Inspection on 31/08/05 for Morton Close

This inspection was carried out on 31st August 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 22/11/05

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 Catherine Paling Unannounced 31 August 2005 10.00hrs st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Morton Close Address Morton Lane East Morton Keighley BD20 5RP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 565955 01274 510392 Barleyglow Ltd c/o Matrix Health Care Mrs Linda Violet Mumbley Care Home Only 40 Category(ies) of Physical Disability Over 65 (40) registration, with number of places Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 2nd August 2005. Brief Description of the Service: Morton Close Care Home is a large detached property set in substantial grounds and 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 lounge and dining areas are all situated on the top floor. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 third inspection visit for 2005/2006 the first two being carried out following the receipt of complaints made to the CSCI. 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 2nd August 2005 in response to a complaint. This was an unannounced inspection carried out by two inspectors who were at the home from 10.00 until 14.30. 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. What the service does well: What has improved since the last inspection? What they could do better: Although the service users and visitors spoke well of the staff group it was also clear from their comments, observations during the inspection and discussion with the staff that there was not enough staff to properly care for the needs of the service users. An immediate requirement was made at the inspection for additional staff to be provided. The increase in staffing levels should allow the staff to spend more time with the service users and to address the issue of boredom amongst some of the service users due to the lack of activities and stimulation. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 6 There needs to be written information for current and prospective service users and their families in the form of the Statement of Purpose and the Service User Guide. These are basic documents every care home should have to give information about the services, facilities and fees payable at the home. Care plans need to be revised to include specific detail about care needs and the service user and/or their families should be involved. The overgrown and unkempt grounds need to be dealt with to improve the outlook from the home; the natural light to some of the bedrooms and the accessibility of the grounds to service users and their families. The extensive grounds could then be an asset to the home. Requirements and recommendations made as a result of this inspection can be found at the end of this report. 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 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 standard(s) 1 and 5. Service users and their families are not provided with enough information to enable them to make an informed choice about the home. EVIDENCE: The care staff on duty could not provide the inspectors or the relatives of a prospective service user with the Statement of Purpose, Service User Guide or a brochure about the home. The senior carer did not know what these documents were. A carer was showing people around the home and providing verbal information only. In addition the senior carer was unable to give any information about the fee structure at the home. Requirements have been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 standard(s) 7, 8 and 10. Service users are treated with respect and staff are aware of their needs, however the lack of appropriate records provides the opportunity for needs to be overlooked. EVIDENCE: Individual records were in place for all the service users and these were in the process of being revised. Service users and/or their families were not being involved in this process. The care plans did not identify all the individual care needs of service users and there was little evidence on how care is to be delivered. In the case of one service user who was no longer able to mobilise with a stick and now relying on a wheelchair, the manual handling assessment had not been updated. The care plan did include the information that the service user could transfer from the chair to the bed however there was no information on how this was done; what staff intervention was needed or on the prevention of falls. The care plan for one service user included the information that bed safety rails were in use although there was no risk assessment or agreement for their use. In addition an assessment document dated on the day of admission indicated that an air flow mattress was in use suggesting that there was a high risk of skin damage; the care plan said this Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 10 was no longer in use and had been replaced with one for a lower risk although there was no information of why and how this decision had been made. There was a Multiple Risk Assessment criteria, which included nutritional screening; falls risk and the risk of skin damage. Risk assessment documents were undated and one had not been reviewed since December 2004. There was no information about continence management for example detail of any toileting programme or prompts needed. There was no detail about the support and guidance service users needed to maintain personal hygiene for example, preferred bathing times, toiletries used, oral hygiene, nail and hair care. In the case of a service user suffering from depression and dementia there was no plan of care for their emotional health. There was evidence of preferred rising and retiring times within the records. There was a risk assessment for medication, which stated that one service user needed close observation, as they had been known to hoard tablets. There was no plan of management of this risk. The lack of specific detail within the care plans suggested that staff did not refer to these documents in the course of delivering care to the service users. Service users spoke highly of the staff but felt that they were working under pressure. Staff felt that they did not always have the time to talk with service users and to spend the time with them without rushing. Staff were observed to treat the service users with respect. Requirements have been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 standard(s) 12 13,14 and 15 Service users are able to make some choices about their daily lives. The opportunities for service users to engage in social and recreational activities are limited and some service users were bored. Although there is a nutritious diet offered there is no allowance for individual likes and dislikes of service users. EVIDENCE: Several service users were spoken with and comments were made about how long they had to wait for their breakfast with one having waited one and a half hours on the day of the inspection and another saying that a long wait in the region of about 40 minutes was not unusual. There was no criticism of the staff but the overwhelming view was that there was insufficient staff to properly care for them. One service user said that although an early riser, sometimes around 06.30am, she was not offered a cup of tea until breakfast time which could be as much as three hours later. There was no choice at mealtimes and the cook was not able to say what would happen if a service user did not like the set meal. Service users were not aware of any alternative either. Although visitors were welcome at the home, activities within the home were very limited with the activities organiser involved in carrying out caring duties. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 12 Service users said that they were ‘totally bored’ and that there was nothing to do apart from sitting around and watching the television. One service user was a practising Roman Catholic however there was no information about how they are supported in following their beliefs or to take communion. Some service users said that they were able to exercise some choice in their daily lives such as going to bed and getting up. A requirement and recommendation has been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 standard(s) 16. Service users and their relatives were not confident that their complaints would be listened to and acted upon. EVIDENCE: Records of complaints were not looked at during this visit. One service user was not clear who to complain to although he knew who the manager was but did not seem confident that she could do anything. Another service user said that he had brought up concerns at the residents meetings, held twice a year, but felt his concerns were forgotten once the meeting was over. A visitor spoken with said that she had raised concerns about staffing but that these had not been acted upon. Three complaints have been received by the CSCI this year all of which have been upheld. A requirement and recommendation have been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 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 standard(s) 19. The home offers a reasonably well-maintained environment, however the grounds are not safe or accessible to service users. EVIDENCE: The large grounds are overgrown and unkempt providing a poor outlook from many of the bedrooms. The grounds are not accessible to service users. In addition a relative commented that an overgrown tree was restricting the natural light in her mother’s room. There was some evidence of refurbishment being carried out at the home. During the daytime the majority of the service users spend their time in the communal lounge and dining facilities on the top floor, meaning that the ground and first floors of the home are largely unoccupied through the day. Windows on the ground floor were open and although restricted could present a security risk. A requirement and recommendation have been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. The numbers and skill mix of staff were not sufficient to meet the needs of the service users. EVIDENCE: There were two care staff on duty on the day of the inspection with a senior carer in overall charge of the home. The staff were observed to be working under considerable pressure a view supported by several service users. A visitor spoken with also supported this view and said that she had raised concerns about staffing with a company representative the day before. Care staff were supported by a cook who worked from 07.30 until 15.30 although they have to carry out non caring duties such as clearing and setting tables and washing pots throughout the day. The housekeeper and one cleaner were currently providing domestic support. Staff were not being provided at a level proposed by the provider and agreed by the CSCI. A complaint had been received recently to this effect, which had been upheld. At the inspection contact was made with the responsible individual and a representative of the company attended the home. An Immediate Requirement Notice was issued at the inspection with regard to the staffing followed up in writing the same day. A requirement has been made. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 36. The manager does not provide clear leadership, guidance and direction to staff to ensure that service users receive a consistently good level of care. EVIDENCE: As the registered manager had recently been working at one of the sister homes there was some confusion as to who was currently managing the home. In addition, with the manager on leave staff were also unclear about any oncall arrangements. Staff were not appropriately supervised in that records were seen of observations of practice but not of any 1:1 supervision of staff. Staff did not understand what was meant by ‘supervision’. This means that staff were not given the opportunity to explore or discuss any issues they may have with caring for the service users and also did not get the chance to discuss any training needs. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x x 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 Standard No 16 17 18 Score 2 x x x 1 x x x 2 x x Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement An up to date Statement of Purpose must be provided for current and prospective service users. A copy must be forwarded to the CSCI. An up to date Service User Guide must be provided for both current and prospective service users. A copy must be forwarded to the CSCI. Care plans must set out in detail 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 ensure that any unnecessary risks to the health and safety of service users are identified and, as far as possible eliminated by means of risk assessment together with a detailed plan of management where a risk is identified. The provider must consult service users about their social interests and make arrangements to enable them to Timescale for action 5/12/05 2. 1 5 5/12/05 3. 7 15 5/01/06 4. 8 13(4) 5/01/06 5. 12 16(2)(m) 5/01/06 Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 19 6. 15 16(2)(j) 7. 8. 16 19 22 23(2)(o) 9. 27 18(1) engage in local, social and community activities. A review of the mealtime arrangements must take place to ensure that service users do not have an unacceptable wait for their meals. This must include fluid provison to make sure that all service users have an adequate fluid intake. The complaints procedure must be made available to all service users and their families. The provider must make sure that the external grounds are appropriately maintained and are suitable for use by service users. The provider must make sure that there are adequate numbers of suitably qualified and competant 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 1/04/05 not met). Staff must be properly supervised. 5/01/06 5/12/05 6/02/06 10. 28 18 Immediate - as detailed in the Immediate Requireme nt Notice 31/12/05 11. 36 18(2) 6/02/06 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. 2. 3. Refer to Standard 15 16 19 Good Practice Recommendations Consideration should be given to providing a choice for service users at mealtimes and to making sure that service users are aware of the choice available. The provider should work to reassure service users and their families that their views are listened to and acted on. A review should be carried out of the security of the ground floor bedrooms. 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 20 Morton Close 4. 5. 32 The manager should make arrangements to ensure that the home is adequately staffed at all times and the staff are aware of on call arrangemnets in her absence. Morton Close 20050831 Morton Close UN Stage 4 S29204 V205171 J52.doc Version 1.40 Page 21 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. 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