Inspection on 30/05/07 for Morton House

This inspection was carried out on 30th May 2007.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morton House 07/08/06

Morton House 10/01/06

Morton House 21/07/05

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 Amanda Longman Unannounced Inspection 30th May 2007 10:00 Morton House DS0000023000.V335548.R01.S.doc Version 5.2 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 House DS0000023000.V335548.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 Adults 18-65. 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 House DS0000023000.V335548.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494 601300 01494 871927 jo.yates@epilepsynse.org.uk martineau@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 DS0000023000.V335548.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 17 residents, some of who may have a physical disability, learning disability. 7th August 2006 Date of last inspection 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 kitchen, a bright and spacious dining room and two living rooms. 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. Fees range from £896.70 to £2425.14 per week. Extra charges apply for such services as hairdressing, chiropody, toiletries, magazines/papers and leisure activities such as football, outings and holidays. The home has an equal opportunities policy in place and is developing a person centred approach to care which will adress the diversity needs of individual service users including religious, ethnic or cultural needs. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. It was a thorough look at how well the service is doing. Unfortunately no information was received from the service provider prior to the site visit which occurred on 30 May 2007. Questionnaires were received from two service users, four relatives and six visiting professionals and their comments were incorporated into this report. Information about the service was received from the acting manager after the site visit and this has been incorporated into the report. During this visit the inspector looked at care records and staff records and spoke at length with the acting manager. Care workers were spoken with and one was interviewed in detail. Care practice was observed and time was spent talking with, and observing the care of, service users. Two service users were interviewed in private. What the service does well: What has improved since the last inspection? The majority of the health and safety requirements from the previous inspection have been met. The manager is currently addressing the issue of fridge temperatures as a matter of urgency. The acting manager has reviewed major areas of the working of the home such as care planning, activities and staffing, with the aim of improving the atmosphere within the home and the quality of life enjoyed by the people who live there. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 6 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 House DS0000023000.V335548.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Morton House DS0000023000.V335548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is adequate. Service users do not have sufficient information to decide whether or not the home is suitable for them and their needs are not always appropriately assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An out of date certificate of registration and inspection record were on display in the entrance hall. Since the site visit an up to date certificate has been issued and the most recent (August 2006) inspection report made available. The Statement of Purpose and Service User Guide are both out of date and are currently being reviewed. The acting manager will ensure that they are reviewed in line with the relevant national minimum standards and regulations and forward up dated copies to the Commission and to service users. There is no evidence that the Service User Guide or Statement of Purpose have previously been made available to service users. Despite this, five out of six service users and relatives who replied to the CSCI questionnaire stated they had sufficient information about the home. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 9 Although all six professionals who replied to questionnaires stated that the home always or usually assessed service users needs appropriately, there was little evidence of an assessment on all three files of service users examined. Some contained brief information on assessed needs and one contained an out of date pen picture of the service user. One which contained some assessment information was out of date. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. Service users do not have appropriate individual plans, nor risk assessment and management plans. However, this is currently being worked on by the acting manager. Service users are appropriately assisted to make decisions about their own lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All six professionals who answered questionnaires said that health care needs were always or usually met. However, none of the service user records checked had detailed service user plans in place. In fact one care plan, including the daily routine, was completely blank. The inspector spoke with the acting manager about the lack of personal service user plans. The acting manager is aware of this deficit and has begun to collate new service user plans with service users. The outline of one was seen. It is largely written in the first person and contains good person-centred information about the persons life history, their care needs and preferences, risk management and choices and their hopes and aspirations. It also contains a section on care after Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 11 death and, as it is person-centred, it will include diversity needs. This exercise needs to be completed with all service users. The four professionals who answered the question about choice said service users were always or usually assisted to make choices about their daily living. Of the four relatives who answered questionaires two said their relatives were always assisted to live the life they chose, one said usually and one said sometimes. The two service users who replied stated that they were able to do what they wanted throughout the day. Service users spoken with said they had choice in lifestle and day to day activities. This was also stated by care workers spoken with. Service users were observed making choices about how they passed their time, which activities they joined in and where and when they ate (either within the home or at the on-site restaurant, and whether they had their main meal at lunchtime or in the evening). The manager recently arranged for a specialist organisation that arranges holidays for disabled people to come and talk with the service users to encourage choice and decision making in holiday planning. The service has a risk assessment and management policy dated July 05. Some risk assessments and management plans were in place but only for certain tasks and there was no evidence of best practice in the compilation of good risk assessments and management plans. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. People who use the service are able to make choices about their lifestyle. Activities within the home need to be further developed to meet individual’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities and employment are available on-site within the NSE organisation. On the day of the site visit two service users were working at Chalfont Assembly and Packing (CAPS), an on-site business run by the Society, and one was employed gardening. The NSE is a large campus and has a learning and skills department, a social centre, a recreation ground, a restaurant and a small shop. There are centrally organised activities, including social and fitness groups but, the acting manager explained, these are limited. The Society also has a therapy centre but there is currently no outreach from the Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 13 therapy centre at Morton. The home itself has experienced a difficult time over the last twelve months. Due to other homes at the site closing , there has been a large turnover of service users at Morton and there has also been turnover in staff. Consequently the atmosphere in the home was affected and one of the effects of this was a lack of internal activities for service users within the home itself. The acting manager has been seconded from another home to address some of these issues. She is currently planning to reintroduce in-house activities such as small groups for reminiscence, music and sing-a-long, and music and movement groups. The home shares the minibus resource with other homes on the site and it has teamed up with another home to use the minibus to take those service users who wish to go to church. Taxis are also used to enable service users to be mobile, for example the married couple at Morton, accompanied by a care worker, to do their own shopping. The site’s transport facilities are also booked by the home for trips to Tescos, local garden centres, open farms and places of interest. The acting manager stated that family relationships are encouraged. Of the questionnaires returned by relatives most supported this, stating that the home always or usually kept them up to date about their relatives. The home supports one married couple to be together. Service users’ civil rights are generally respected. All service users are registered to vote and service users hold keys to their rooms. Service users are encouraged to take responsibility for assisting in the care of the home and environment and some service users help in the kitchen and with gardening. Menus are provided in advance to the home from the central kitchen on the site. This offers a very large choice of main meals including options for traditional meals, healthy meals, vegetarian meals and light meals. Service users are assisted to choose from this menu. The home has its own kitchen from which breakfasts and other meals are provided. On the day of the site visit the inspector witnessed a service user, who had chosen to get up later, helped to have breakfast, and a service user who did not wish to eat the cooked meal at lunchtime enabled to have a cooked meal at teatime. The inspector was also aware of at least one couple who chose to eat in the on-site restaurant at lunchtime being assisted by a care worker to enable them to do so. Although care planning was not good in the home, there were some care plans with dietary needs and weight monitoring noted. Lunchtime and teatime were observed in the home. A good quality of food is provided and care workers offered a good level of practical assistance. However, there was a noticeable difference in the atmosphere between the two mealtimes. At lunchtime there was no “easy banter” between care workers and service users. Staff were professional and assisted, but did not engage with service users on a friendly Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 14 basis. In contrast, the atmosphere at teatime was a happy, homely atmosphere with staff chatting easily with service users. The acting manager informed the inspector that this was one of the “ethos” changes she was seeking within the home. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. The health and personal care that people receive is generally based on their needs. The home needs to ensure that the principles of respect, dignity and privacy are consistently put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy relating to privacy, dignity and choice but this has not been reviewed since May 2003. Although questionnaires received from relatives and visiting professionals indicate that service users’ healthcare and medication needs are met, the lack of person-centred service user plans means that service users’ needs and wishes for their personal support are not properly documented. There is, therefore, little evidence that the service users’ own needs and wishes are at the centre of the delivery of care at this home. However, the acting manager is aware of this situation and plans to address this with the introduction of person-centred planning as referred to above. During the site visit the inspector witnessed one service user being assisted with personal care in a bathroom where the door had been left open, allowing no privacy or respect for that service user’s dignity. This matter was Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 16 raised with the acting manager. The acting manager explained that the home is in the midst of many staff changes, including staff being removed and new staff being recruited and trained, as one of the measures being employed to change the ethos of the home to a person-centred ethos. Staff turnover figures reflect this (seven staff have left the service since the last inspection). There has been a recent incident, reported anonymously to the Commission, of an inappropriate detrimental note being put up in a service user’s room. This was discussed with the manager. The member of staff concerned has been removed from the home and a disciplinary hearing is pending. Many staff observed and spoken with during the site visit did display an appropriate understanding of the values of privacy and dignity. Staff were observed knocking on service users’ doors, not entering their rooms when service users were not present, speaking with service users in a respectful way and using a hoist to transfer a service user in a manner that respected her dignity. Service users are issued with keys for their own rooms and some choose to lock their rooms. Evidence of an agreed protocol for overriding the door lock was seen on one service user’s file who chooses to lock his door. Arrangements are in place to meet the health care needs of individuals. The GP holds a weekly surgery at the NSE and the dentist also has a surgery on site. Physiotherapy and occupational therapy can be accessed through the therapy centre on site, and dietician and speech therapist visits are arranged as necessary. All service user files examined contained information about medical records. One service user’s file showed evidence of weight monitoring. There is always a first line nurse on duty at the NSE who can be contacted by staff for medical input or advice. However, in a recent incident a service user was not taken for an X ray until midway through the following morning, having injured themselves whilst having a seizure at night. The records for this incident were examined during the site visit and it was discussed with the acting manager who spoke with the department operating the first line nurse service. It was concluded that it would have been better for the service user if they had gone straight to hospital following the injury and that the delay was due to staffing and transport. The acting manager will review operational procedures that cover such incidents. The home has a medication policy which was last reviewed in March 2005. However, it has recently overhauled its medication storage system. Medication records and drugs were checked for three service users and found to be in order. A named member of staff is responsible for medication on each shift and all these staff have received appropriate training. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. Service users are generally protected from abuse but a record of complaints received needs to be kept. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place which was last reviewed in January 2005. However, as an up to date Service User Guide is not distributed to service users, they do not have a copy of this. There is a visual complaints procedure on display in the dining room but it is set at too high a level for anyone using a wheel chair and it contains the wrong address for the Commission for Social Care Inspection. Service users who responded to the questionnaire and those spoken with on the day of the site visit all stated that they would raise a complaint with the manager. Three out of four relatives who responded to the questionnaire stated that they knew how to make a complaint. Information regarding two complaints was received by the Commission in the two months preceding the site visit. These were discussed with the acting manager and were seen to have been investigated and dealt with appropriately by the service. However, no routine complaints log is maintained which could be used to monitor performance and provide information for quality assurance. The home has an appropriate procedure for safeguarding vulnerable adults which was last reviewed in April 2005. The procedure is laminated and available to all staff and service users. Staff spoken with were familiar with the procedure. It is in line with the local multi-agency guidelines for the protection of vulnerable adults and evidence was seen that it had been followed appropriately following a recent complaint. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 18 Evidence showed that staff have received training in the protection of vulnerable adults and that a POVA ‘train the trainers’ course is also planned. The manager informed the inspector that the NSE is currently looking into the possibility of providing protection of vulnerable adults training for service users. The home has a policy relating to the management of service users’ money which was last reviewed in May 2005. The NSE acts as appointee for all 15 current service users. Small amounts of cash are held in the office safe in individual purses for service users. Financial records and cash were checked for three service users and seen to be in order. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Quality in this outcome area is good. Service users live in a comfortable and safe environment which is well maintained and suitable for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home on the day of the site visit revealed it to be clean and hygienic. The entrance hall and stairwell are large, bright and airy and have recently been decorated and fitted with new lighting. The main living room and the dining room are on the ground floor and are furnished in a comfortable and homely style. They have also recently been redecorated and improved by widening the door between them. There is a second, smaller living room on the first floor which also had a kitchenette area. This too is comfortably furnished with domestic style fixtures and fittings. It can be used by service users at any time and is particularly suitable for individuals or small groups wishing to entertain or socialise together. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 20 There is a bathroom on each floor. The one on the ground floor has recently been refitted with a “malibu” bath, with a hoist and seat. In addition there are three shower rooms, one of which is newly fitted. Service users who replied to the questionnaire stated that the home was fresh and clean. Service users spoken with on the day also stated this. Records provided by the manager showed that all appropriate safety checks on services, equipment and appliances were up to date. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. Service users benefit from appropriately recruited and trained staff who are regularly supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has in place a policy for recruitment and employment that was last reviewed in February 2005. Up to date job descriptions are in place for all positions within the home. Staff records showed that the recruitment procedures had been followed and all appropriate checks completed. Records include a checklist of evidence required to meet The Commission’s standards. The staff complement currently includes three registered nurses. Of the remaining care workers, only 27 are qualified to NVQ Level 2 or equivalent. Further NVQ training is currently planned for Levels 2, 3 and 4. There has been a great deal of change in staffing during the previous 12 months with seven staff having left for a variety of reasons. New staff are currently being recruited. (At the time of the site visit the home was awaiting CRB clearance for three people so they could start working at the home). Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 22 Use is currently being made of bank staff and four staff including the acting manager and deputy are currently seconded from other homes within the NSE. The registered manager is currently on long-term sick leave. The acting manager has a commitment to improving the lifestyle afforded by the home through improving opportunities for service users and changing some working attitudes by the introduction of new staff and training. Service users and staff spoken with stated that the home is a better place than it was 12 months ago. This view was also reiterated by visiting professionals who replied to the questionnaire. Service users spoken with felt that staff were well trained. Relatives who replied to the questionnaire stated that staff usually had the skills to meet the needs of service users. Staff records showed that supervision was provided regularly and that team leaders who supervise staff have attended supervision training courses. Staff spoken with felt that supervision was useful. Training records are held for each member of staff. All new staff undergo an induction in line with the common induction standards and attend mandatory training courses such as moving and handling and the protection of vulnerable adults. Additional training courses are organised in a wide variety of subjects including, for example, the certificate in care of people with epilepsy, care of older people and courses to improve English. Training is also provided in equality and diversity awareness. Supervision is used to identify individual training needs and staff are then booked onto appropriate courses. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 23 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. Service users are beginning to feel the benefits of a well run home although quality assurance still needs to be addressed. Health and safety is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is on long-term sick leave and has been absent since December 2006. The acting manager is seconded from another home within the NSE. The home went through a difficult period prior to the previous inspection which was held in August 2006, with there being many admissions and discharges at the home due to the closure of some of the other homes on the NSE site. The acting manager has reviewed major areas of the working of the home, such as care planning, activities, staffing and supervision structures and processes, with the aim of improving the atmosphere within the home and the quality of life experienced by its service users. Changes are currently Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 24 being introduced to working practices as a result. Staff and service users spoken with, together with comments received from visiting professionals, state that progress is being made and that the home is a happier place. The acting manager is aware that further improvements are required, for example in the areas of quality assurance, care planning and risk assessment, and is planning to address these. The home currently has no formal quality assurance process. However, the acting manager stated that she wished to develop mechanisms to assess the home’s performance against its aims and objectives in order to inform an annual development process. Individual areas, which do currently get regularly audited, include medication within the home and service user finances. Policies and procedures are reviewed and updated by the NSE organisation and the home is also inspected monthly by the NSE under Regulation 26. A keyworker system has been developed and the acting manager wishes to develop formal and informal ways to ensure that service users share their views and ideas. The home has a health and safety policy, a fire safety policy and a food safety policy, all of which were reviewed in July 2005. Evidence was seen that training is provided in these areas. The home had a visit from the health and safety department in May 2006 and has booked another one for June 2007. The home monitors water temperatures and fridge temperatures. The manager informed the inspector that the fridge temperatures were showing that the fridge was running too warm and this would be dealt with as a matter of urgency. The home’s policy relating to the control of substances hazardous to health was reviewed in June 2005. The COSHH storage cupboard was locked. There are many information sheets for substances used. It was suggested to the acting manager that these could be reviewed to identify any that are no longer required, and the remaining ones laminated. The tour of the home showed staff following safe working practices with regard to moving and handling. The laundry door was found to be unlocked. It was suggested that this be kept locked when not being used by staff or service users. Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 25 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. 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 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 3 X 2 X 2 X X 3 X Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 26 no 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 YA2 Regulation 14 Requirement To ensure a full assessment of each service user’s needs is undertaken and a process put in place to ensure that these are regularly reviewed. To ensure a Service User Plan is in place for all service users. To make proper provision for the health and welfare of service users. (see Recommendation 1, below). To ensure a Complaints Procedure is made available to all service users and a record of complaints and their outcomes maintained. To devise a procedure to ensure that the quality of service provided is reviewed and improved as necessary. Timescale for action 30/07/07 2. 3. YA6 YA9 15 12 30/08/07 30/08/07 4. YA22 22 30/07/07 5. YA39 24 30/09/07 Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 27 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 YA9 Good Practice Recommendations In order to fulfil requirement Number 3 above, it is recommended that the home introduce full risk assessment and management procedures as part of service users’ plans. In fulfilling Requirement 2 above, it is recommended that a “person centred” approach to care planning be used. It is recommended that the home increase the proportion of NVQ qualified care staff to at least 50 . 1. 2. YA18 YA32 Morton House DS0000023000.V335548.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 House DS0000023000.V335548.R01.S.doc Version 5.2 Page 29 - 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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