Inspection on 25/09/06 for Morton House Nursing Home

This inspection was carried out on 25th September 2006.

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 22/05/07

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 25th &26th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton House Nursing Home DS0000007035.V312848.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.V312848.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 Mr Terence Anthony O’Connor 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.V312848.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. 7th March 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.V312848.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days. The registered manager was present for the duration of the inspection. The deputy manager was also consulted and approximately eleven staff, three of who belong to Lewisham’s Intermediate Care (LINC) team was spoken to. In addition, seven service users and one relative were also spoken to. Other inspection methods included inspection of care records and a partial tour of the building. What the service does well: What has improved since the last inspection? The home has drawn up information for prospective and current service users about the services offered within the home. The home has made some improvements in the drawing up of risk assessments that address falls and other risks presented by individual service users needs. The home has addressed some of the requirements made in respect to medication such as making sure all medication returns are logged. Efforts have been made to spend individual time with service users that are bed bound or unable to engage in the group activities. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 6 Recruitment practices are more efficient with all the required checks being carried out. To ensure the home is run in the best interests of service users a customer satisfaction survey has been carried out. 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. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, 4 &6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is information available for prospective service users. Not all service users had a copy of the terms and conditions that they had signed. A full needs assessment had been obtained for all service users that had been admitted to the home. Service users know that their needs will be met by the home. Generally service users are supported by an effective intermediate care service. EVIDENCE: Subject to a previous requirement an updated statement of purpose and service user guide had been drawn up since the last inspection that generally includes all the information required by regulation although a new regulation now specifies that all homes must specify fees payable and a breakdown of the fees must also be provided within the statement of purpose. This came into effect from September 1st 2006 and therefore needs to be added to the home’s Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 9 statement of purpose. This will be checked at the next inspection. All service users 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 complaint policy, a summary of the last inspection report, the results of a customer satisfaction survey carried out with service users and a statement of terms and conditions was also included in the folder but it was identified this had not been issued to all service users and some of those that had been issued were not signed by service users (See Requirements). Of seven service users’ files that were inspected five belonged to service users that had been admitted to the home since the last inspection. All the files contained evidence that a full needs assessment had been obtained prior to their admission to ensure that their needs could be fully met by the home. Apart from gaps in mandatory training as detailed in standard 30, the home is able to demonstrate that it has the capacity to meet the assessed needs including the specialist needs of those individuals admitted to the home. Intermediate care is offered for up to eleven service users. 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, which 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 service users 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 to fully maximise the support available to service users. Subject to previous requirements and recommendations the home has introduced measures to address this, for example a member of the LINC team now attends handover meetings to share and receive information. Also, as part of daily recording care and nursing staff are required to provide a brief daily review of service users’ progress in the areas of need identified by the LINC team. Despite this both the LINC team and the nursing and care staff still reported some problems around inconsistencies of approach and communication issues although service users spoken to were very positive about the service. Therefore, it is advised that the service continues to be monitored and kept under review to try to further identify ways of addressing these issues (See Recommendations). Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 &11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users’ care plans were detailed but they had still not been signed by service users, relatives or a representative to indicate their involvement in the care planning process. The health care needs of service users have still not been fully addressed within individual plans although individual risk assessments have improved. There are still inconsistencies in the way medication systems are being used. All service users need to be consulted about their personal wishes and instructions at the time of death. EVIDENCE: In total seven service users’ care plans were looked at, two of which belonged to those service users within intermediate care. The care plans consist of a daily living plan that addresses service users’ personal and social care needs and a clinical plan that addresses health care needs. The plans are written in the first person as if the service users had written them themselves and positively they focus on the strengths of service users, what they are able to do themselves rather than just looking at those areas with which they require Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 11 support. There is also a separate form that identifies specific goals in respect to service users’ needs that require particular attention. It was evident the care plans have generally been completed based on the full needs assessments obtained from referrers and also the home’s own assessment that is carried out with service users. Overall, the daily living plans contained good detail in respect to individual preferences around daily routines such as times for getting up and going to bed, assistance required with carrying out personal care and the social care needs and interests of service users were outlined. One care plan that was looked at the service user had only been admitted six days previously but the care plan had been completed containing a good level of detail about their needs. Monthly reviews had also been carried out. In addition, as part of the home’s assessment the risk of falls had been addressed and within all the daily living plans looked at measures to be taken to reduce any identified risks were specified. However, it was noted that one service user had suffered a fall within the home resulting in a serious injury that had not been reported to CSCI as required (See details and Requirements in respect to Standard 42). Subject to a previous recommendation communication needs had been added to the daily living plan although for one service user it was noted that the care plan stated they had no significant problems with communication. Yet, there was information on the file that indicated they did have a speech impairment following a stroke. Furthermore, it was noted in the home’s own assessment that the religious and cultural needs of service users had consistently been left blank and were not addressed in the daily living plan. Finally, a previous requirement that service users, their relatives or a representative should sign the care plans to indicate their involvement in the care planning process and agreement with its content had still not been addressed (See Requirements and Recommendations). In respect to intermediate care it was identified at the last inspection that although all the service users had a care plan drawn up by the LINC team, none of the service users had a daily living plan or a clinical plan outlining the support and care to be provided by the home’s care and nursing staff. At this inspection there was evidence that this had been addressed. Subject to a previous requirement that all health care needs of service users should be fully addressed and risk assessments need to be more comprehensive with measures to reduce risks identified, this had been partially met. As mentioned, fall risk assessments and action to be taken to reduce risks were in place for service users. There was also more evidence within care plans of risks presented by individual service user’s needs being identified and addressed although this is still an area that requires improvement. However, in respect to health care it was still evident that needs identified within the full needs assessments obtained for service users and also Registered Nursing Care Contribution (RNCC) reviews that are carried out externally were still not accurately reflected within individual clinical plans. For example, for one service user a RNCC review described how the service user suffered from asthma and any difficulties breathing should be monitored. This had been Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 12 identified within the home’s own assessment but had not been addressed within their clinical plan. Also, the service user had experienced problems with skin cancer but this had not been included in the clinical plan. For another service user, the needs assessment specified that the service user was at risk of choking and being bed bound required two hourly turns. Neither the risk of choking nor the need for two hourly turns was identified in the clinical plan and although there was a pressure area care turning chart in place the times that turns were recorded were erratic. Turns were recorded hourly for a period but generally the times for turning were irregular sometimes occurring four hourly or three hourly and on one occasion records indicated the service user had not been turned for a period of seven hours. Furthermore, it was noted that of the seven service users’ care plans looked at five of them had pressure sores. There was evidence that risk assessments had been carried out with regards to identifying service users at risk of pressure sores that had been monitored monthly. Also, equipment necessary for the promotion of tissue viability and the prevention and treatment of pressure sores was being used. The incidence of pressure sores was discussed with the registered manager and the deputy manager who reported that the tissue viability nurse is consulted for advice where there are particular concerns about a wound not healing but that there were no such concerns identified at present. However, the occurrence of pressure sores should be kept to a minimum and the home needs to review their practices around pressure area care with a view to reducing the number of pressure sores developing. Also, it must be ensured that measures put in place to address pressure sores need to be consistently implemented by all nursing and care staff (See Requirements). Following the last inspection a referral was made to the pharmacist inspector due to ongoing concerns about errors being made in the administration of medication. This resulted in two immediate requirements being issued that specified the home should ensure service users receive all prescribed medication and this is accurately documented. Also, all medication returns must be logged as this had been stopped by the home. At this inspection, it was found that the home had logged all medication returns. However, in respect to ensuring that service users receive all prescribed medication and that this must be logged, this remains unmet. A sample of six Medication Administration Record (MAR) sheets were checked from the previous month as the home had just commenced a new monthly medication cycle. It was identified that three of the service users had not received medication due it being out of stock, for example, for one service user they had not received medication to help control their diabetes that was diet controlled for two days whilst another service user had not received two different types of medication for pain relief with one being out of stock for five days. Furthermore, a number of missing signatures were identified for each service user although whether or not service users had received this medication could not be checked as the all the previous months medication had been disposed of (See Requirements). Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 13 A previous requirement that the medication bin used for the disposal of unused medication is locked away at all times when not in use has been met. Also, at the last inspection it was identified that although self-administration risk assessments were included in the assessment form to be carried out with intermediate care users only one had been completed. At this inspection risk assessments inspected had been completed. However, there were concerns that none of the service users in intermediate care were taking responsibility for their own medication. This is particularly important given the aim of intermediate care is to maximise the independence of service users to enable them to return home. Therefore, it is advised that ways of supporting service users to self –administer their medication is looked at. This will be inspected more closely at the next inspection and may be subject to requirements if it is considered this has not been adequately addressed (See Recommendations). Service users spoken to were very positive about the support they receive from the nursing and care staff and considered that their privacy and dignity is respected at all times. They confirmed that staff knock before entering their rooms and one service user spoken to in respect to the support they receive from staff with personal care said, “ They look after you and make sure no one comes in.” Service users were observed as being well dressed and well groomed. There have been recommendations stated at the last two inspections that service users need to be consulted around their personal instructions and wishes for death and dying. At this inspection two service users whose personal files were looked at included detailed plans. However it is important that all service users are consulted and their wishes recorded (See Recommendations). Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Service users are provided with a good range of activities in and outside of the home and there have been improvements in the amount of individual time spent with those service users less able to engage in group activities. Service users are supported to maintain contact with family and friends and maintain links with the local community. Service users are able to exercise control and choice over their lives. A wholesome appealing and well balanced diet is provided to all service users. EVIDENCE: The home has a weekly activities programme in place that includes reminiscence, bingo, what the papers say, playing board games, music and movement, crafts, baking and cooking and a beauty day. The home does not have an activities co-ordinator. Instead, care staff are allocated a day to carry out activities with service users. On the days the inspection was held a reminiscence session was held and a number of the service users were also engaged in playing board games. In addition, positively the home does arrange for service users to go out on outings to various places of interest. Feedback from service users about activities varied although they confirmed activities are held within the home and that they had been on outings, for example most Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 15 recently some were taken to Whitstable in Kent to the seaside. However, although the majority of service users are given opportunities to be involved in group activities concerns have been raised at the last two inspections that the social care needs of those service users that are bed bound or less able to engage in group activities such as those with memory impairment are being adequately met. As a result, it was required that the home demonstrates more clearly within those service users’ care plans the need for individual time to be spent with them and individual records should be kept. At this inspection it was found that there were individual records in place for all service users, which did indicate that efforts have been made to spend time with service users who are bed bound. Therefore, the previous requirement is deemed met although it is advised the home still look at ways of using the key worker system effectively to encourage more individual time is spent with all service users in a way that stimulates social interaction (See Recommendations). There was evidence within service users’ care plans that the home aims to supports service users with maintaining contact with relatives and friends and service users spoken to confirmed that they receive visitors regularly and they are always made to feel welcome by staff. In terms of religious observance representatives from local churches visit the home regularly. Church services are also held within the home at weekends. A previous recommendation that the home obtain information regarding external advocates to support service users to access independent representation if required has been met. This was available on the notice board in the reception area. Service users are encouraged to bring in their personal possessions and rooms seen were suitably personalised. Service users’ personal files are kept in their rooms giving them full access to see their personal records. Regular residents meetings are also held in which service users can express any concerns or give feedback on issues within the home. All service users spoken to were very positive about the food and service users were satisfied with the menu. One service user said, “ The food is very good and they give you a choice”. The menu also caters to the specific cultural needs of individuals. Lunchtime was observed and this was relaxed and unhurried with service users being given sufficient time to eat their food. Where service users required assistance this was given in an appropriate and respectful manner. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Service users were confident their complaints would be listened to and acted upon but the home must ensure that all complaints are thoroughly investigated. Service users are still not being fully protected from abuse. EVIDENCE: Service users spoken to did not have any complaints about the home but were confident that their complaints would be listened to and acted upon. The home complaints log was inspected and it was identified that there had been four complaints made since the last inspection one of which was found to be substantiated, two partially substantiated and one was unsubstantiated. All the complaints involved allegations about the conduct of care staff towards service users. There was evidence that investigations for all complaints had been carried out. However, records in place indicated that these had not been addressed thoroughly with statements from care staff or service users not being recorded. Also, a letter to the complainant outlining the outcome of the investigation had not been completed (See Requirements). A previous requirement that the home’s adult protection policy should be reviewed as the one in place was found not to be very comprehensive and also that all staff working at the home should receive training around adult abuse has been partially met. The home’s adult protection policy is still to be reviewed. Also, a recommendation that Lewisham’s Interagency Guidelines be Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 17 obtained has not been fully addressed. The registered manager reported that it is accessible via the Internet. However, it is advised a paper copy is made available to staff. The registered manager provided evidence that approximately 38 of staff so far have completed adult abuse training that was carried out in –house (See Requirements & Recommendations). Since the last inspection the home has had one adult protection investigation, which was ongoing at the time the inspection was held. The registered manager had conducted a detailed investigation, a copy of which had been sent to CSCI. However, concerns were raised with the registered manager as there was a delay of five days before social services or CSCI were informed of the incident. This is unacceptable and contravenes adult protection procedures (See Requirements). Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,25 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Service users live in a safe, well–maintained environment. Generally the home does have safe and comfortable communal facilities indoors and outdoors but one of the communal areas is still being inappropriately used for storage. Generally service users live in safe and comfortable surroundings but documentation that water temperatures are being checked was still not available. The home is clean, pleasant and hygienic. EVIDENCE: The home, which has been purpose built is very well maintained and is accessible to all service users with a passenger lift in situ and provides a safe environment. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 19 At the last two inspection concerns have been raised about the communal lounge that is supposed to be specifically for the use of intermediate care users on the first floor but instead has been used to store items belonging to service users no longer living at the home as well as boxes of the home’s supplies and air flow mattresses for the prevention and treatment of pressure sores. The registered manager reported that a lack of storage space is a problem for the home and a requirement was stated at the last inspection that alternative storage must be looked into. However, at this inspection, the situation was found to be unchanged. This issue needs to be addressed to prevent it impeding on service users living at the home. It also presents a health and safety issue (See Requirements). Standard 25 continues to be assessed as largely having been met. However, the home has consistently failed to provide documentation to evidence that the home is checking water temperatures monthly to prevent risks of scalding (See Requirements). The home was clean on the days the inspection was held and free from any offensive odours. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service There are sufficient levels of staff with the required skills to meet the needs of service users. Over 50 of care staff have achieved a qualification as specified within the National Minimum Standards (NMS). Service users are protected by the home’s recruitment practices. Although there have been improvements there continue to be gaps in mandatory training for staff that still need to be addressed. EVIDENCE: It was observed that there were sufficient staff on duty to meet the needs of service users and the rota, which was examined accurately, reflected the staff on duty. The registered manager reported that at present 62 of the care staff working at the home have achieved a NVQ Level 2. Therefore, the home has exceeded the 50 target specified within the National Minimum Standards that care staff must be qualified. The last two inspections have identified concerns about the home’s recruitment practices in that new staff recruited had been allowed to start working at the home without a new Criminal Record Bureau (CRB) check being obtained. Instead CRB checks from a previous employer had been accepted and the Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 21 home had not carried out a check against the list that provides notification of individuals that are unsuitable to work with vulnerable adults. At this inspection, six staff files were inspected four of which belonged to staff members that had begun working at the home since the last inspection. It was found that for those new staff members new CRB checks had been obtained prior to them being allowed to commence their employment and for the other staff who had been working at the home for some time there was evidence that new CRB checks had been obtained to replace those accepted which were from previous employers. In addition, all other information required by regulation was in place. Previous requirements in relation to induction and training continue to be partially met. There was evidence available at this inspection that new care staff have been in receipt of an induction although this still does not meet with Skills for Care specifications (previously NTO National Training Organisation) and this needs to be looked into by the home. The present induction does not require staff to read all policies and procedures in place and it is advised this is altered to include this as part of the present induction used. Also, it was reported that nursing staff are inducted but a record of this is not maintained. It is advised that evidence of all staff who have undertaken an induction is kept. Annual appraisals have been completed with staff but a comprehensive training plan that includes all the individual training needs of staff is yet to be drawn up. There was evidence that some staff have completed specific training in nutrition, intermediate care, tissue viability and chiropody but other specific training should have been identified from the appraisals undertaken with staff. This was not evident. There was a plan in place that included some training needs for staff such as fire safety, manual handling, food hygiene, first aid that are mandatory and adult abuse. This indicated that that the majority of staff had completed training in fire safety and approximately 50 of staff have done manual handling training. However, the home needs to try to ensure all staff completes this training. Also, infection control and health and safety training which is mandatory needs to be included in this plan (See Requirements & Recommendations). Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36&38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Generally the home is well run and the manager is experienced with relevant qualifications. Information was available to demonstrate that the home has used quality assurance tools to ensure the home is run in the best interests of service users although some improvements are still required. Service users’ finances are being safe guarded. There have been improvements in the regularity of supervision received by staff working at the home. There are still areas that need to be addressed by the home to ensure that the health, safety and welfare of service users are fully protected. EVIDENCE: Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 23 The registered manager is experienced and is committed to running the home to a good standard. He has a background in nursing and a MSc in Inter Professional Health and Community Studies. Also, to update his skills he has recently completed a course in conjunction with the Royal College of Nursing and the Department of Health “Leadership Development for Nurses Working with Older People”. At the last inspection it was reported that a customer satisfaction survey was completed with service users and residents by an independent agency but evidence of this was not available. Since this inspection a copy of the report detailing the results of the survey completed in June 2005 was sent to CSCI. Also, at this inspection as mentioned previously a summary of the results of the survey had been included in the folder containing the service user guide and other information in service users’ rooms. A survey for this year has yet to be completed. In addition, it was noted that in last years survey the views of professionals involved in the home had not been obtained and it is advised these are included. Also, as part of quality assurance the registered manager performs a number of monthly audits on medication, pressure sores, falls, nutrition and infections. Subject to a previous requirement that monthly provider visits should be carried out there has been an improvement in this area although copies of reports sent to CSCI would indicate they are still not occurring regularly (See Requirements and Recommendations). The home provides minimal assistance to one service user who largely manages their own finances. However, records maintained in respect to this were inspected and found to be in order with details of transactions and receipts being kept. All other service users receive support with their personal finances from their relatives apart from one for whom the local authority acts as appointee. Subject to a previous requirement, the home has updated the policy on the management of service users’ money to ensure staff are aware of their responsibilities in the prevention of service users being financially abused. Since the last inspection records indicated that there has been an improvement in the regularity that staff are receiving supervision and the majority are on course to have received six sessions by the end of the year. Appropriate topics are discussed including role of the key worker and various practice issues such as recording, personal care giving. However, it is advised that staff be allowed to bring their own agenda items to supervision sessions (See Recommendations). Subject to a previous requirement the home has now made available health and safety policies and procedures within the home, updated maintenance certificates were in place for PAT (Portable Appliances Testing), the gas boiler and specialist equipment used. A fire risk assessment had been sent to CSCI prior to the inspection being held and fire points had been tested weekly. However, fire drills had still not been carried out as regularly as required and a building risk assessment had not been completed. Finally as previously Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 24 mentioned in standard 7 the home failed to notify CSCI of an incident where a service user fell and incurred a serious injury. This needs to be addressed and notifications of the death of a service user should also be sent to CSCI (See Requirements). Morton House Nursing Home DS0000007035.V312848.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5 (1)(b) Requirement The registered person must ensure that every service user admitted to the home has a statement of terms and conditions that contains all the information required under this standard. (Previous timescale of 28/02/06 & 30/06/06 partially met) The registered person must ensure that care plans are signed by the service user, their relative or a representative where appropriate to evidence their involvement in the care planning process. (Previous Timescale of 30/04/06 not fully expired & timescale of 31/08/06 not met) The registered person must ensure that all health needs of service users are fully met and risk assessments are more comprehensive in that where risks are identified action and control measures to be taken should be identified to reduce the risk. DS0000007035.V312848.R01.S.doc Timescale for action 30/04/07 2. OP7 12 & 15 30/04/07 3. OP8 12(1) 13(4)(c)& 15 (1) 30/04/07 Morton House Nursing Home Version 5.2 Page 27 4. OP8 12(1) 5. OP9 13 (2) 6. OP16 22(3) &(4) 7. OP18 13(6) 8. OP18 13(6) (Previous timescale of 30/04/06 not fully expired & timescale of 31/08/06 partially met) The registered person must ensure that practice around the prevention and treatment of pressure area care is reviewed to minimise occurrence and that where measures are put in place to prevent and treat pressure sores these are consistently implemented by all care and nursing staff. The registered person must ensure that service users 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) The registered person 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. The registered person 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. The registered person must ensure that all staff receive training around adult abuse/protection. (This is an updated requirement. Previous DS0000007035.V312848.R01.S.doc 30/04/07 28/02/07 28/02/07 28/02/07 30/04/07 Morton House Nursing Home Version 5.2 Page 28 9. OP20 23 (2) (g) 10. OP25 13 (4) (b) & (c) 11. OP30 18 (1) (c) 12. OP33 26 timescale of 30/09/06 not fully expired but had been partially met) The registered manager must ensure that the communal spaces such as the intermediate care lounge are not used for storage of equipment or for belongings of service users no longer living at the home and that an alternative space for storage is looked into. (Previous timescale of 28/02/06 & 31/08/06 not met) The registered manager must ensure that evidence that water temperatures are checked on a monthly basis to prevent risks from scalding is sent to CSCI. (Previous timescales of 28/02/05, 28/02/06 &30/04/06 not met). The registered person 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. (This is an updated requirement. Previous timescales of 28/02/06 & 30/06/06 partially met). The registered provider must ensure that monthly provider visits are conducted and copies of the reports are sent to CSCI. (This is an updated requirement. Previous timescale of 31/08/06 DS0000007035.V312848.R01.S.doc 31/07/07 28/02/07 30/04/07 30/04/07 Morton House Nursing Home Version 5.2 Page 29 13. OP38 13 (4) (a) 23 (4) & 37 partially met). The registered person must 30/04/07 ensure that - All incidents adversely affecting 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. 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 OP6 Good Practice Recommendations The registered person should keep the working relationship between the care and nursing staff and intermediate care staff under review and continue to look at ways of improving how the teams can work effectively together. The registered person must try to ensure all aspects of the home’s assessment are completed specifically cultural and religious needs and any issues arising addressed within care plans. The registered person must try to identify ways of supporting service users in intermediate care to be able to take responsibility for their own medication. The registered person should try to consult with all service users on their wishes concerning death and dying and ensure these are recorded. The registered person 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 person should consider obtaining a paper copy of the London Borough of Lewisham’s interagency guidelines on adult protection. The registered provider should consider obtaining the views of professionals working within the home as part of customer satisfaction surveys. The registered person should try to include the agenda DS0000007035.V312848.R01.S.doc Version 5.2 Page 30 2. OP7 3. 4. 5. 4. 7. 8. OP9 OP11 OP12 OP18 OP33 OP36 Morton House Nursing Home items brought by staff within supervision sessions. Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton House Nursing Home DS0000007035.V312848.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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