Inspection on 17/07/08 for Morton Cottage Residential Care Home

This inspection was carried out on 17th July 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Morton Cottage Residential Care... 15/01/09

Morton Cottage Residential Care... 30/01/08

Morton Cottage Residential Care... 06/09/07

Morton Cottage Residential Care... 19/07/06

Morton Cottage Residential Care... 04/12/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Morton Cottage Residential Care Home 210 Wigton Road Carlisle Cumbria CA2 6JZ Lead Inspector Diane Jinks Unannounced Inspection 17th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton Cottage Residential Care Home DS0000064307.V368169.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 Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton Cottage Residential Care Home Address 210 Wigton Road Carlisle Cumbria CA2 6JZ 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) 01228 515757 01228 521876 Morton Cottage Residential Care Home Ltd Mrs Amanda Jane Longford Care Home 32 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (32) Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include: up to 32 service users in the category of OP (Old age, not falling within any other category) up to 6 service users in the category of DE(E) (Dementia over 65 years of age) 1 service user in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so, and when a shared space becomes vacant the remaining service user must have an opportunity to choose not to share, by moving to a different home if necessary. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 30th January 2008 2. 3. Date of last inspection Brief Description of the Service: Morton Cottage is owned and operated by Mrs April Dixon with Mrs Amanda Longford as the registered manager. The home is registered to provide accommodation for up to 32 older people. The property is a large detached house on the outskirts of Carlisle. Accommodation for the residents is on two floors with a passenger lift accessing the first floor. There are 24 rooms for single occupation and four that can be shared by two people. All the bedrooms have en-suite toilet and washbasin facilities and there are communal toilet and bathing facilities throughout the home. There are two lounges, one lounge/dining room and a separate dining room on the ground floor. A guide to the services and facilities provided by the home is available on request from the manager. The scale of charges range from £386.00 to £449.00 per week (July 2008). Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The assessment of this service took place over several weeks and included a visit to the home. People using this service, staff, visitors and relatives were asked for their views and opinions about the home, either during the visit or by completing questionnaires. The manager completed an Annual Quality Assurance Assessment, which helped verify information throughout the inspection process. We looked at care records and staff training records as part of this inspection. The pharmacist inspector assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, staff and residents. This part of the inspection took five hours. What the service does well: What has improved since the last inspection? The manager has made improvements to the way in which people’s care needs are recorded and monitored. This helps to ensure that people using this service get the care and support they need. Improvements have also been made to the social and leisure activities at the home. Some of the people using this service have been asked about their interests and hobbies. An activities coordinator has been appointed. This should help ensure that people using this service are given more opportunities to take part in social and leisure activities. One member of staff told us; ‘There are activities for residents, this has been more so recently, for example music, dominoes, bingo, looking at Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 6 books, in particular one about Carlisle and another about Coronation Street – this encouraged conversation and reminiscence amongst the residents. We take people out to the local shops and have been out for a meal recently to a pub in Port Carlisle.’ The home has also made substantial improvements to the general environment. Communal toilets and bathrooms have been refurbished and many of the residents told us how pleased they are now with these facilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 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 Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are able to visit the home and have their care needs assessed prior to moving in. This helps to make sure that the home will be suitable and capable of meeting their needs and expectations. EVIDENCE: The manager has reviewed and updated the home’s statement of purpose and brochure. These documents include information about the facilities at the home and the admission process. Prospective residents are encouraged to visit the home for afternoon tea or for a day visit prior to making a decision. A six week ‘trial period’ is also offered. These measures help to make sure that the home will be suitable and able to meet the needs of people. We looked at a sample of five resident’s care files. They show that people are only admitted to the home following an assessment of their care needs. The manager has reviewed the recording system for assessments that she carries out. Samples of completed assessment forms were seen and samples of the new recording format. Some improvements to the way in which these are Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 9 carried out were noted. There are some gaps in the assessment process and they would benefit from more detailed information being recorded. This will help ensure a suitable and appropriate care plan is drawn up. Where people are admitted to the home from hospital or with the help of a social worker, care needs assessments are also obtained. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service generally have a plan to manage their care needs and requirements. This helps to make sure that care staff provide an appropriate level of care and supported. Medicines were not well managed and this places peoples health at risk. EVIDENCE: At our last inspection of this service, the care plans we looked at did not provide sufficient information about people’s needs or how those needs would be met. We told the manager that improvements had to be made to the way in which care plans were devised and the information recorded. We looked at a sample of five care plans during this visit to the service. We found that care plans have been reviewed and include some reference to risk assessment. The plans generally contain individualised and detailed information about a persons’ health and social care needs and how those needs should be met. Although the people who occasionally stay at the home for respite care have an assessment of their needs, they do not have a detailed Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 11 care plan. This is an area that the manager needs to address quickly to ensure that their needs are not overlooked and are met appropriately. Care plans are reviewed monthly by seniors and audited by the manager. This helps to ensure that they are up to date and continue to meet the changing needs of people who use this service. Some of the people that use this service told us that the ‘care and support they get is very good.’ Daily records show that people using this service have access to health and social care professionals when required. People are visited or visit their doctor, optician and attend hospital appointments. Doctors, community nurses, chiropodists and dentists also make visits to the home when requested. We checked records for receipt, administration and disposal of medication. These are inaccurate and incomplete, placing peoples’ health at risk from errors. Medicines cannot always be accounted for. Records of administration of medicines are mostly printed by the pharmacy and are replaced weekly but contain errors such as wrong dates. Some records are not signed when medicines are given. We checked some of the medicines and in one case a box contained two different strengths of tablets, raising the risk of wrong administration and wrong treatment. We saw medicines being given to people living at the home and this was done sensitively. People are asked discretely if they need pain relief. One person we spoke to is very happy at the way he is given his medicines. He told us that he always got pain relief when he needed it. Some medication, including that packed by the pharmacy into weekly cassettes, is not double checked against records when they are given. This could lead to errors that could affect health. One medication had been stopped six weeks earlier but records continue to be signed for administration. It is not possible to tell if the person has received it in error or if the record has been signed by mistake. We saw a new medicine being given that was a different strength to that recorded. It has been given previously but staff have not noticed the differing strength. Medicines used to thin the blood, need regular blood tests and dosage changes are not managed well. These medicines are packed by the pharmacy into weekly cassettes and this is not recommended, as it is difficult to change doses promptly. One person’s dose had been changed by the doctor a week before the inspection but this has not been changed in the cassette. The person continued to get the old dose leaving them at risk from blood clots. Records of blood tests are poor and it is not always possible to check when they have been done or what the results are. People are able to receive non-prescribed medicines such as laxatives or painkillers and this allows them to have prompt treatment for minor ailments without waiting to be seen by a doctor. However, on two recent occasions staff have given people two doses of paracetamol but have not allowed enough time between them and this could cause harm. New regulations now state that all care homes must have a suitable cabinet for safe storage of medicines liable to misuse, called Controlled Drugs. The service does not have a suitable cupboard and one must be obtained. The service would benefit from undertaking regular checks, or audits, of medication so that problems can be identified and corrected promptly to keep people safe. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to help ensure people using this service are consulted about their preferences and interests and they are provided with opportunities to participate in a variety of activities and outings. EVIDENCE: At our last visit to this service we told the manager that she must consult the people using this service about their interests and hobbies so that an interesting and stimulating programme of activities could be provided by the home. The manager has consulted people using this service and continues to do so on a variety of topics via a monthly meeting for residents. Records show that attendance at the meeting is variable. Sometimes people using this service are consulted as individuals. The manager has started to produce a monthly newsletter to help keep residents and visitors up to date with planned events and other activities that may be happening in the home. The home has just appointed an activities co-ordinator. She was busy for part of the day sorting out the activities cupboard and completing an audit of what Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 13 equipment the home has and needs. In the afternoon residents were entertained with a quiz (some visitors were able to join in too) or played dominoes. Outings and entertainments have been arranged. Residents have recently been out for a pub lunch. Their relatives were able to attend too. People from Tuille House museum have been to the home to carry out an activity with the ‘reminiscence box’, which residents enjoyed and a singer has also visit the home to entertain. An activities book is kept showing a variety of interesting and stimulating opportunities that have been provided for the people that live at Morton Cottage. Some of the people who completed our surveys did say that there ‘is not always enough activities that all can take part in’. A large notice board has been placed in the reception area of the home – this gives information to residents regarding the staff on duty each day and the activities that will be held each day. Garden furniture has been purchased and residents are able to sit out in good weather. One resident has been helped to grow tomato plants. Private bedrooms do have locks on them, but one resident in particular was unable to use theirs, as they are wheelchair user and could not reach. They made a request to change the height of the lock so that they can use it. The manager has actioned this request, making the room more private and secure for this person. People living at the home are able to see their visitors when they wish and may use their own room or one of the communal areas. Visitors to the home are offered refreshments. One resident has been able to bring her pet cat to live at the home with her and another resident has frequent visits from her son and her pet dog. People have access to religious support and Holy Communion, if they wish. The serving of the lunchtime meal was observed. Staff reminded residents what they had ordered for lunch, choices with drinks were given (hot and cold) and condiments were available on the tables. Individual sachets of sauces are used at the home. These may not always be appropriate for many of the residents, especially people who may have dementia. They can struggle to open them, may not recognise what they contain and so may use them inappropriately. We asked people about the food available at the home. One person told us; ‘there are always at least two choices at meal times. The food is all right but the meat is sometimes lacking in portion size. There are fresh fruit and vegetables available, although they do use tinned stuff too.’ People were helped to the table by staff. This was done sensitively and staff used good handling techniques, using specialist equipment where necessary. This helps to make sure that people using this service are supported with their mobility needs safely. Staff spoke to the residents they were assisting and gave clear explanations of handling processes. This helps people to understand what is going to happen and reduces any anxieties they may feel. People were asked if they needed assistance with their food, for example cutting up meat. Some of the residents needed help to eat their meal. Staff helped these people with sensitivity. They spoke to the residents and helped them at an appropriate speed and level. The interaction observed between staff and residents was much improved since our last visit to the home. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in relation to the protection of vulnerable adults. These procedures are not followed, which means that people using this service are at risk from harm or injury. EVIDENCE: We have not received any complaints or concerns about the home nor has the manager of the home. There is a complaint process in place at the home and documentation is in place for recording complaints and monitoring outcomes. People living at the home indicate that they are aware of the complaint process and know who to speak to if they are not happy about something or have concerns. The complaint process is displayed in the home and is included in the home’s Statement of Purpose. Staff at the home have received training in adult abuse and protection. This is covered in their induction training and on-going training. There is a policy and procedure in place regarding abuse and adult protection at the home. The manager also has a copy of the local authority’s guidelines and procedures. There have been no concerns reported to us. However, inspection of some care records indicate that some residents may at times display aggression towards others that live and work at the home. Although the manager has brought these matters to the attention of the community psychiatric nurse, they have not been reported to social services or to us. This means that some people may be at risk of harm or injury at times. This is an area that the manager needs to review and make sure that all of the necessary people are alerted promptly to concerns or allegations of any abuse. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment at the home has improved and people using this service live in a clean and safe environment. EVIDENCE: The manager and owner of the home have started to develop a maintenance plan to help ensure that the home is kept to a good standard and in a good state of repair. Our previous inspections of this service have reported poor communal bathing and toilet facilities and poor hygiene practices. We asked the manager to develop an improvement plan for the home, including arrangements for ensuring the general environment at the home was safe and pleasant for the people that live there. We looked around the home as part of our inspection of the service. Two of the three communal toilets have been refurbished to a high standard. The main bathroom has also been refurbished There are aids and adaptations Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 16 provided to assist people with mobility and promote independence. Some of the people we spoke to are very pleased with the new facilities at the home. One person said ‘The old toilets and bathroom were disgusting, they really let the home down’. There were some residents who had been unable to have baths due to the old facilities; they are now able to enjoy bathing again because of the improved facilities. We also looked at some of the bedrooms used by the residents. There is a programme of re-decoration at the home and some of the rooms had been painted and carpets cleaned or replaced. People living at Morton Cottage are able to personalise their rooms with small items of furniture, pictures and ornaments. Some people have brought their own televisions and radios to the home with them. The home employs housekeepers and the manager has put cleaning schedules in place to ensure that the home is clean and hygienic. The laundry was found to be in a clean and tidy condition with the door kept closed. Some of the people taking part in the inspection indicated that the home was kept clean and tidy. Staff are provided with protective clothing such as gloves and aprons. Bathrooms and toilets are fitted with soap dispensers and paper towels. Staff have been reminded of the infection control procedures in place at the home. These measures help to minimise any risk of cross infection. We had a brief look at the kitchen in the home. The kitchen has been replaced within the last year. It appeared to be in a clean and tidy condition and has been inspected by the food safety office from the local council. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that staff receive suitable training. This helps to ensure that people using this service are supported by skilled and knowledgeable staff. EVIDENCE: The manager has not recruited any new staff since our last inspection of this service. At the last inspection, we found that the manager ensured that all the necessary checks are made on staff, before they commence working in the home. There is a low staff turnover at the home and this helps to ensure consistency and continuity of care for the people that live there. At our last visit to the home, we recommended that the manager devised a staff training and development plan to help ensure that they are kept up to date with their training, skills and knowledge. Some progress has been made with regard to staff training and training plans but this is an area that the manager acknowledges could improve further, especially by implementing a yearly training plan. We looked at a sample of staff records, including training records. They show that approximately 75 of the staff, including night staff, have gained or are working towards a National Vocational Qualification (NVQ) at level 2 or 3. All staff including night staff have completed some specialist training in dementia awareness and challenging behaviour awareness. Training in relation to safeguarding adults (abuse) is included in the induction training programme Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 18 and the NVQ programme. The manager has arranged some refresher training in this subject, for all staff, during July and August 2008. Manual handling refresher training has also been arranged for September and October 2008. The manager has covered the Safer Food Better Business food hygiene processes with staff responsible for preparing tea, as recommended by the food safety officer. All night staff and senior staff employed at the home have completed an appointed persons first aid course. The manager carries out some of the training herself and is an assessor for the NVQ programme. External training providers also provide training, where specialist input is required. We spoke to some of the staff and others completed surveys. One member of staff told us that; ‘I am provided with all aspects of training and I fully take advantage of all courses available to me. We have a daily report every shift change so relevant information is passed on to staff at every shift.’ A resident commented; ‘Staff will help when needed; they are very capable and confident. I feel that they know what they are doing. There is handling equipment, which they use, to help them with people who are difficult to move.’ Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the way in which the home is maintained and managed. There are some gaps in the record keeping processes, which means that people using this service may not always be properly protected from harm. EVIDENCE: After our last visit to the service the manager was asked to produce an improvement plan to ensure that any requirements we had made were addressed and implemented. We have found that action has been taken and improvements have been made where required. The manager has started to put into place a system for reviewing and improving the quality of services, including an annual development plan for the home. Surveys have been used to obtain the views of visiting professionals Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 20 and relatives. People who use this service are able to attend the monthly residents meeting and are encouraged to express their views and opinions. These measures should help the manager to continue making improvements to the service. As part of our inspection process, the manager is required to send us a self assessment of the service – the AQAA. In this assessment the manager has identified areas where improvements have been made and areas that would benefit from further action and improvements. Where the home is responsible for the safe keeping of resident‘s monies and valuables, accurate records are maintained and safe storage is available. We looked at a sample of three staff records. These show that staff supervision has commenced and include individual and full staff meetings with the manager and direct observation of care practices. Some of the health and safety records were looked at. All the electrical appliances testing at the home has been completed. Fire fighting equipment has been serviced and the fire alarm panel has now been replaced. Central heating systems and boilers have been serviced. These checks help to make sure that the home is a safe place to live and work. Manual handling risk assessments have been undertaken, including the use of handling equipment. These are reviewed frequently, with the care plans. Copies of these risk assessments are kept in individual’s bedrooms so that staff have easy access to them and are reminded of the potential risks. There are some records, which the manager does not keep up to date or accurate. Medication and the safeguarding of people that use this service is managed poorly. There are some gaps in the way medication is managed and recorded, which may leave people using this service at risk from harm or of not receiving the right treatment. Some, but not all accidents and incidents are recorded. The manager is required by law to notify us of any incident, which affects the well-being of people that use this service. Records show that the manager does not comply with this, despite the fact that we have made requirements at previous visits to the home. Where incidents of abuse have occurred, the manager has not reported these matters to social services. Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 17(1) Requirement Records for receipt, administration and disposal of medicines must be accurate to protect people from errors. Timescale for action 01/09/08 2. OP9 13(2) Medicines must be checked and 01/09/08 given as prescribed, and changes to medication must be accurately recorded and implemented promptly so that residents receive safe and effective treatment. A legally compliant controlled drugs cupboard must be used to store controlled drugs to help ensure they are not mishandled or misused. There must be a robust process for recording and reporting all suspicions or allegations of abuse, including arrangements for ensuring that the appropriate authorities are notified of such incidents without delay. People using this service must be protected from the risk of harm or abuse. DS0000064307.V368169.R01.S.doc 3. OP9 13(2) 17/10/08 4. OP18 13 14/08/08 Morton Cottage Residential Care Home Version 5.2 Page 23 5. OP38 37 The records required to be kept by regulation, including accident and incident records, must be maintained accurately and kept up to date. The Commission for Social Care Inspection must be notified of any event, which adversely affects the well-being or safety of any person using this service. 14/08/08 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 OP7 Good Practice Recommendations A detailed plan of care should be developed for each person using this service for respite care. The plan should take into account the needs and risk assessments. This will help ensure that people using this service are supported safely and the care needs and outcomes identified are being met properly. Medication from different containers should not be mixed to reduce the risk of wrong medication being given. Regular audits of medication should be done to monitor the management of medicines and to keep people safe. It is recommended that people using this service continue to be consulted and involved in the development of the activities programme at the home. It is recommended that the manager and provider continue to develop the quality assurance and monitoring processes at the home. This will help identify where further improvements to the service can be made. 2. 3. 4. OP9 OP9 OP12 5. OP33 Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Local Office 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton Cottage Residential Care Home DS0000064307.V368169.R01.S.doc Version 5.2 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. 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