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Inspection on 18/09/06 for Morton Court Nursing Home

Also see our care home review for Morton Court Nursing Home for more information

This inspection was carried out on 18th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This home provides a pleasant homely and clean environment for residents. The home has provided evidence prior to this inspection, which shows that the home continues to meet the needs of the residents. Those residents spoken to expressed their satisfaction about all aspects of the care provided. The care staff are a competent team, who were observed to be kind and polite when speaking to residents. The manager and staff are good at developing positive relationships with each resident. The home also has a training profile for all care workers detailing what training has been undertaken. The homes quality assurance system enables the home to ensure that continuous improvements are identified and acted upon.

What has improved since the last inspection?

What the care home could do better:

The provider must ensure that all residents or their representatives are aware of the plan of care and have signed the care plan acknowledging that they agree with the care provided by the home. The homes risk assessment must state what action is to be taken if a risk relating to a resident is identified in the building. The homes quality assurance format undertaken by the manager must be made user friendly, posted on the notice board for the information of residents and provided in large print. The manager has been made aware that it is perceived that during staff handovers (when new staff come on duty and are informed of the days events) that there is a lack of carers on the shop floor to care for residents.

CARE HOMES FOR OLDER PEOPLE Morton Court Nursing Home Ashby Avenue Lincoln Lincs LN6 0ED Lead Inspector Mr Doug Tunmore Unannounced Inspection 18th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton Court Nursing Home DS0000002614.V312148.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 Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton Court Nursing Home Address Ashby Avenue Lincoln Lincs LN6 0ED 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) 01522 689400 enquiries@lacehousing.org LACE Housing Limited Mrs M E Waterer Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: Morton Court is a care home that provides both nursing and personal care for persons who are 65 years of age or over. Morton Court is a purpose built home that is sited to the south of the City of Lincoln. There is limited car parking facilities to the side of the building but street parking is available. Accommodation for residents is provided in single rooms with en-suite WC, wash hand basin and shower. Facilities are on the ground floor and the first floor, which is accessed by a passenger lift. Morton Court is one of a group of homes owned and operated by a voluntary organisation, LACE Housing. The day-to-day management of the home is the responsibility of the registered manager. The current scale of charges at this home is from £360.00 to £541.00. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took into account any previous information held by Commission for Social Care Inspection (commission) including the homes previous inspection reports, their service history, the homes pre-inspection questionnaire and residents questionnaires sent to the home by the Commission prior to this inspection. The site inspection consisted of case tracking a sample of two resident’s records and assessing their care. The inspector spoke with one of the residents who was being case tracked and joined two other residents for lunch. The inspector also spent time with the manager, deputy manager and one member of staff. One visitor was also spoken to. A partial tour of the home and a review of a sample of the records was also included. What the service does well: What has improved since the last inspection? What they could do better: Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 6 The provider must ensure that all residents or their representatives are aware of the plan of care and have signed the care plan acknowledging that they agree with the care provided by the home. The homes risk assessment must state what action is to be taken if a risk relating to a resident is identified in the building. The homes quality assurance format undertaken by the manager must be made user friendly, posted on the notice board for the information of residents and provided in large print. The manager has been made aware that it is perceived that during staff handovers (when new staff come on duty and are informed of the days events) that there is a lack of carers on the shop floor to care for residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Morton Court Nursing Home DS0000002614.V312148.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 Court Nursing Home DS0000002614.V312148.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive care needs admission assessment, which helps to ensure that a residents needs would be met. EVIDENCE: A review of all information available prior to this inspection, including previous inspection reports dated 07/06/05 and 27/09/05, and evidence seen at this inspection in residents files and care plans, showed that the home does not admit residents without a care needs assessment being undertaken. Residents files also showed that health care professionals and social workers are involved in assessing the care needs of residents prior to admission. Files also evidenced that prospective residents are also written to by the home confirming whether they can meet the residents care needs or not. Residents can have a trial visit lasting up to 4 weeks to see whether or not they like the home. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care. The commission sent residents questionnaire forms (Have Your Say About…) to the home prior to this inspection and seventeen were returned. Relatives and care staff helped to complete the majority of questionnaires on behalf of residents. Fifteen questionnaires confirmed that residents had information about the home prior to admission and nine also agreed that they had received a contract. A number of questionnaires were only completed in part, so numbers will not always reflect the number of questionnaires received. Written comments made in questionnaires were;’ I have stayed here about five years ago and enjoyed my stay’. One resident said that ‘It’s been a very good experience and it’s a very good home’. The manager confirmed that contracts are kept at head office and residents or their representatives are given a copy. Morton Court Nursing Home DS0000002614.V312148.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Residents are not involved in the care plans. There is good care planning in this home which helps ensure that the general health and welfare of residents is addressed. Nursing staff are trained and proficient in administering medication. EVIDENCE: A previous inspection undertaken on the 27/09/05 showed that ‘all residents had detailed care plans, which described their health and welfare needs’. Care records included admission details, assessment of daily living activities, personal history and moving handling assessment, risk assessment, care plan and daily report. One visitor said that care plans had not been reviewed with their brother on a monthly basis. This inspection also showed that GPs and chiropodists visit the home on a regular basis to attend to the health care needs of residents. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 11 Those files of residents who were being case tracked were found not to have empowered residents in respect to ensuring that they signed their care plans or care needs reviews. This needs to be undertaken to ensure that any changes to residents care is jointly agreed between the manager, residents or representatives. The questionnaires (Have Your Say About…) returned by residents showed that eleven felt that they always receive the medical support that they need and six felt that they usually received the medical support that they need. Individual care plans evidenced that accidents are recorded in the homes’ accident book and in the resident’s daily notes. Accidents are also recorded on the resident’s body map, which is used for the mapping of any cuts or abrasions over a period of time. Residents questionnaires also showed that twelve felt that they received the support that they need and four said that they usually receive the support that they need. One resident felt that he sometimes receives the support that he needs. This was brought to the attention of the manager. Seven residents commented that they felt that staff are always available when they need them and ten felt that staff are usually available when they need them. Written comments made by relatives were, ‘I do not feel the care would be adequate without daily visits from myself, my sister or my brother’. ‘The nursing staff are always available for medical needs’. My mother has dementia and MRSA. The staff at the Morton Court looked after her and she is now clear of MRSA – and has a quality of life I doubted she would ever have again’. One resident commented that ‘ I am looked after very well and if I was ill they would get things done’. The local authority on the 24/02/05 undertook a contract compliance visit and found that ‘residents spoke expressed satisfaction with the care and support they received at Morton Court’. The commission received a copy of the pharmacist inspection report undertaken on the home on the 07/06/06 and recorded that medication was maintained satisfactorily. Due to this and the fact that medication was seen to be correctly recorded in the homes last inspection, medication was not inspected at this time. The homes training profile evidenced that safe handling of medication training had been undertaken on the 06/10/05 for those nurses charged with this task. Morton Court Nursing Home DS0000002614.V312148.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. A range of stimulating activities are made available to residents. Relatives and friends of residents are made welcome in this home. Meals are well managed and reflect the dietary needs of residents. EVIDENCE: Previous inspections have found that the home has an activities programme. The commission has received, prior to this inspection, an activity programme from the manager. Activities include bingo weekly, cards and dominoes, movement to music twice weekly, communion monthly and visits to local parks as well as the use of a day centre. A barbeque was held on the 12/09/06. Residents questionnaire showed that six commented that there are activities and they are available to them always, three residents commented that activities are usually available and four felt that activities are sometimes available. One resident’s written comment was that ‘music afternoons are much appreciated’. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 13 One visitor stated that he had a lot of respect for most of the staff who do their job to the best of their ability. Three residents stated that they get involved in activities such as baking, bingo and movement to music. One of the residents confirmed that she walks in the garden when it is sunny and if not in the homes corridors to keep herself mobile. The regulator noted that after lunch this resident did in fact take time to walk around the garden. The home has a designated activities organiser who works nineteen hours a week. One resident stated that the food is very good and if you don’t want it you can have something else. Residents felt that their relatives are made welcome at this home. The inspector joined two residents for lunch and was informed that the food is always fresh and choices are available. The staffs were seen to be supporting residents to eat during lunch. They were sensitive to the residents needs and coaxed them to eat as much as they required. At the time of the inspection it was a hot day and it was noted that soft drinks were available in lounges and residents bedrooms. Residents questionnaires showed that eight always liked the meals and six usually liked the meals provided. Morton Court Nursing Home DS0000002614.V312148.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe environment in which residents are protected from abuse. EVIDENCE: Previous inspections of this home have shown that a detailed complaints procedure is in place, which is posted on the residents’ notice board. The homes pre-inspection questionnaire recorded that that one complaint had been made in the last year. This complaint was discussed with the manager. A visitor was seen who stated that he had a degree of dissatisfaction regarding the home and a meeting was planned for the 20/09/06 when members of his family would meet the provider to discuss their concerns. Resident’s questionnaires showed that they all were aware of how to make a complaint and twelve knew who to speak to if they were unhappy. Written comments made were that, ‘Any complaints have been dealt with promptly’. ‘Everybody is so kind’. All three residents seen stated that the staff are lovely and that they felt safe in this home. The homes training profile shows that safeguarding vulnerable adults training has been undertaken by all care workers on the 01/03/06 and 02/03/06. A Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 15 care worker confirmed that she had undertaken adult protection training and was clear about what action she would take if it came to her attention. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 16 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): 19,26 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained and is clean and tidy, with a pleasant smell throughout. EVIDENCE: The home employs separate staff for domestic and laundry services. Gloves and aprons are available and the home has an infection control policy. A tour of the home found that it was clean and well aired and no unpleasant odours were evident. The homes pre-inspection questionnaire showed that five bedrooms have been refurbished, as well and one lounge, dining room and corridors. The environmental risk assessments were seen and it was found that they did not include what action to take on any identified risk to a resident Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 17 The local authority contract compliance visit found that ‘the home presents well, furnishing was of a good standard and the home had a good atmosphere’. The residents survey overwhelming confirmed that the home always smells nice and is clean and tidy. One comment made was that the home is not as clean or tidy at weekends. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 18 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 & 30 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by robust recruitment practices. Residents benefit from a staff team who are well trained and work well together and complement each others skills. EVIDENCE: Previous inspections and information received prior to this inspection show that this establishment undertakes robust recruitment procedures to help ensure the safety of those people who live in this home. All care workers have been given the General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. The home has twenty two care workers, eight nurses, two kitchen assistants, two cooks and a maintenance man two days a week. The homes training record was seen which showed that, ten care workers had NVQ (National Vocational Qualifications) level 2, with three of these having NVQ 3, two workers are currently awaiting to undertaking NVQ level 2 training. Five care workers have undertaken the Skill For Care training as well as the homes induction to the home training. Two kitchen assistants have NVQ 1 & 2. The home meets the standard for 50 of staff to be trained to NVQ level 2. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 19 One carer stated that she has undertaken mandatory training and has NVQ levels 2 and 3. She also said that they could do with another carer in the mornings when they are busiest. She also confirmed that the residents call bells are responded to answered as quickly as possible. One resident confirmed that ‘I press my buzzer and staff come straight away’. She also said that ‘I am sure there are enough staff, they have taken on a new staff member I have not seen before’. The homes pre-inspection questionnaire evidenced that since the last inspection forty-eight hours of care time is available in the home on a weekly basis. The homes pre inspection questionnaire and the homes training profiles show that both nursing staff and care workers undertake statutory training such as fire training, moving and handling and first aid are undertaken at this home. Other training undertaken included; diabetes update, stroke awareness, infection control and tears building. Those questionnaires completed by residents showed that fourteen stated that staff listen and act on what I say and two commented that staff usually listen and act on what I say. Other comments were that the handover period when new staff come on duty and are briefed causes numbers of staff to be absent from the ‘shop floor’. This was brought to the manager’s attention. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 20 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): 31,33, 35, & 38 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and trained to manage this establishment. Records seen show that residents health and general welfare and safety is promoted. EVIDENCE: The registered manager is qualified and experienced in running this home for older people who have nursing needs. She has completed her registered managers award and continues to up date her training as required. A care worker stated that the manager is professional and supportive in carrying out her duties. The home conducts an in house quality assurance (QA) report. The quality assurance report is not posted for the information of residents and visitors. A sample of the homes internal audit was seen and showed that comments were Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 21 positive in respect to the care provided to residents. However, it was not user friendly and should be simplified to ensure that all residents are aware of the outcomes of any survey. The manager also undertakes residents meetings with minutes kept for future reference. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. The homes pre-inspection questionnaire evidenced that fire alarm, fire drills and emergency lighting checks have been undertaken. A check of the fire log was undertaken and it was found to be up to date. Care staff also receive fire training as part of the homes initial training and as a regular training event. Residents’ personal allowances were seen and it was found that an accurate record is kept and receipts are available for any monies spent, with signatures made by the registered manager or the deputy manager. Supervision of care staff has been undertaken in 2005/06; the registered manager carried out appraisals of nursing staff or care staff. One carer confirmed that her supervision had been undertaken in 2005/06. The homes pre-inspection questionnaire has evidenced that maintenance and service histories of all aids and adaptations are carried out as required by law. All wheelchairs seen on the day of the inspection had footplates, which were in use. Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 22 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 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 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 3 X 3 X 3 X X 3 Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 (2)(a) Timescale for action The provider must make the care 25/11/06 plan available to the resident or their representatives for signing thus agreeing to the care to be provided. The provider must have a risk 25/11/06 assessment, which includes what action to take on any identified risk to a resident. Requirement 2 OP24 13(4)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Morton Court Nursing Home DS0000002614.V312148.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Court Nursing Home DS0000002614.V312148.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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