Inspection on 09/02/06 for Morton Close

This inspection was carried out on 9th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Catherine Paling Unannounced Inspection 9th February 2006 09:50 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.V282808.R01.S.doc Version 5.1 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.V282808.R01.S.doc Version 5.1 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.V282808.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 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 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. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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 sixth inspection visit for 2005/2006. Three have been carried out following the receipt of complaints made to the CSCI and two routine inspection visits. 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 22 December 2005 following receipt of three complaints about residents being got up in the morning from 05.30. The complaints were upheld. This was an unannounced inspection carried out by two inspectors who were at the home from 09.50 until 15.30. 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 previous visits. The methods used at this inspection included looking at staff and maintenance records; observing working practices over the lunchtime as well as talking to staff and service users. The operations manager for the company was at the home during the inspection and full feedback was provided to her in the absence of a home manager. What the service does well: What has improved since the last inspection? What they could do better: The improvements to the staffing levels need to be extended to include Saturdays and Sundays. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 6 The practices for keeping records need to be reviewed as a matter of urgency to make sure that individual information is held securely and that care needs are not overlooked. The provider needs to work with the manager and her staff to make sure that all residents are offered and helped to make choices. The routine practice of getting residents up early must cease, unless the resident has requested or indicated clearly that this is their choice. Detailed adult protection procedures must be made available to staff and must link into the local authority multi agency procedures. Staff must receive training in adult protection so that they know what to do should such an incident occur. The provider must review the training made available to staff to make sure that they can effectively care for the residents. This should include induction training. Proper arrangements should be put into place for formal staff supervision. Recruitment practices must be reviewed to make sure that all they are robust and that the required checks are carried out prior to employment. The refurbishment programme must continue and the provider needs to ensure that servicing and maintenance is up to date to make sure that the residents live in a safe environment. The provider must make sure that residents, relatives and staff are aware of the company policy on the handling of residents’ money. The provider must respond as required to the fire safety officer’s report and make arrangements for the maintenance of all the fire equipment. Requirements and recommendations have been made to address the shortfalls and can be found at the back of the 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 DS0000029204.V282808.R01.S.doc Version 5.1 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.V282808.R01.S.doc Version 5.1 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): EVIDENCE: None of these standards were inspected at this visit. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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 and 8. The practices employed with regard to record keeping provide the opportunity for residents’ individual care needs to be overlooked. EVIDENCE: Although the individual care records were not inspected at this visit, records were seen during the course of the visit that raised concerns about the practices for recording resident information. The staff utilise a table in the dining room as a staff station for handover and as somewhere to keep various records. There were two A4 hardback books one marked as a message book and the other as a report book dated from December 2005. It was of some concern to find that details of individual resident care were documented in both these books. In addition to this, all the resident daily records were held together in a ring binder. This practice raises concerns about record keeping with regard to data protection and the security and accessibility of information held about individual residents. In addition the separation of the daily record from individual care records suggests that staff do not refer to care plans and that care plans are not seen as vital ‘living’ documents, crucial to care. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 10 The above practices were discussed with the operations manager at the time of the inspection. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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): 14 and 15. The more able residents can exercise choice over their daily lives. Staff need to make sure that they do always offer and encourage choice to those less able residents. Although there is only limited choice at mealtimes a nutritious diet is offered to residents. EVIDENCE: Following the investigation of the complaints about early rising the provider was reminded of the requirement to facilitate residents in making decisions about their daily lives including the time they get up in the morning. Information was seen on the notice board in the dining room referring to the night routine staff are expected to follow. This information conflicts with residents being able to exercise choice. For example, the ‘night routine’ refers to checks being carried out at 1am, 3am and 5am; it goes on to state ‘if awake get up and dressed. Do not put back on bed as residents go back into sleep mode in clothes and sometimes urinate over bedding and clothes, please leave comfortable in easy chair with a cup of tea’. This is poor practice and unless residents request or clearly indicate that they want to get up and dressed they should be made comfortable so that they can go back to sleep in bed. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 12 The message book indicated that over half the residents are currently up and dressed when the day staff come on shift at 07.30. This issue was discussed with the operations manager with regard to resident choice. The lunchtime meal was observed and was conducted in a relaxed, unhurried manner with staff assisting residents as needed. The tables were appropriately laid with table decorations and condiments. Residents were offered squash with refills offered freely. Residents were not offered any choice of main course. Liquidised meals were given to two residents with all the components mixed together and served in bowls. It was not possible to recognise that it was sausage, potato and vegetables or to taste the different components of the meal. As previously recommended, the components of liquidised meals should be served separately so that the residents can experience the different flavours. There was a choice of sweet offered to the residents. Residents were seen to be enjoying their food. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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): 18. The lack of detailed in-house procedures and the level of staff understanding does not always give assurance that residents will be protected from abuse. EVIDENCE: The in-house procedures for adult protection are vague. They do not provide staff with clear procedures to follow should they suspect abuse. There is no reference to the local authority multi-agency procedures and there are no contact numbers for the local adult protection unit. Staff were not clear as to whether the local authority procedures were available in the home or not. There is a satisfactory procedure to support whistle blowers. The senior carers on duty said that they had not received any training in adult protection, although one had had received some training in this area as part of National Vocational Training. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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. The implementation of the refurbishment programme must continue to make sure that the residents live in a safe and well-maintained environment. EVIDENCE: There was evidence of ongoing re-decoration at the home in that carpets had been replaced in the lounges and some new chairs and occasional tables provided. However a dip noted in the floor of the main lounge does not appear to have been dealt with prior to the new carpet being fitted. One resident said that she felt that this was unsafe. It was noted that some of the toilets were out of use and the operations manager said that she was aware of several maintenance issues that needed addressing at the home. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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 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. Overall, there were sufficient staff to care for the needs of the residents although there were shortfalls at the weekends. The homes recruitment practices and training for staff do not always support and protect residents. EVIDENCE: The senior care staff on duty said that staffing levels had improved since the last visit in that there was support over the breakfast and lunchtime meals from a dining room assistant. This allowed care staff to concentrate on the care needs of the residents. However this support was not provided at weekends and there were only three care staff rostered for duty on Saturdays and Sundays. The operations manager agreed that this shortfall must be addressed. Ancillary support is provided to the care staff over seven days although the kitchen is only manned until 15.00hrs at weekends leaving care staff to cover the evening meal. Two staff have commenced National Vocational Training (NVQ) in care at level 2. One carer has already achieved NVQ level 2 with one other senior carer having achieved level 3. Personnel files were looked at for two recently employed staff. There were completed application forms in both cases and references had been obtained. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 16 However it was not possible to establish who had provided the references in one case. Although there was evidence of Criminal Record Bureau (CRB) checks in one case the check had been carried out for the previous employment and was not current. There were no interview records and no evidence of any induction. Although one of these staff said that she had worked with under supervision for a week neither had taken part in formal induction programme. There was a training matrix that provided information about training for 2005. This indicated that there was one day of training held on 4 May 2005 when an enormous range of topics was covered for staff: manual handling update; fire drill; fire training; health and safety; food handling; adult abuse and dementia. To cover this amount of information in one day raises questions about the quality and depth of knowledge provided to the staff and how well equipped they are to care effectively for the residents. This is the main source of training for the majority of care staff who are not yet registered for their NVQ in care. Records of supervision were poor and suggested a lack of understanding about formal supervision. Staff were being observed carrying out care practices. However, they were not being provided with the opportunity on a 1:1 basis to discuss their role; any difficulties they might be experiencing; to receive encouragement through positive feedback or to agree any training or development needs. The care staff appraisal tool did not seem to be user friendly and had yet to be introduced to staff. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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): 31, 35 and 38. The management is not well organised with staff not always adhering to company policies. There are some practices at the home that do not promote and safeguard the health, safety and wellbeing of the people using the service. EVIDENCE: The current manager has only been in post a matter of weeks. She has yet to make application to the CSCI to be registered as manager of the home. The manager was off sick at the time of the inspection and the operations manager was overseeing the home in her absence. The company has a policy of not handling resident monies including personal allowances although care staff did not seem to be aware of this. It was established at the inspection that money had been handed to care staff by the relatives of at least two residents to pay for hairdressing. The care staff said that any money handed in was given to the manager or, in their absence the money would be locked in the controlled drug cupboard. No records were Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 18 kept of this poor practice. The operations manager was not aware that residents had money kept at the home and said that the company policy was that any additional expenses incurred by residents would be added to the monthly invoice. There has been no response to the fire safety officer’s inspection report as requested by the CSCI. Maintenance records indicated that the maintenance and servicing of fire safety systems has not been carried out. Fire extinguishers were last serviced in August 2004. Although there is in-house testing of the alarm system, there were no records of maintenance or servicing of the alarm system or the emergency lighting since July 2004. The annual testing of portable electrical appliances was up to date but it was not possible to establish when the five-year testing of the electrics had been carried out or was due. The operations manager said that there had been problems with the plumbing but that these were now being addressed. The water at several of the hot water outlets was far in excess of the required 43°C ( /- 2°C). Records indicated that all staff had received fire training on 4 May 2005 as part of a training day covering numerous topics. Records suggested there had not been any fire drills at the home since September 2005. The provider needs to be satisfied, and there must be evidence, that all staff have taken part in at least one fire drill over a 12 month period and this must include the night staff. Records are kept of accidents involving residents. The report of a recently occurring accident provided a good description of what was found. The detail of action taken was insufficient stating ‘all observations taken’ without information or detail of what these observations were and where they were recorded. This was an unwitnessed accident and there was no indication of when the time the resident had last been seen by staff prior to the accident. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 1 2 X 1 Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 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 OP7 Regulation 15 Requirement 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 the service users are met. The care plans must be drawn up in conjunction with the service user and/or their relatives. (Carried forward from the previous inspection) Timescale for action 05/06/06 2. OP8 13(4) The provider must make sure 05/06/06 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 together with a detailed plan of management where a risk is identified. (Carried forward from the previous inspection) Medication practices must be reviewed together with the policies and procedures. (Carried forward from the previous inspection) 08/05/06 3. OP9 13(2) Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 21 4. OP12 16(2)(m) 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. (Carried forward from the previous inspection) 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. The provider must make sure that the care home is conducted in a manner that respects the privacy and dignity of residents. 08/05/06 5. OP14 12(2)(3)& (4)(a) 08/05/06 6. OP18 12(1)(a)1 3(6) 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. 05/06/06 7. OP27 18(1) The provider must make sure 03/04/06 that there are adequate numbers of suitably qualified and competent staff on duty at all times. (Previous timescale of 31/01/06 not met) The provider must ensure that there is a minimum ratio of 50 trained care staff to NVQ level 2. (Previous timescale of 31/12/05 not met) The provider must review DS0000029204.V282808.R01.S.doc 8. OP28 18 07/08/06 9. OP29 19 01/05/06 Version 5.1 Page 22 Morton Close 10. 11. OP31 OP35 8 17(2) Schedule 4 recruitment practices to make sure that they are robust to properly protect the residents. The manager must make application to the CSCI to become registered as manager. The provider must make sure that proper records are kept of any money handed to staff for safekeeping. If there is a policy not to handle any resident monies then residents, their relatives and staff must be clear about the situation. Staff must be properly supervised. (Previous timescale of 06/02/06 not met) 24/04/06 24/04/06 12. OP36 18(2) 12/06/06 13. OP38 23(4) The manager and provider must 01/05/06 produce an action plan with timescales for the issues raised within the fire safety report, as requested. (Previous timescale of 31/01/06 not met) The provider must make proper arrangements for the maintenance of all fire equipment. Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 23 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. 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. 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. OP15 3. OP15 4. OP19 5. OP30 Morton Close DS0000029204.V282808.R01.S.doc Version 5.1 Page 24 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.V282808.R01.S.doc Version 5.1 Page 25 - 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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