Inspection on 22/05/07 for Morton House Nursing Home

This inspection was carried out on 22nd 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 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 Nursing Home 04/09/08

Morton House Nursing Home 25/09/06

Morton House Nursing Home 07/03/06

Morton House Nursing Home 04/11/05

Morton House Nursing Home 28/02/05

Morton House Nursing Home 17/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Morton House Nursing Home Morton House 12-14 Lewisham Park Lewisham London SE13 6QZ Lead Inspector Ornella Cavuoto Unannounced Inspection 22nd May 2007 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 House Nursing Home DS0000007035.V339733.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 House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton House Nursing Home Address Morton House 12-14 Lewisham Park Lewisham London SE13 6QZ 020 8314 1075 020 8690 3419 terry@missioncare.org.uk 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) Mission Care Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 16 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male). 11 patients, who require intermediate care, aged 55 years and above both male and female. 25th September 2006 Date of last inspection Brief Description of the Service: Morton House is a care home providing nursing care and accommodation for 27 older people. Mission Care owns it, which is an inter-denominational Christian registered charity. The organisation has five other homes in South East London and the head office is in Bromley. The home looks out over Lewisham Park and is close to buses and to Ladywell railway station. There are some local shops nearby and Lewisham centre with all its transport and shopping facilities is approximately ½ mile up the road. The home, which is a modern building, opened in 1991 and consists of three storeys. It has recently been decorated. All the bedrooms are single and none have en-suite facilities. There is a passenger lift. The home has parking and a small garden to the rear of the property. Morton House also provides intermediate care for up to 11 service users and there is a portakabin extension at the rear of the property to provide additional facilities for those individuals receiving intermediate care. The home works in close partnership with Lewisham Intermediate Care team comprising of physiotherapists, occupational therapists and social workers and there is at least one member of the team on site at all times. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced inspection that was carried out over one day. The home has a new manager after the previous manager was transferred to take responsibility for another Mission Care home. The new manager of the home also worked at another of the Mission Care homes but at the time the inspection was held had only been in post at Morton House for six weeks and so was yet to settle fully in their new role. They were present for part of the inspection but the deputy manager who has worked at the home for some years was available for its duration. The inspection involved speaking to seven residents two of whom were receiving intermediate care. Two care staff were also spoken to and following the inspection the operational manager of the intermediate care team was also consulted. Other inspection methods included inspection of care records and a partial tour of the building. Four of the previous requirements were identified as met at this inspection although eight new requirements have been specified. In addition there are areas where requirements have consistently not been met and these must be given particular attention, as continued non- compliance will lead to enforcement action being taken. What the service does well: Although there were some varied views the majority of residents spoken to were satisfied with the staff and the care they had received. Comments included; “ Staff are nice” and regarding the home “ You could not fault it at all”, “They are making me very comfortable here”, “They all work hard all of them” Individual care plans are written in a way that residents can more easily understand and positively address areas residents can do things for themselves rather than just areas where they need help. Personal care needs are addressed well with good detail included in care plans about residents preferences in daily routines, times they like to get up and go to bed. Although some improvements are required residents’ health care needs have generally been well met with the home ensuring involvement of a range of different health professionals. Family and friends are welcomed by the home ensuring residents maintain relationships that are important to them. Residents have been supported to maintain links with the local community with trips organised to local places of interests such as a local museum and art gallery. Service users’ personal records are kept in their bedrooms to allow them to have access to information recorded about the care they receive. The home provides a varied and nutritious menu to service users. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 6 The home is very well maintained and is kept clean and hygienic. The majority of care staff working at the home are qualified having obtained a NVQ Level 2 in care. What has improved since the last inspection? What they could do better: Although there had been some improvement in this area residents’ care plans need to be signed by themselves, their relatives or a representative to indicate their involvement and agreement with the content. Care plans need to address more comprehensively residents’ health care and social care needs including any specific cultural needs they may have. Where risk assessments are carried out in respect to pressure sores and other health needs these should be regularly reviewed. Although there had been some improvements in this area staff need to ensure medication policies and procedures are consistently adhered to, to fully protect residents. Improvements need to be made to ensure all staff are made aware of the need to respect residents at all times and maintain their dignity. Although there is a good range of activities offered to residents, these need to take place on a more regular basis and up to date records of when these occur and which residents are involved should be maintained. The complaints procedure needs to be more stringently applied to ensure complaints are thoroughly investigated and complainants informed of the outcome of their complaint in writing. Procedures around adult protection need to be followed more closely and although some staff have received training around adult abuse all staff need to receive training in this area. Although there have been some improvements around induction a training plan outlining all training to be undertaken by staff including mandatory training that needs updating and any specific training to be completed to ensure residents needs are fully met. Residents’ and relatives’ views about the service need to be sought on a regular basis as part of self- monitoring and to identify ways of improving outcomes for residents. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 8 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 House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user guide needs to include information about the fees of the home as specified by regulation to fully ensure prospective and current residents have all the information they need about the home. Not all residents had been issued a statement of terms and conditions of their stay within the home and these had not all been signed. All new residents had had their needs assessed prior to moving into the home. Generally, those individuals receiving intermediate care are receiving an effective service. EVIDENCE: At the last inspection evidence was in place of an updated service user guide and statement of purpose that generally included all the information required by regulation. However, a new regulation that came into effect in September 2006 required that information regarding the fees of the home must be included in the service user guide and this had still to be addressed. At this inspection the service user guide was checked and it was found that this Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 10 information had still not been added to the document. Also, at the last inspection it was found that all residents had been issued with a service user guide. They all had a folder in their rooms that included a copy of the service user guide, the home’s complaints policy, a summary of the last inspection report, the results of a customer satisfaction survey and a statement of terms and conditions was included in the majority of the folders although for some residents this was missing. Also, not all the terms and conditions that were looked at had been signed either by the resident themselves or a relative or representative. At this inspection, it was identified that terms and conditions had still not been issued to all residents and they had still not all been signed. This needs to be addressed (See Requirements). Six personal files of residents were looked at, at this inspection of which two belonged to individuals that had been admitted to the home on a permanent basis since the last inspection and two belonged to those receiving intermediate care. All the files contained evidence that a full needs assessment had been obtained from the referring authority prior to their admission to ensure the home could fully assess whether or not they were able to meet their needs. The home had also carried out their own detailed assessments although it was noted some parts of the assessments that were seen had not been fully completed. It is advised attention is given to this and that any areas that may not be relevant to the needs of the individual that this is specified rather than left blank (See Recommendations). Intermediate care is offered up to eleven people. All of the bedrooms on the ground floor and part of the corridor on the first floor have been dedicated to providing intermediate care. There are specialist staff, Lewisham’s Intermediate Care (LINC) team, that comprises of physiotherapists, occupational therapists and social workers and there is a portakabin at the rear of the premises that provides specialist facilities and equipment to support people with their rehabilitation so they can return home. Previous inspections have identified a need for more integration between the LINC team’s intervention and the home’s care provision in order that a consistent approach is maintained for those individuals receiving intermediate care. Some measures have been put in place to address this, for example a member of the LINC team now attends handover meetings to share and receive information and as part of daily recording care and nursing staff are required to provide a brief review of individuals’ progress. At this inspection those receiving intermediate care that were spoken to were generally satisfied with the care they had received. However, in discussing the service with the operational manager of the LINC team following the inspection it was evident that achieving consistency had still proved difficult to achieve despite further changes being made with the introduction of prompt sheets that are kept in the bedrooms and are aimed at communicating more effectively any changes in support or new instructions to nursing and care staff. At present the deputy manager as the clinical lead oversees the intermediate care service and also the residential part of the home. As an added measure to try to improve Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 11 communication and consistency between the home and the LINC team another option that could be considered by the home is to delegate the responsibility for the intermediate care service to one of the nursing staff who acts as a direct point of contact and liaison with intermediate care staff (See Recommendation). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans set out in detail their personal care needs but some areas of individuals’ health care needs had not been specified and social care needs need to be more comprehensively addressed. Generally residents’ health care needs had been addressed although for individuals with whom bed rails were being used risk assessments had not been completed and other risk assessments addressing health care needs had not been reviewed. Despite some improvements staff had still not consistently adhered to medication policies and procedures to fully protect residents. Not all residents spoken to considered staff treated them respectfully. EVIDENCE: Six residents care plans were looked at this inspection. The care plans consist of a daily living plan that aims to address residents’ personal and social care needs and a clinical plan that is aimed at identifying health care needs that need to be addressed. The plans are written in the first person as if residents had written them themselves and positively focus on their strengths, what they are able to do themselves rather than only looking at those areas with which Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 13 they require support. There is also an additional part to the care plan that identifies specific/ clinical goals that may require particular attention. Overall, the daily living plans contained good detail in respect to individuals’ preferences such as food likes and dislikes. There was also information on daily living routines such as times for getting up and going to bed, the assistance required with carrying out personal care and other needs in relation to physical care were also specified including for those with mobility problems support with transfers to reduce the risks of falls occurring. The daily living plans did address some social care needs although the detail provided needed to be more comprehensive, for example one resident who was seen by a Consultant Psychiatrist for concerns about depression specified in their report that it was important the resident received as much stimulation as possible but this had not been specified in their daily living plan. For another resident there was information in their personal file that shortly prior to their admission to the home they had suffered the bereavement of their partner but this had also not been addressed in their care plan. The specific cultural needs of residents could also feature more within the plans. For two of the residents there was evidence within their personal files of a life review document to look at their social care needs in more detail but only one had been partially completed. Health care needs were generally covered in sufficient detail in the clinical plans that were seen although for one resident who had pressure sores the need to be turned and how often had not been specified although a turning chart was in place (For further details see Standard 8). For another resident although it specified regular blood sugar testing was required it did not indicate that the individual was diabetic and the type of diabetes they had. The care plans had been reviewed monthly and did reflect changing needs and progress. In respect to a previous requirement that the care plans should be signed by either the service user themselves or a relative or a representative on their behalf an improvement was identified in that a care plan review form was seen on personal files that should be signed by the resident and a staff member at each review. Although, this had not been consistently completed those service users that were able to sign the form had done so at least on one occasion. However, for other residents where they required a relative or a representative to sign on their behalf this had not been completed. The deputy manager reported that it is not always possible to ensure relatives sign the care plans or to identify an appropriate representative. As a result this requirement is deemed partially met but it is advised that for those residents who are not able to be involved in the care planning process and where a relative or a representative is not available this should be specified on the care plan. Finally, personal files did not have photographs of residents to help with identification and it is recommended these be put in place (See Requirements and Recommendations) Apart from aspects of health care needs not being fully set out in individual care plans there was evidence within personal files and other records to indicate that health care needs had been addressed with liaison with a range of health care professionals including GPs, consultant psychiatrists, podiatrists, Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 14 opticians, community incontinent nurses and with members of the Care Homes Support team who had provided advice on physical and mental health issues concerning individual residents. Monthly or where it had been assessed that it was required to be done more frequently, weight monitoring had taken place. At the last inspection concerns were identified about the number of residents with pressure sores and turning charts in place indicated that residents were not being turned regularly. In addition, it was found that how often residents should be turned had not been specified within their clinical plans. This was still identified as an issue at this inspection (See Standard 7) although the number of residents with pressure sores had reduced. It was reported that only two residents had pressure sores with one of those having acquired them whilst in hospital and since being at the home the larger pressure sore they had come in with had healed. The turning charts for both residents were looked at and both indicated that they had been turned three – four hourly. As a result of this improvement the previous requirement specified in relation to pressure area care is deemed met. In respect to risk assessments there was evidence that these had been completed in respect to pressure sores, falls, nutrition, to assess for depression and levels of independence but these had not been reviewed to monitor for any changes in needs since December. At the last inspection it was identified that particular risks presented by individual service users’ needs outlined within the needs assessments provided by the referrer or within the assessment completed by the home prior to admission had not always been addressed within their care plan. At this inspection it was found individual risks had been more comprehensively addressed. However, for two residents that needed bed rails there was no evidence that risk assessments had been completed (See Requirements). The last two inspections have identified concerns about the number of errors made by staff in the administration of medication. Only qualified staff are allowed to handle medication. At this inspection a sample of medication records were checked from both medication trolleys in use at the home. It was evident there had been an improvement in that fewer errors had been made. However, the number of errors identified was still at an unacceptable level and involved residents still not receiving all their medication with medication being signed for and not being given to residents. Also, medication was given but had not been signed for. Other aspects of the management of medication were found to be in order including all residents having photographs in place, fridge temperatures for the cold storage of medication had been regularly checked, lists for the use of homely remedies had been drawn up and controlled drugs had been regularly checked and were found to be in order. Self -administration risk assessments had been completed for all residents including for those receiving intermediate care. A previous recommendation that individuals within intermediate care should be encouraged to take responsibility for their own medication where appropriate had been addressed. It was identified that for the two service users who were case tracked that some measures had been taken to support them to do this (See Requirements). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 15 Feedback from residents about being treated respectfully by staff varied. Two residents reported certain staff had spoken them to abruptly whilst another stated that whilst some staff were very good others were not very considerate. In addition, at lunch- time one resident was observed being assisted to eat whilst slumped low down in their chair and their feet were raised off the ground without any type of foot support in place. No attempt was made to try to make them more comfortable and the inspector had to intervene, as there was a risk that they could choke in the position that they were in. Staff need to be made aware that residents need to be treated respectfully at all times and their dignity maintained. Generally, residents were observed as well dressed and well groomed and on the day of the inspection a hairdresser was available to residents (See Requirements). A previous recommendation that all residents should be consulted about their personal wishes and instructions for death and dying was not assessed on this occasion and will be checked at the next inspection. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there was evidence that residents had been involved in a range of activities, records indicated these had not taken place on a regular basis. Residents do maintain contact with family and friends and links with the local community and are able to exercise choice and control over their lives. Residents had received a varied and appealing diet. EVIDENCE: In terms of activities and opportunities for social interaction the home has a weekly activities schedule in place but records that had been kept for individual residents indicated that this was not adhered to and that activities had not taken place on a regular basis. Also, on occasions, care staff had only stated that the resident had taken part ‘in the morning activity’ without specifying what the activity was or if they had enjoyed it. More details should be provided. The home does not have an activities co-ordinator. Instead, care staff had been delegated the responsibility to involve residents in activities on different days although the deputy manager reported that this arrangement had proven difficult to sustain. From the records that were seen activities that had taken place included bingo, quizzes, movement and exercise, reminiscence and nails and beauty. Residents spoken to confirmed that they had played Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 17 bingo and done quizzes and during the inspection some residents were observed having their nails manicured and painted by a member of the care staff team. In addition, the deputy manager reported that some of the residents had been taken on outings locally to Eltham Palace, the Horniman museum, Dulwich Art gallery and some had been to the pub and cinema. Again, some of this was evident from the records maintained and one of the residents confirmed they had been involved in some of these trips out. However, it is important that activities take place on a regular basis and individual activity records need to be kept up to date to evidence this. Furthermore, a previous recommendation that the key worker system is used to ensure individual time is spent with residents particularly those that may be less able to engage in group activities or to go out this is to remain in place (See Requirements and Recommendations) Residents spoken to confirmed that they receive visitors regularly and that they are made to feel welcome by staff. During the inspection a number of visitors were observed visiting residents. To support residents to maintain links with the local community as mentioned they had been taken out to places of local interest, the pub and the cinema. There was also evidence that local entertainers visit the home and in respect to meeting residents’ religious needs a Baptist minister, a priest from the local Catholic Church and a representative from the Seventh Day Adventist church regularly visit the home. In terms of residents being supported to exercise choice and control, they are encouraged to bring their personal possessions with them when they move into the home and rooms that were seen were suitably personalised. Residents’ personal files are kept in their rooms giving them full access to their personal records. There was evidence that resident meetings had been held three monthly in which residents had been given the opportunity to give their views and opinions on various aspects of living in the home including activities and the food provided. However, it is advised meetings are held on a more regular basis (See Recommendations). All residents spoken to were positive about the food. One resident said,“ I do enjoy the food” whilst another commented, “The food is very good here hot and tasty”. The menu was seen and a choice was offered and some foods to cater to the specific cultural needs of individuals were included although it was noted from a residents meeting that it had been expressed that this was not sufficient and more meals and foods from different cultures was requested. It is advised this should be looked into with the cook. A lunch- time was observed. This was unhurried with residents being given sufficient time to eat their food. Apart from one resident that was being assisted to eat being positioned inappropriately in their chair placing them at risk of choking on their food (See Standard 10 for more details) others were supported appropriately by care staff (See Recommendations). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents spoken to were confident their complaints would be listened to and acted on but the home still needs to ensure that complaints are addressed in line with the home’s complaints policy. Not all staff had received training on adult abuse to ensure residents are fully protected. EVIDENCE: Most of the residents spoken to said they did not have any complaints about the home. One resident stated they had made complaints to the previous registered manager of the home that had all been dealt with to their satisfaction. Other residents considered their concerns would be listened to and acted upon and they would approach the deputy manager or speak to head office. There was information about an independent advocacy service available to residents, which was on a notice board in the entrance of the home and also in the lounge area. The complaints log was checked and four complaints had been logged since the last inspection. Two of the complaints concerned care staffs’ attitude towards residents that had both been dealt with appropriately. In respect to the other two complaints, one had been made recently and was still ongoing at the time the inspection was held. A close friend and representative of a resident had made a complaint about them not being provided with an appropriate mattress for pressure area care and after falling out of bed had incurred carpet burns. The other complaint involved the alleged theft of £100. The deputy manager reported that an incident form detailing action taken had been sent to CSCI although this had not been received. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 19 A copy of the report was seen on the day of the inspection. This indicated that the matter had been looked into with the resident being interviewed. The matter had then been referred to the home’s head office, which agreed to inform the insurance company. The deputy manager also reported that social services had been informed. However, a letter informing the complainant of any investigation carried out and the outcome of their complaint, which should be done in line with the home’s complaints policy, had not been completed (See Requirements). The last two inspections have required that the home’s adult protection policy should be reviewed, as the one in place was not very comprehensive. However, at this inspection there was still no evidence available to indicate this had been addressed. A previous requirement that adult protection procedures must be strictly adhered to and any incidents of suspected abuse are immediately reported to social services, CSCI and if appropriate the police could not be fully assessed at this inspection. This followed concerns raised at the last inspection in relation to an adult protection investigation undertaken by the registered manager in which there had been a delay of five days before the matter had been referred to social services or the Commission of Social Care Inspection (CSCI) had been informed. The deputy manager reported at this inspection that the investigation found the allegations not to be substantiated. There had not been any further adult investigations carried out by the home since the last inspection. Consequently, this requirement will remain in the report and checked at the next inspection. In respect to the requirement in relation to all staff working at the home should receive training on adult abuse and adult protection procedures, the registered manager provided evidence at the last inspection that 38 of staff had completed this. However, at this inspection records could not be identified to evidence how many more of the staff team had undertaken the training although there was evidence to indicate this topic is now included as part of the induction programme for new staff (For further details see Standard 30 & See Requirements). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,25 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well - maintained environment. The home has communal areas indoors and outdoors that are safe and generally comfortable. The surroundings of the home were safe and comfortable. The home was clean and hygienic. EVIDENCE: The home which has been purpose built is very well maintained, is accessible to all service users with a passenger lift in situ and provides a comfortable and safe environment. The home has adequate communal areas with a large lounge/dining room area downstairs. Upstairs on the first floor there is a small room that is aimed at providing residents who receive intermediate care with their own separate lounge although the manager of the home reported that it is rarely used as residents prefer the main lounge. However, at previous inspections it was Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 21 found this room had been used to store items belonging to residents no longer living at the home as well as equipment and boxes of supplies for the home making it an unattractive space and uncomfortable for residents to use. However, at this inspection the lounge was found to be generally clear of items meeting the previous requirement. The home also has a small attractive garden to the rear of the property with table and chairs for residents to sit outside. Overall the home is comfortable and safe for people staying at the home. However, the manager reported that a recent visit by an inspector from the Health and Safety Executive (HSE) had made a requirement that all windows needed to have extra window restrictors to those that were already in place. The manager consulted CSCI about this matter but it was advised that further clarification is sought from the HSE. A previous requirement that the home needed to evidence that water temperatures had been regularly checked to prevent risks of scalding was identified as having been met. The home was clean and hygienic on the day of the inspection and free of any offensive odours. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There were sufficient levels of staff with the required skills to meet the needs of residents. Over 50 of care staff had achieved a qualification as specified within National Minimum Standards (NMS). Generally residents had been protected by the home’s recruitment practices but gaps in employment need to be more thoroughly addressed. There had been improvements in the induction programme provided to new staff but a training plan addressing the training needs for all staff was not available for inspection. EVIDENCE: On the day of the inspection it was observed that were sufficient staff on duty. There are two qualified nurses and six care staff on duty in the morning, two nurses and four care staff in the afternoon and one nurse and two care staff at night. An accurate rota is maintained. The deputy manager reported that at present 70 of permanent care staff had achieved either a NVQ Level 3 or 2 and the remaining staff were in progress of completing a NVQ Level 2. As a result the home has exceeded the 50 target specified within NMS that care staff must be qualified or working towards achieving a relevant qualification. In respect to recruitment the personal files of three care staff that had been employed since the last inspection were checked. These were found to include Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 23 all the required documents required by regulation including an up to date Enhanced Criminal Records Bureau (ECRB) check, two references and appropriate identification. All new staff have a full health assessment carried out. However, in relation to vetting procedures it was noted on the application forms that there were gaps within employment and there was no evidence that these had been explored with the applicants and the reason for the gaps noted (See Requirements). The provider has developed a new induction programme that has to be undertaken by all new care staff and involves looking at various areas including person centred care, fire safety, health and safety including infection control and protection of vulnerable adults. On completion attendees are issued with a staff handbook, the General Social Care Council’s (GSCC) Code of Practice and the Common Induction Standards work booklet that meets with Skills for care Specifications to be completed through supervision. Evidence was available for one of the staff members whose file was checked that they were in the process of completing the booklet. The recommendation that a record should be kept for nurses when they complete an induction is to remain in place. At the last inspection although appraisals had been completed with staff a comprehensive annual training plan that outlined all individual training needs of staff including any mandatory training that needed to be updated and any other specific training courses to be undertaken had not been drawn up. At this inspection, the deputy manager was unable to identify any evidence that this had been completed (See Requirements & Recommendations). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new manager in post at the home who is qualified but does not come from a nursing background. Service users finances have been safeguarded. Feedback from residents, relatives and professionals involved in the home has not been sought on a regular basis to ensure the home is run in residents’ best interests. The health, safety and welfare of the residents had still not been entirely protected. EVIDENCE: As mentioned in the summary of the report the registered manager of the home had been transferred to work in another Mission Care home whilst the manager who has been appointed to work at Morton House in their place also previously worked at another care home run by Mission Care, which is for individuals with a range of physical disabilities. The new manager had only Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 25 been in post for approximately six weeks when the inspection was held and was still settling into the post and trying to become familiar with the running of the home. They had commenced the process to become the registered manager for the home. Having managed a care home previously they had already obtained relevant qualifications including a NVQ Level 3 and Level 4 including the Registered Managers Award (RMA). In addition, although the manager does not have a nursing qualification it is considered they would have transferable skills to be able to manage the home effectively. The deputy manager is a qualified nurse and is the clinical lead for the home. However, it is recognised that the deputy manager will need some support in their role and therefore it is recommended that the arrangements be put in place for the deputy manager to receive some clinical supervision (See Recommendations). At the point of the last inspection the home or the registered provider had yet to carry out any customer satisfaction surveys with residents, relatives or professionals who had links with the home as part of self -monitoring and to identify areas the home needs to improve for the best interests of residents. The last survey that was carried out was completed in June 2005 and at this inspection there was still no evidence available to demonstrate that another survey had been carried out. In addition, a previous requirement that monthly provider visits need to be carried out on a regular basis with copies of reports sent to CSCI this had not been met. The last report sent to CSCI was in December 2006 (See Requirements). The home provides minimal assistance to one resident that largely manages their own finances. All other residents receive support with their personal finances apart from one for whom the local authority acts as appointee. In respect to health and safety, maintenance certificates for gas safety, specialist equipment and that small electrical appliances had been tested were in place. However, a previous requirement that any incidents adversely affecting residents should be sent to CSCI, that fire drills should be carried out regularly and that a risk assessment of the building / environment should be completed had not been met. As mentioned in respect to Standard 18 although the deputy manager reported an incident form concerning an allegation of theft had been sent to CSCI this had not been received, records indicated that the last fire drill had been carried out December 2006 and there was still no evidence of a building risk assessment having been completed or to demonstrate regular health and safety checks of the physical environment of the home had been carried out (See Requirements). Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 26 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 2 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 2 Requirement The registered provider must ensure that all information required by regulation about the fees of the home are included in the home’s service user guide and this is made available to all prospective and current residents. The registered provider must ensure that every resident admitted to the home has a statement of terms and conditions that contains all the information required under this standard. (Previous timescales of 28/02/06, 30/06/06 & 30/04/07 partially met). Continued non-compliance will lead to enforcement action being taken. The registered provider must ensure that care plans are signed by the resident their relative or a representative where appropriate to evidence their involvement in the care planning process. (Previous timescales of 30/04/06 & 31/08/06 not DS0000007035.V339733.R01.S.doc Timescale for action 30/11/07 2. OP2 5 (1)(b) 30/11/07 3. OP7 12 & 15 30/11/07 Morton House Nursing Home Version 5.2 Page 28 4. OP7 12(1) 5. OP8 12(1) 13(4)(c) 6. OP8 12(1) 13(4)(c) 7. OP9 13 (2) 8. OP10 12(4)(a) met, timescale of 30/04/07 partially met). Continued non- compliance will lead to enforcement action being taken. The registered provider must ensure that all residents’ health care and social care needs including any specific cultural needs they may have are set out in detail within their care plans to ensure their individual needs are fully addressed. The registered provider must ensure that risk assessments carried out in respect to pressure sores, nutritional needs, depression and independence levels are regularly reviewed to monitor for any changes in need and ensure appropriate interventions are put in place. The registered provider must ensure that prior to using bedrails for individual residents a risk assessment is completed to ensure the health and safety of the resident is maintained. The registered provider must ensure that residents receive all medication as prescribed and all administration is documented (Previous timescale of 28/02/06 not met and Immediate Requirement issued by Regulatory Inspector 16/03/06 not met. Timescale of 28/02/07 partially met) Continued non- compliance will lead to enforcement action being taken. The registered provider must ensure that all staff working at the home are aware of and ensure they take measures to treat all residents respectfully at all times and maintain their DS0000007035.V339733.R01.S.doc 30/11/07 30/11/07 30/11/07 30/11/07 30/11/07 Morton House Nursing Home Version 5.2 Page 29 9. OP12 16(2)(n) 10. OP16 22(3) &(4) 11. OP18 13(6) 12. OP18 13(6) 13. OP29 19(5)(a)& (d). dignity. The registered provider must ensure that activities are offered to residents on a regular basis on a group and individual basis to provide them with opportunities for social interaction and as evidence of this up to date records are maintained. The registered provider must ensure that all complaints made against the home and staff are thoroughly investigated and records of investigations maintained. Also, that the complaints procedure is adhered to specifically that a letter is sent to the complainant once an investigation has been completed informing them of the outcome. (Timescale of 28/02/07 partially met) The registered provider must ensure that adult protection procedures are strictly adhered to and any incidents of suspected abuse are immediately reported to social services, CSCI and if appropriate the police. (Not able to be assessed. New date for compliance set to be checked at next inspection) The registered provider must ensure that all staff receives training around adult abuse/protection. (Previous timescales of 30/09/06 & 30/04/07 partially met) The registered provider must ensure that as part of vetting procedures when recruiting staff any gaps in employment are addressed with the applicant and a record made of the reasons DS0000007035.V339733.R01.S.doc 30/11/07 30/11/07 30/11/07 30/11/07 30/11/07 Morton House Nursing Home Version 5.2 Page 30 14. OP30 18 (1) (c) 15. OP33 26 16. OP33 24 17. OP38 13 (4) (a) 23 (4) & 37 given. The registered provider must ensure that all staff receives an induction to Skills for Care specifications (previously the National Training Organisation (NTO) when they commence working for the home and also receive training on a regular basis with mandatory training being updated. A training plan should be developed and an individual record of training undertaken by staff kept on staff files. (Previous timescales of 28/02/06 & 30/06/06 partially met. Timescale of 30/04/07 partially met. Inductions meeting with Skills for Care specifications had been met). Continued non- compliance will lead to enforcement action being taken. The registered provider must ensure that monthly provider visits are conducted and copies of the reports are sent to CSCI. (Previous timescale of 31/08/06 partially met & timescale of 30/04/07 not met). The registered provider must ensure that as part of self monitoring that regular feedback from residents, relatives and professionals involved in the service is sought, the results complied in a report and made available to residents, relatives and CSCI. Also, a development plan should be drawn up outlining aims and outcomes for residents. The registered provider must ensure that - All incidents adversely affecting DS0000007035.V339733.R01.S.doc 30/11/07 30/11/07 30/11/07 30/11/07 Morton House Nursing Home Version 5.2 Page 31 service users and including death notifications are sent to CSCI. - In respect to fire safety fire drills are carried out regularly. - A comprehensive building/environment risk assessment is drawn up. (Previous timescale of 30/04/07 not met) 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 OP3 Good Practice Recommendations The registered provider should try to ensure all areas of the home’s assessments carried out with prospective residents are completed with those parts that are not relevant being specified as not applicable rather than left blank. The registered provider should consider the option of delegating responsibility for the intermediate care service to one of the nurses as a measure to try to improve consistency of care and communication between the home and the intermediate care service The registered provider should try to ensure all residents’ personal files include an up to date photograph. The registered provider should try to ensure that where a resident is unable to be involved in the drawing up of their care plans and there are no relatives or a representative available this is specified on their care plan. The registered provider should try to make more effective use of the home’s key working system so that individual time is spent with service users. The registered provider should try to ensure that residents meetings take place on a more regular basis. The registered provider should try to consult with the cook about the inclusion of more foods/ meals catering to the specific cultural needs of individuals are included on the menu. The registered provider should try to ensure that a record of induction carried out with nursing staff is maintained. DS0000007035.V339733.R01.S.doc Version 5.2 Page 32 2. OP6 3. 4. OP7 OP7 5. 7. 8. OP12 OP14 OP15 9. OP30 Morton House Nursing Home 10. OP31 The registered provider should try to make arrangements for the deputy manager to have clinical supervision as the new manager does not have a nursing background. Morton House Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 Nursing Home DS0000007035.V339733.R01.S.doc Version 5.2 Page 34 - 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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