of monthly reviews were on a separate sheet. The information was set out as an assessment of residents needs. It did not provide a detailed picture of how to meet an individual’s physical, health and social care needs. The information given was generalised and could have applied to anybody. For example, where it was clear that residents had poor short-term memory or specific skin disorders, this had not been detailed in Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 13 their plan and how it should be addressed. The entry would give a generalised statement about their lack of engagement in activities in the home and what their bathing requirements were. In one file, there was written evidence to show that the resident had a specialist pressure-relieving mattress in place and that their position needed changing every three to four hours. There was no written evidence to show that this was being done. One file included a support workers assessment, which had been done in October 2005. There was no other entry to show this had been updated since. One resident is an insulin dependant diabetic. District nurses visit the home to check blood glucose levels and give the insulin. Inspectors arrived at the home during the morning and a carer was doing the morning medication round in the dining room. The carer asked a resident if they had taken her morning tablets. The reply was that they (the carer) would go to the resident’s bedroom and check, but that they thought they had. When asked about this later, the resident said that staff gave them their morning medications the night before; they then kept it in their room and took it when they got up. The manager was unaware of this practice and there were no risk assessments or agreements in place about self-medicating. The medication policies and procedures did not provide guidance around self-medication. Other examples of poor practice were noted during the visit: • • • The drugs trolley was left open and unattended while the carer left the room to take medicines to people in their own rooms; Tablets were left with some residents to take and no checks were made to make sure that they had been taken; The carer used her fingers to put tablets directly into resident’s mouth’s but she did not wash her hands before returning to the trolley to dispense more tablets to other residents. The carer was seen doing this on at least three occasions. When asked, the carer said she had done medication training and had been responsible for ordering repeat prescriptions. The procedure described was satisfactory apart from the fact that staff in the home do not sign the prescriptions before they are sent to the pharmacist. This must be done in order to prevent the possibility of fraud by other parties. Records were in place to check what had been ordered, what had been written on the prescription but the section for received drugs said that a full 28 day supplied but in fact the home uses the nomad system and the boxes are supplied weekly. The manager was advised to review the process for recording drugs received. The nomad boxes are filled and supplied weekly by the pharmacist. Those seen were not tamper proof and there is a risk of tablets moving out of the Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 14 designated space. Staff said that when new residents are admitted to the home, they would dispense their tablets into a nomad box. This is secondary dispensing and potentially unsafe. Staff must either dispense from the original medication containers or ask the pharmacist to deal with the nomad boxes. The medication administration records were computer generated by the supplying pharmacist. The carer checked these before taking tablets to a resident and they were signed straight away. The drugs fridge was not locked and although a thermometer was kept inside it there was no daily record of the fridge temperatures. The homes medication policies and procedures are brief and basic. They had been written by the supplying pharmacist and do not reflect or refer to the Royal Pharmaceutical Society Guidelines for the administration of medicines in care homes. The section on homely remedies does not say if the doctor is in agreement with using the medications listed, there is no information about how to deal with drug alerts and hazard notices or how to look after medical gases. The manager was not aware of recent alerts about blood glucose monitoring devices and said the home did not receive alerts from the CSCI. A wooden storage unit was seen outside the home, with two oxygen cylinders stored in it. None of the current residents were prescribed oxygen. There were no policies and procedures about the storage or administration of oxygen. Details of a medication administration error were found in the staff communication book. NHS direct had been contacted for advice. The manager did not know if a Regulation 37 notification had been sent to CSCI. During the visit a doctor came in to see a resident, who was taken from the dining room to the lounge. The doctor, helped by a care worker dealt with the visit in the lounge, in front of other residents. This is contrary to good practice as the privacy and dignity of the resident was not upheld. The inspector asked the doctor for his view about the home and the quality of care. The doctor felt unable to give a view as he said he had not been to the home for many years and felt unable to make any comment. Moving and handling practices seen during the visit were unsafe and put staff and residents at risk of injury. On two occasions staff were seen using underarm lifts to transfer residents from wheelchair to armchair. A hoist was brought in by a carer but this was left beside the resident and removed again without being used. The carer said that they were not confidant using the equipment and it was general practice to use manual handling techniques. During the visit interactions between staff and the residents were good. Staff appeared friendly and helpful. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Residents are not provided with social and leisure activities. Staff do not always offer or encourage choice to residents in their daily lives. Food provision is satisfactory although choice is limited. EVIDENCE: Breakfast was still being served to some residents at 10am. The dining room was not totally cleared before the lunchtime meal was served. Residents in wheelchairs were still sat at the tables an hour after they had finished their breakfast and this also happened after lunch. Care staff said that one resident preferred to sit at the table all day. This resident was observed to sleep after breakfast and was woken to eat lunch. When staff were asked about the length of time residents were being left in wheelchairs they felt this was acceptable as they were on pressure relieving cushions. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 16 In the lounge residents were sat in chairs against the walls of the room. The television was switched on but most of the residents were asleep or disinterested in it. There is little or no recreational activity other than what little staff can fit in during the day and occasional entertainment. Staff said there was no community contact other than residents’ visitors. The home does not have an activity organiser. Comments from them and visitors included: • ‘Not grumbling, you’ve got to be thankful for what you get, it could be worse.’ • ‘We spend a lot of time doing nothing.’ • ‘The food is OK and there is enough for me’ • ‘We used to do things before, but now there is nothing happening’ • ‘There is no stimulation for residents; they are sat in the lounge all day. Some of them only get to sit outside if their visitors take them.’ Some practices observed in the home were ‘institutionalised’. For example staff put draw sheets on all the seat cushions. When asked why they said it was ‘to protect the cushions and it had always been done that way’. Drinks were given to residents at set times, for example a ‘tea round’ was done at 11.00am. There was no choice of drinks and no snacks on the trolley. Residents could have tea or nothing. The carer said that ‘residents preferred tea’. Residents sat in the lounge did not have cold drinks and there were no jugs of juice or water available. Making sure the people have enough to drink is important at any time but in warmer weather even more so. On the day of the visit the weather was warm and sunny. One resident said that the food was fine, they could eat as much as they wanted to and leave what they did not want to eat. Consideration should be given to improving the presentation of the liquidised meals. The components should be served separately to allow the service users to experience all the flavours. This was commented on at the previous inspection. The cook has no formal qualifications. She has not completed any basic food handling and hygiene certificate. She has not done any other type of training while working at the home. The cook returned to work in January 2006. She had previously work for the home in 2005 for five months. During a discussion with the cook it was clear she was aware of methods of enriching foods and full fat milk is used. New menus had been produced by the registered provider and had been generated by Head Office. There had been no consultation with residents. However, the cook knows what they do and do not like and has made alterations to the menus, after consulting with the director of the company. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 17 There is only one choice of main course at lunchtime. A visitor and a resident said if they don’t want the meal, they are offered a sandwich. The home was last visited by environmental health officers in April 2006. On the day of the visit the kitchen was clean, tidy and well stocked. Visitors are welcomed at the home throughout the day. The inspectors were able to talk to three visitors during the course of the day and comment cards were given out. The opportunity for residents to make choices about their lives is limited by a lack of guidance and poor staffing levels. One example is around the rising and retiring times of residents. It was clear from written evidence and discussions with staff and residents that night staff start getting residents up very early so that they are dressed ready for the day staff. Three accounts showed that at least sixteen residents are up and dressed before the night staff go off duty. The majority of these residents are in need of staff assistance; therefore staff are starting to get people up very early. It was not clear if residents are given a choice about the time they get up or whether this is done for the convenience of the staff. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 18 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): 16 and 18 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Residents are placed at potential risk by poor management and organisation of the home and a lack of staff training. EVIDENCE: A notice was displayed in the main entrance inviting people to take a copy of the complaints procedure, but there were no copies to take. Residents and visitors were not aware of a complaints procedure but said that if they had any concerns they would take them to the manager. The manager was not able to provide any records of the complaints received and dealt with. Concerns received by the CSCI in May 2006 were sent to the provider for investigation. No response has been received to date. Not all the care staff or manager had received training on adult protection. Discussions with staff showed that they had an overall awareness of adult protection but there were gaps in their knowledge. At the time of the visit the home did not have responsibility for any resident’s finances or valuables. Morton Close DS0000029204.V297336.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 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 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The home requires work to make sure it is safe and fit for purpose. Some practices put residents at risk of cross infection. EVIDENCE: Residents said they were happy with their rooms. They and their visitors said that they were nicely decorated and furnished and that the home was always clean, tidy and did not smell. A number of requirements relating to the building were discussed with the manager at feedback. It was evident that some of the toilets and bathrooms are not in use as they are currently being used to store unused equipment and furniture. A problem has arisen following the sale of another property on site which until recently was being used to store surplus equipment and furniture. This has now been Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 20 brought into Morton Close and staff are finding it difficult to accommodate it in the limited storage space they now have available. Most of the store cupboards that had notices saying they should be locked shut were found to be open. Bins in toilets did not have lids and contents were found spilling onto the floor. Some of the bedroom doors did not close properly. The maintenance man should check all doors to identify which ones need to be repaired. Bottles of shower gel and tubs of ‘Conotrane’ and ‘Sudocrem’ were seen on the window ledge of one toilet and in the bathrooms. These areas were accessible to residents. Use of communal creams increases the risk of cross infection and this practice must stop. Creams, lotions and toiletries belonging to individual residents must be kept in their own rooms and be stored appropriately. A commode armrest had been repaired with tape. This presents a risk of cross infection. A nurse call system is in place. Buzzers were going off for a long time and staff were seen cancelling them in the corridor and not at source. The manager said that if call bells were not cancelled at source they would sound again. The nurse call system was checked by inspectors during the visit. On the two occasions staff visited the room within a short period and did cancel the call bell at source. Visitors said that often the front door bell is not heard and they have to wait a long time to be let in. This has been identified at previous inspections. The manager said that a new system was to be fitted with an intercom so that any caller would be able to speak to a staff member and be let in without there being a delay. When the conversions to the old building have been completed the home will be without a car park. No alternatives have yet been given to visitors who are anxious that they will have to park on the roadside and face a long walk up the driveway to the home. The rooms on the ground floor at the back of the building had views of derelict looking grounds. The grounds were not well tended or pleasing to look at. There were signs in some of the bedrooms above hot water outlets that said ‘very hot water, risk of scalding’. One outlet was checked using the room thermometer and the hot water was above 50 degrees Celsius. This must be addressed as residents are at risk. The laundry is small and does not lend itself to the separation of dirty and clean laundry. There were no disposable gloves available but there was a pair Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 21 of used blue rubber gloves drying over a pipe. It was of concern to see that blue rubber gloves were also being used in the dining room kitchenette. This poses an infection control risk. There was a notice in the laundry that staff must sluice soiled items, as the washing machines do not have a sanitary programme. Not all residents’ bedrooms have a lockable facility for storing personal items. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 22 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, 28, 29 and 30 Quality in this outcome poor. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skills do not ensure that residents’ needs can be met. Recruitment practices do not consistently protect residents. EVIDENCE: Staff said there is a lack of support from Head Office about staffing levels in the home. Staff have been told that they needed to revise their routines to accommodate the amount of work they had to do rather than be provided with additional staff. There are no arrangements to allow the manager to concentrate on the management responsibilities. Staff said that even when agency staff were booked they were often subsequently cancelled leaving the home short staffed. Without exception staff, including the manager were rushed and comments made during the visit confirmed that they felt under pressure. At one point the manager slipped on a wet floor rushing between tasks such as attending to paperwork, answering the telephone and checking on residents all at the same time. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 23 During the visit staff were carrying out domestic/household duties in and amongst their caring roles. For example they were serving meals to residents and doing the washing up in between attending to the personal care of other residents in the home. Comments from residents and visitors about staffing levels included: • ‘they are always short staffed.’ • ‘not enough staff around. You never know when you will get help to get up or go to bed and sometimes you have to wait a long time.’ • ‘use a lot of agency staff and often new faces and they are inexperienced, but the regular staff team are lovely.’ • ‘agency staff used a lot at weekends and some of them don’t know what to do.’ • ‘not enough staff to provide more than basic care.’ • ‘not enough staff to send anybody as escort if somebody has to go to hospital.’ The recruitment procedure is not robust. Staff are being re-employed without the necessary pre-employment checks being carried out. An example of this was the cook who returned to work at the home earlier this year and was reemployed without being checked against the Protection of Vulnerable Adults register (POVA) or having a Criminal Record Bureau (CRB) check. Three staff files were examined. One application form did not give a full employment history, none of the files included interview notes and one file only had one written reference. Staff said that there had been little, if any training over the last twelve months. One carer said they had not had any training in six months of working at the home. All said they were short staffed and that they did not have enough time to provide anything other than the basic care for residents. There was no time to sit and talk to them. It was of concern that staff said that they did not have time to look at care plans. Training must be provided to staff to make sure that they have the necessary skills and knowledge to care for the specific needs of the resident group. The training provision must be reviewed to make sure that the quality and depth is adequate. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager does not provide clear leadership, guidance and direction to staff to make sure that residents receive a good level of care. This results in some practices that do not promote and safeguard the health, safety and wellbeing of the residents. EVIDENCE: The manager is not 21 years old and should not be left in charge of the home. She has little experience of care work. The manager had no understanding of the legislation associated with care homes and did not have access to a copy of the National Minimum Standards for Care Homes for Older People or the associated Regulations. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 25 The manager was working seven days and was often using her time to supplement the lack of staff on the rota by working as a carer rather than fulfilling her managerial role. The rota did not allow for any supernumerary management hours to allow the manager to concentrate on staff issues or matters affecting the home. This means that no progress has been made in meeting requirements and recommendations made at previous inspections. One resident said the manager was ‘a lovely girl but seems to be more of a carer because she is always working as a carer and comes back to work when they are short staffed. Last weekend she came back to do the tablets.’ A group of relatives have formed a group to try and resolve any issues that they have about how the home is run and managed. They meet outside the home and do tell the management team about concerns that they have but do not feel as if they are taken seriously. Issues they have concerns about are: • Not enough staff • No activities or stimulation for residents • The grounds are not looked after • Residents don’t get to sit outside or go out anywhere One visitor said a relatives meeting was held in the home two weeks previously. Another said they were not sure if it was the homes management systems that needed changing. They said the manager ‘now always seem to be working on the floor and does not appear to be in charge’. There is no meaningful quality assurance system in place. There is no structured staff supervision or guidance from senior staff. When asked about handovers from each shift and how information is passed over between carers and senior staff, staff said they did not have formal handovers but relied on staff coming in earlier or reading the communication book. They said not all information was written down so the sharing of information was adhoc. This provides the opportunity for important information about residents to be overlooked. It was normal practice for staff to move residents in wheelchairs without putting the residents feet up onto the footrests. This is a dangerous practice and puts residents at risk of injury. Some of the wheelchairs seen were dirty and looked in need of some maintenance. One had a missing side panel. Steps must be taken to make sure that wheelchairs are serviced and maintained for the person who owns it, either by the home or community wheelchair services. The recording of accidents is not being monitored. One resident had severe bruising to the face. The inspector asked to see the accident report. The Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 26 accident had happened five days previously. The carer on duty said she had not had time to complete the document but would attend to it. A form was subsequently produced. On checking the resident’s file a form had in fact been completed at the time of the incident. The newly completed form repeated some on the same information. However there was a time difference of half an hour and the events surrounding the injury were different. One account described the resident hitting their head on a bedside table the other referred to the floor. The manager was unable to provide certificates for the electrical wiring, gas appliances, hoists or passenger lift. Written confirmation is required to demonstrate these have been serviced and are safe. West Yorkshire Fire Service carried out a fire safety inspection of the home in November 2005. Their report raised a number of issues. A further copy of the report was sent to the home in November 2005 and in February 2006 with a requirement to produce an action plan with timescales. The lack of response was raised in the inspection reports of visits carried out in November 2005 and February 2006. A written response to indicate how the matters will be dealt with has not been received to date. Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 27 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 2 1 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 2 2 2 2 3 2 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x x 1 1 1 Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 28 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 provider/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(1)(c) Schedule 1 and 17(2) Schedule 4 17(2) Schedule 4 14(1) Requirement The provider must provide up to date and accurate information relating to the home. This includes the Statement of Purpose and Service User Guide. The provider must make sure all residents have a written contract at the point of moving into the home. The provider must make sure all residents have a full and detailed assessment of their care needs prior to moving into the home. The provider must be able to demonstrate that the home can meet the needs of the residents living in the home. The provider must make sure prospective residents are given the opportunity to visit the home prior to admission and be offered a trial stay if appropriate. Care plans must set out in detail the action which needs to be taken by care staff to make sure that all aspects of the health, personal and social care needs of residents are met. The care DS0000029204.V297336.R01.S.doc Timescale for action 08/09/06 2 OP2 18/09/06 3 OP3 08/09/06 4 OP4 15(2) 08/09/06 5 OP5 12(1) 08/09/06 6 OP7 15 28/09/06 Morton Close Version 5.2 Page 29 plans must be drawn up in conjunction with the service user and/or their relatives. This requirement has remained unmet since 22nd November 2005. The provider must make sure 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 together with a detailed plan of management where a risk is identified. This requirement has remained unmet since 22nd November 2005. Medication practices must be urgently reviewed together with the policies and procedures. This requirement has remained unmet since 22nd November 2005. Residents must be dealt with in a way that preserves their privacy and dignity at all times. 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. This requirement has remained unmet since 22nd November 2005. The provider must make sure residents have contact with the local community as they wish. The provider must made sure all complaints are investigated fully and a record kept. The provider must make sure systems are in place for DS0000029204.V297336.R01.S.doc 7 OP8 13(4) 28/09/06 8 OP9 13(2) 08/09/06 9 10 OP10 OP12 12(4)(a) 16(2)(m) 08/09/06 08/09/06 11 12 13 OP13 OP16 OP14 16(2)(m) 22 12(2)(3)& (4)(a) 08/09/06 08/09/06 08/09/06 Page 30 Morton Close Version 5.2 residents to be able to make choices and have control over their lives. The provider must enable residents to make decisions about the time they get up. As far as possible the provider must find out and take into account the wishes and feelings of the residents with regard to what time they wish to get up. This remains unmet from 08/05/06. The provider must make sure all staff have received appropriate training in relation to complaints and adult protection. Residents and their relatives must be made aware of the complaints procedure. The provider must make sure that the home develops and implements an adult protection procedure that complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. The Local Authority Multi-agency procedure must also be available to staff. The provider must make sure the home is well maintained and safe. The provider must make sure the home is well maintained and safe. The provider must make sure there are sufficient bathrooms and toilets available to residents at all times. The provider must make sure there is sufficient storage space available. The provider must make arrangements to ensure that hot water is delivered at a safe DS0000029204.V297336.R01.S.doc 14 OP18 12(1)(a)1 3(6) 28/09/06 15 15a 16 OP19 OP20 OP21 23 23 23(2)(j) 28/09/06 28/09/06 28/10/06 17 18 OP22 OP25 23 13(4) 28/10/06 08/09/06 Morton Close Version 5.2 Page 31 19 20 OP26 OP27 23 18(1) temperature, that is 43°C ( /2°C) The provider must make sure systems are in place to minimise the risk of infection. The provider must make sure that there are adequate numbers of suitably qualified and competent staff on duty at all times. This requirement has remained unmet since 6 January 2006. The provider must ensure that there is a minimum ratio of 50 trained care staff to NVQ level 2. This requirement has remained unmet since 31 December 2005. The provider must make sure the recruitment procedures used are robust enough to protect residents. 08/09/06 08/09/06 21 OP28 18 08/12/06 22 OP29 19 08/09/06 23 OP30 24 OP31 25 26 27 OP32 OP33 OP33 28 *RQN This requirement has remained unmet since 1 May 2005 19 The provider must make sure there is a training programme in place to make sure staff have the necessary skills to care for the residents. 9 The provider must make sure there is a suitably qualified, experienced and competent manager in post to run the home. 9 The provider must make sure the home is managed properly. 24 The provider must have an effective quality assurance system in place. 24A The provider must produce an improvement plan setting out the methods and timetable of how they intend to improve the services provided at the home. Section 31 The provider must complete and DS0000029204.V297336.R01.S.doc 08/09/06 28/09/06 28/10/06 08/10/06 21/08/06 07/08/06 Page 32 Morton Close Version 5.2 CSA 2000 29 30 OP36 OP38 18(2) 23(4) return the pre-inspection questionnaire. This has been an outstanding request since 18/05/06. Staff must be properly supervised. (Previous timescale of 06/02/06 not met) The manager and provider must produce an action plan with timescales for the issues raised within the fire safety report, as requested on 31 January 2006. The provider must make proper arrangements for the maintenance of all fire equipment. 25/09/06 08/09/06 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 OP15 Good Practice Recommendations 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. Two choices should be provided at mealtimes and residents should be involved with menu planning. The provider should make suitable alternative arrangements for adequate parking facilities for visitors and staff. Arrangements should be made to improve the outlook from the home for residents. The provider should review the call bell system to make sure that it can only be cancelled at source. Lockable facilities should be provided in every room. The provider should review the training provision to make sure that the quality and depth of training provided properly equips the staff to effectively care for the residents. 2 OP19 3 4 5 OP22 OP24 OP30 Morton Close DS0000029204.V297336.R01.S.doc Version 5.2 Page 33 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.V297336.R01.S.doc Version 5.2 Page 34 - 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!