Inspection on 21/07/05 for Morton House

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Morton House 30/05/07

Morton House 07/08/06

Morton House 10/01/06

Morton House 26/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Morton House The National Society For Epilepsy, Chesham Lane, Chalfont St Peter Gerrards Cross, Bucks SL9 0RJ Lead Inspector Barbara Mulligan Unannounced 21st July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 House Version 1.10 Page 3 SERVICE INFORMATION Name of service Morton House Address The National Society For Epilepsy, Chesham Lane, Chalfont St Peter, Gerrards Cross, Bucks, SL9 0RJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01494 601300 01494 871927 jo.yates@epilepsynse.org.uk The National Society for Epilepsy Johanne Hazel Yates Care Home 17 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Morton House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 5th January 2005 Brief Description of the Service: The National Society for Epilepsy is an independent registered charity that is administered by a Board of Governors who oversee the running of the Chalfont Centre. The centre is located on a large rural site on the edge of the village of Chalfont St Peter. It consists of residential houses, a supported living project, a number of workshops and sites for daytime activities, an assessment unit which is an NHS provision, and additional services including a chapel, a restaurant central kitchens and laundry, a small shop run by service users, administrative buildings and staff accommodation. Morton House is one of the residential houses and is situated centrally on the site. The house is surrounded by attractive, open, grassy areas. It has no private garden of its own but a small area at the front with benches and tubs of flowers. The home is a two storey building and access to the upper floor is by stairs or passenger lift. All rooms are single accommodation and there is a small kitchen, a bright and spacious dining and living room. There is access to public transport and this is used by service users living in the home. The home provides double bedroom accommodation on request, presently providing for one married couple. Morton House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 21st July 2005, 2005 at 11.00am. The visit consisted of discussions with the deputy manager and a tour of the home. Records, policies and procedures were also examined. The Registered Manager was not present for the majority of the inspection but returned at the end of the visit. The inspection officer was Barbara Mulligan. The Registered Manager for the home is Johanne Yates. What the service does well: What has improved since the last inspection? What they could do better: Morton House Version 1.10 Page 6 Although care planning documentation has been enhanced, not all care plans have yet been improved and updated. This has been on-going for a lengthy period and now needs to be completed. Requirements made at the previous announced inspection regarding the environment have not been complied with. The organisation need to ensure that prompt attention to repairs and a rolling programme of maintenance is sustained. Generic risk assessments need to be completed and implemented following the health and safety inspection of the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Morton House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Morton House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 and 5. Prospective service users have the opportunity to visit the home on an introductory basis, before making a decision to move there, ensuring that service users are able to make an informed choice about where they live. Each service user has an individual written statement of terms and conditions with the home that needs to be signed by service users, relative or relevant third party and the registered manager. EVIDENCE: Morton House Version 1.10 Page 9 The home has had one new admission since the previous announced inspection. A detailed assessment was observed for this individual. The assessment tool used is the National Society for Epilepsy’s own assessment tool. This is comprehensive and covers all areas detailed in Standard 2. There is evidence in the care notes that the care-plans are working documents. All specialised services offered are accessed through health care professionals on site. Specialist services include physiotherapy, psychology, dental and chiropody services. There is specialist equipment in place that includes an adapted bath and grab rails. Trial visits are individual to each service user. These can range from a few days to a month. Following the trial visit the potential service user will have a review. If this is successful and the service user is offered a placement; on condition of agreed funding and a contract with the placing authority; a contract/statement of terms and conditions is signed when the service users moves, in the home, these were looked at during the visit. The home does not accept emergency admissions. Morton House Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 10. Not all care planning documentation adequately provides staff with the information they need to satisfactorily meet service users needs and this needs to be addressed. Personal information is handled appropriately ensuring that personal confidences are respected. EVIDENCE: Morton House Version 1.10 Page 11 A random selection of personal files and care plans were looked at. Each service user has two files. One is a working document that contains information and plans of care used on a daily basis. The second file contains information used infrequently. These include old daily reports, copies of reviews and old communications. Following the previous announced inspection a requirement was made for a full assessment of needs for service user R.F to be undertaken and for staffing levels to be reviewed following this assessment. It was pleasing to see that this had been complied with. Following this assessment service user R.F had a detailed, informative and comprehensive plan of care in place and this is to be commended. Care planning documentation has been improved and most care plans have been updated to incorporate this. However there are still approximately six plans of care that need to be completed. This needs to be done as soon as possible. It is a requirement of the report that all service users plans are fully completed and contain an action plan that details the action that needs to be taken by care staff, to ensure that all aspects of the health, personal and social care needs of the service user are met. The care plans looked at cover communication, mobility, personal hygiene needs, health care needs, religious needs, social life (off the centre) and social life (on the centre) and family contacts. A requirement was made following the previous announced inspection that all individual records and home records are confidential and used in accordance with the Data Protection Act 1998. It was pleasing to see that this had been complied with. All files were seen to be stored in lockable filing cabinets in the staff office. All service users records looked at were accurate and secure. Staff training in issues of confidentiality takes place during their initial induction. Matters regarding confidentiality are included in the Adult Abuse Policy dated 1999. The families of service users are not given information about confidentiality. Morton House Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during the inspection. EVIDENCE: Morton House Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Morton House Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. The home has effective complaints procedures to ensure that service users or their representatives are listened to. EVIDENCE: There is a complaints procedure and this is available in pictorial form and gives a list of people whom service users can approach with their complaint. Copies of the complaints procedure are included in the Statement of Purpose and the Service Users Guide and this gives guidance about referring a complaint to the Commission for Social Care Inspection. There is a separate complaints format used for service users to make a complaint regarding the food. The home has a dedicated book for the recording of complaints. No complaints have been received since the previous announced inspection. Morton House Version 1.10 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. However, prompt attention to repairs and maintenance of the home needs to be sustained, to ensure that the home remains safe, comfortable and accessible to the people living there. The kitchen needs to be replaced to ensure that it is accessible to service users. Work needs to be carried out to improve this area of the home. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. EVIDENCE: Morton House Version 1.10 Page 16 Morton House is a two storey building which can accommodate seventeen service users. Access to the upper floor is by stairs or a passenger lift. Each service user has their own bedroom all with hand basins. Each room is decorated to individual tastes and personalised with pictures, photographs and ornaments. Bedrooms are lockable, and the inspector was told that service users who have been risk assessed regarding safety issues have their own keys, although some service users did not wish to have a lock on their door; this choice is reviewed regularly. Communal areas are comfortable, bright, cheerful, airy, clean and free from offensive odours. The lounge and the dining area are decorated tastefully and the furnishings and fittings are of good quality and domestic in character. However, the kitchen area is not readily accessible to service users and is very small. It was noted that when the hot food trolley was in the kitchen it was very cramped and was hazardous to staff working in this area. The drawers are broken and difficult to open, cupboards are in need of replacement and storage is inadequate. Access for service users with mobility problems is difficult. A requirement was made following the previous announced inspection that the kitchen units be replaced, with consideration being given to improving accessibility for service users. The timescale for this is 30/08/2005. However, the registered manager stated that there was no planned work due to take place. This will remain a requirement of the report. Work had been completed to provide shared accommodation for a married couple. This has involved converting two single rooms into one double bedroom and the transition of one single room into a kitchen/dining room. Bathing and toilet facilities comprise of five toilets, two bathrooms and two shower facilities. Shared spaces in the home include a lounge and a dining room that were both bright and spacious. On the upper floor there is a quiet kitchenette/dining area that is used mainly by the service users living on the upper floor. This is spacious and nicely decorated. The home has one quiet room where service users can meet visitors in private. The laundry facilities are situated in the home’s utility room which ensures soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. There is also a large laundry on site for linen and red bag laundry. Service users are encouraged to help with or do their own personal laundry themselves. Hand washing facilities are prominently sited in the toilets and bathrooms. The home has a sluicing facility in the utility room. There is an infection control policy available for staff and there were instructions for the washing of foul linen displayed in the laundry area. It was noted that the corridor both up and down stairs have worn and stained carpet and this needs to be replaced. This was a requirement of the previous announced inspection and will be a requirement of this report. Morton House Version 1.10 Page 17 The coir matting by the front door is very worn and has become slippery and urgently requires replacing. Again, this was made a requirement of the previous announced inspection and will be a requirement of this report. Service users are able to meet with visitors in the privacy of their own room if they wish to. Service users who smoke do so outside of the home. There is no private garden area, however the grounds surrounding the home has been looked after by the service users, and plants and pots were on display. The home offers access to local amenities and examples of these are the local library, restaurants, health/medical centre, shops and pubs. The home has access to transport, but does encourage service users to access public transport. There are no CCTV cameras in use. Morton House Version 1.10 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Staffing numbers are adequate to ensure that the assessed needs of the service users are met. EVIDENCE: Following the previous announced inspection a requirement was made for the Registered Manger to undertake a full assessment of needs for service user R.F. and to review staffing levels following this assessment. It was pleasing to see that this had been completed and extra care hours have been allocated to provide extra support for this service user. However, the extra hours are provided by agency staff which does not provide consistency of care. The home has one vacancy for a full time support worker and is seeking to recruit for this post at the time of the visit. Three care staff are on duty throughout the day and one agency staff. There are two waking night staff and a further carer until 23.00hrs. This level of cover was seen to be in place on the staff rota and sufficient to meet the needs of service users living in the home. Morton House Version 1.10 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40, 41 and 42. Overall health and safety procedures are in place, although there is a need to ensure that records are maintained of all mandatory training for staff. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. EVIDENCE: Morton House Version 1.10 Page 20 All policies and procedures are kept in the office and are accessible to all staff working in the home. Staff are encouraged to read the home’s/organisation’s policies. The organisation’s policies and procedures were looked at during the visit and there is evidence to demonstrate that these are being reviewed and updated. At the time of the visit the complaints procedure was in a picture format, however there are no other policies available in different formats for service users. Service users do have access to their own records if they so wish. Service user records and home records are up to date, stored securely and in good order. A requirement was made following the previous announced inspection regarding the recording of confidential information. It was pleasing to see that this had been complied with. The care plans that have been updated to incorporate the new format were informative and detailed. However there still remain approximately six care plans to be completed and this needs to be undertaken with urgency. The records for health and safety matters and regarding maintenance of the environment were up to date. The homes policies and procedures are comprehensive and cover a wide range of issues. All confidential information is kept in secure areas of the home. Training records for the staff team were looked at. The Deputy Manager said that all staff were up to date with mandatory training. However training records do not demonstrate this. The registered manager is required to provide the Commission with evidence that all staff are up to date with mandatory training. This is to include fire training, moving and handling training, basic food hygiene training and first aid training. Records were looked at regarding fire safety. Certificates were seen for the servicing of fire safety equipment. This was last completed on 20/06/2005. The home holds two annual fire drills and evacuation. There was documentation that fire exits and the fire alarm panel are checked on a daily basis. During the previous announced inspection concerns were raised by staff regarding the fire exit in the lounge, leading to the small patio area at the back of the house. This is a deep sloping pathway leading from the fire exit door which was felt to be unsafe for any service users who may have difficulties mobilising. A requirement was made for the registered manager to risk assess this fire exit door and to provide an action plan on how to minimise the risk to service users. A copy of the risk assessment to be sent to the Commission. This has not been complied with and will be a requirement of this report. During the previous announced inspection there were no health and safety generic risk assessments in place. This was discussed with the manager and it was advised that the home needs to identify a health and safety officer/representative. Following this a thorough health and safety inspection needs to be undertaken during which risks will be identified and risk assessments put in place; this was made a requirement of the report. The Deputy Manager said that the home now has a named health and safety officer and a recent health and safety inspection was undertaken. However, there was Morton House Version 1.10 Page 21 no paperwork, i.e. generic risk assessments available for inspection purposes. It will be a requirement of the report that generic health and safety risk assessments are in place and made available at the next inspection. There was evidence that the gas cookers and the boiler were last serviced on 07/11/2004. There was evidence that water temperatures are recorded on a weekly basis and the manager informed the inspector that the water systems were last tested for Legionella on 26/06/2004. An electrical wiring certificate was seen and dated 15/11/2003 and PAT testing was last undertaken in November 2004. All hazardous substances were seen to bestored appropriately and the COSHH sheets were observed to be up to date and accurate. There were health and Safety posters in place around the home. The home has an accident and incident book and this was well documented and legible. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Morton House Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 x Standard No Version 1.10 Score Page 22 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x 3 Score 24 25 26 27 28 29 30 STAFFING 2 3 3 3 2 2 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 2 x Morton House Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 18 Requirement The registered manager is required to ensure that all care plans are completed using the new care plan format. (Previous timescale of 30.05.05 not met.) The registered provider is required to ensure that the kitchen at Morton House is replaced, with consideration being given to improving accessibility for service users. The registered manager is required to ensure that the carpets in corridors both up and down stairs are replaced. (Previous timescale of 30.06.05 not met.) The registered manager is required to ensure that the coir matting by the front door is replaced. (Previous timescale of 30.05.05 not met.) The registered manager is required to ensure that evidence of staff mandatory training is sent to the Commission. The registered manager is required to ensure that health and safety generic risk assessments are completed and made available for the next Version 1.10 Timescale for action 30/10/05 2. 28 23 30/08/05 3. 24 23 30/08/05 4. 24 23 30/08/05 5. 42 18 30/08/05 6. 42 13 30/09/05 Morton House Page 24 7. 9 13 inspetion. ( Previous timescale of 30.06.05 not met.) The registered manager is required to risk assess the fire exit door in the lounge and to provide an action plan on how to minimise the risk to service users. A copy of the risk assessment is to be sent to the commission. (Previous timescale of 30.04.05 not met.) 30/08/05 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. 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