Inspection on 04/09/08 for Morton House Nursing Home

This inspection was carried out on 4th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Morton House Nursing Home 22/05/07

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 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Morton House Nursing Home Morton House 12-14 Lewisham Park Lewisham London SE13 6QZ Lead Inspector Rosemary Blenkinsopp Unannounced Inspection 4th September 2008 09:20 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.V364280.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.V364280.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 ade@missioncare.org.uk www.missioncare.org.uk Mission Care 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) Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (27) of places Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 27) 2. Physical disability - Code PD (maximum number of places: 27) The maximum number of service users who can be accommodated is: 27 22nd May 2007 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 which is an inter-denominational Christian registered charity owns it. 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 redecorated. 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.V364280.R01.S.doc Version 5.2 Page 5 Fees range between the following £750- £781.01 for intermediate care self funding. Local Authority fees for older persons care are between £599.00 to £615.00 Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over a one day period. The Manager facilitated the site visit. Periods of observation were undertaken on the ground floor. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CSCI. This was well completed with comprehensive information including the updates in respect of the issues specified. Six resident’s comment cards were provided and returned during the inspection. In addition three staff surveys were completed. During the visit the inspector met with two relatives and several residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: What has improved since the last inspection? Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 7 Since the last inspection refurbishment of the home has begun and many areas had benefited from redecorating some new flooring and a general improvement to the accommodation. There has been a new manager appointed after a period of time where temporary managers have filled the vacancy. This provides the home with consistency and continuity. Several of the requirements arising out of the previous inspection had been actioned including those around documentation, key working and care planning. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Morton House Nursing Home DS0000007035.V364280.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.V364280.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): 3and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The registered manager ensures that all prospective residents are appropriately assessed prior to admission; making sure that their care needs can be met. EVIDENCE: On the day of the site visit there were twenty two residents in the home, with 5 vacancies. Resident occupancy fluctuates due to the number of residents brought in for rehabilitation. Assessment information was inspected of those residents recently admitted and were included as part of case tracking. Assessment information included Lewisham Primary Care Trust assessments, hospital discharge summaries, and the assessment conducted by the manager of the home. In the first Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 10 assessment it was clearly identified that the resident had significant risks identified in physical care aspects although the section for social and spiritual needs was only partly completed. The Manager advised this was awaiting further information to be provided. The second assessment information included Lewisham Social Services information, and an intermediate care assessment as well as the homes own. The private contract for one resident was seen. Other contracts are issued through the funding authority. Assessment information for those residents requiring intermediate care were available. The Statement of Purpose had been updated September 2007 and was again under review. This will need to include new staff members and the Manager’s details once registered, in the updated version. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 11 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 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care plans seen reflected the assessed health and personal care needs of the individual and gave clear guidance on how these needs were to be met, although other aspects of care were limited namely social. Some of the health care needs of the person using the service were identified at the pre-admission assessment ensuring that appropriate healthcare professional input was accessed prior to admission and as needed. The medication policies, procedures and practice ensure that the people who use the service are given the correct medication at the correct time by competently trained staff. Some of the storage of medications introduces a margin of risk to residents. EVIDENCE: Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 12 Care plans of residents recently admitted were selected for inspection. Care plans included physical care issues and the interventions were to a reasonable content, which would provide staff with good information on which to base care. Staff and residents signatures confirmed input into the development of the care plan. Risk assessment for nutrition, falls, skin integrity, and the use of bed rails were completed. Multi disciplinary information included out patient letters and GP notes. Daily events records were to a reasonable standard. A second care plan was to a similar standard although it was clearly stated this resident was a smoker and several risks identified whilst these were identified in a care plan, there were no supporting risk assessment these should be developed. This resident also had issues with weight loss and these were identified in the care plan although the supporting food charts were limited in their completion. Care plan reviews were limited to statement such as “care plan to be continued”. This provides very little information on the progress made in that area, which is particularly important for rehabilitation residents due to their short stay in the home. Both care plans were limited on leisure and social aspects of care. One file included a behaviour monitoring chart which indicated aggression on a number of occasions, however there was no care plan for this. The behaviour chart was limited in content and would not aid staff to identify possible trigger factors, or other information on possible causes of the aggression or emerging themes. The weight chart indicted significant weight loss from 102 kilos to 87.8 kilos, between the period 15/7/08 to 1/9/08. The manager explained it was due to a malfunction of the scales although this was not indicated, nor was the weight checked on other apparatus. The nutrition care plan did not include the significant weight reduction or refer to the body mass index. Other records regarding weight and nutrition did not indicate issues with weight loss. Wound care plans are retained separately for ease of access by staff completing them. The medications were inspected. The policy relating to medication administration and the NMC guidelines were available for staff to reference. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 13 Medications are safely stored in appropriate trolleys. All bedrooms have a lockable storage cabinet for those residents who self medicate. Homely remedies were signed by the GP and indicated the maximum dose to be given. Medication administration charts contained a photograph of the resident for identity purposes and a record of any allergies that they may suffer. All medications inspected on the Intermediate Care unit were hand transcribed by staff. This was said to be very time consuming although there was no another system available due to the turnover of residents. The hand transcriptions made the charts look untidy and some of the writing difficult to read. Not all of the records were fully completed on those charts inspected, the omissions included quantities of medications received full instructions for the administration of “as required “medicines”. In one bedroom a prescription only medication “Traxam” gel was found not securely stored. Controlled drugs had supporting records which were fully completed. There was an oxygen cylinder which was not attached to a wall but was free standing. This needs to be securely fixed in a safe area free from naked flames or other hazards. The following advice was sought from the CSCI pharmacist on the matter “Oxygen cylinders must be secured so as not to fall and cause injury to anyone or damage to the cylinder or cylinder head”. Please see requirements 1, 2 and 3. Morton House Nursing Home DS0000007035.V364280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home endeavours to provide appropriate activities to the residents supporting and encouraging them to maintain their chosen lifestyle in their home environment. The residents are provided with a nutritious and healthy menu; choices are available and they eat in nice surroundings enabling them to feel comfortable and receive appropriate support and encouragement. EVIDENCE: Observation periods were undertaken in the lounge where residents were spending time. One staff member was attempting to do a quiz, two residents were participating. Later on another staff member held a church service and more residents participated. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 15 Visiting is open and relatives were seen to visit throughout the day which promotes family contact. Comments received from relatives and residents were generally favourable regarding the home and services it provides. One resident, who was sat in a wheelchair, said this was his choice he was complimentary about his bedroom staff and the food was said to be “Ok”. He enjoyed the TV and read the newspapers during the day; he had little family who could visit. The activities file was inspected and this had a record of the activities available and provided. Two staff, on the day of the site visit, were doing training on activities. There were periods, when in the main, residents in the lounge were sleepy and there were limited signs of engagement with one another or their surroundings in general. In the top floor day room had a kitchette in the fridge there were two items of food not labelled or dated one a plate of chips the other a kebab. All food must be dated and covered to ensure it is safe to eat. As we approached the home it was clearly visible that a staff member was in the kitchen with a baseball cap on eating from a bowl. This staff should of used the staff areas to have his meal, and whilst in the kitchen be properly attired. Prior to lunch the tables were set. There were two options of food on the menu including vegetarian and ethic dishes. On the menu sheet food preferences are recorded. Staff assisted residents in an unhurried manner with their meal. The environmental health department had reported good conditions during their inspection December 2007. Morton House Nursing Home DS0000007035.V364280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents have information on how to make a complaint and they can be assured that those received would be investigated. Appropriate procedures for referring adult protection issues are not being adhered to; this introduces a margin of risk to residents. EVIDENCE: Complaints information was on display in large print. This is also available in other documents provided to residents during their stay. Staff have access to policies and procedure for adult protection. In addition the Lewisham Adult Protection Guidelines were also available. The complaints file was retained in the office. One complaint received 22/8/08 was regarding a staff member being abrupt with a resident. It was unclear if this had been referred to adult protection and the manager said it had not. It could not be confirmed if all issues were being appropriately referred through adult protection procedures. The manager needs to make herself and all staff aware of the Interagency Guidelines to ensure all appropriate concerns are Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 17 referred. In the complaint form under the section “lessons learnt”, it stated that the carer would need constant supervision, this would be impossible to implement and this should be revisited. The information in the file itself was not in date order. The complaints’ forms themselves need to be amended to clearly state if the complainant was satisfied with the outcome of the investigation. Other complaints’ related to missing items of clothing, of which there were several on this issue, staff supervision and the lift out of service. One complaint had been raised through Social Services regarding bruising however there was limited information on this including what the outcome of the investigation was. Within one comment card received from a resident there was a comment stating that the resident was unaware of how to raise a complaint although would raise it through her daughter. During discussion with staff members staff were asked about whistle blowing and adult abuse measures both of which staff had a good grasp of. They were aware of the internal reporting systems although less knowledgeable about external organisations. Please see requirement 4. Morton House Nursing Home DS0000007035.V364280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides residents with satisfactory accommodation in which to live with adequate bedroom and communal areas. EVIDENCE: There have been some improvements to the environment including wooden flooring to the entrance hall and redecoration to the ground floor completed. Generally the home was clean although there was an odour in the hallway. The odour present in the entrance hall was difficult to trace or to establish the source of this, it was referred to staff for investigation. Lift access is available to all floors. The lift was referred to in the complaints file as it has been out of order on occasions. The home has as service contract Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 19 for it however when it is out of service, it has at times compromised residents lives and placed an extra burden on staff. There were a few areas where repairs and/or maintenance were needed to improve the environment for residents .The door guard to bedroom 28 was bleeping as an indication that it needed a new battery this was referred to staff for attention. On the top floor the radiator cover was broken and on the first floor the radiator guard was removed possibly in preparation for redecoration. The top floor day room had a kitchette drawer broken. In bedroom 209 which was empty but accessible to residents window restrictor was missing. The hot water was tepid in many outlets tested in bedrooms. There was a hole in the boxing around the pipes in the ground floor toilet. Some bedrooms were personalised and evidence of clocks and calendars for orientation purposes were seen. The manager was aware of the need for further improvement in the home environment and was addressing this as a priority. On going maintenance is required to keep the building safe and pleasant. Morton House Nursing Home DS0000007035.V364280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. At times there are insufficient staff numbers to meet resident’s needs. Training in mandatory subjects have been insufficiently updated to ensure that staff are safe and competent to undertake these practices. Evidence of checks on nurse’s registration are insufficient to confirm they are currently registered and safe to practice. EVIDENCE: During the site visit, on duty, there were two clinical team leaders, two Registered Nurses and six care staff as well as the manager, administrator and ancillary staff. The activities post is still vacant two care staff share the post working part of their week doing activities. There was discussion with the manager regarding the current staff group. Whilst the staff team does not reflect the background of the resident group the manager advises us that it reflects staff selected from the locally available workforce. The manger is working hard to recruit a multi cultural staff group to work in the home. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 21 Two staff comment cards confirmed that three days induction had been put in place covering mandatory topics. This comment card also referred to regular meetings with the manager and discussion about clinical issues. The absence of appraisal was in one comment card. Discussion with staff members indicated that they had a good knowledge of infection control measures and MRSA. Other training topics included use of the syringe driver and a half day first aid course. Staff shortages particularly at weekends, were commented upon by two staff, and the high use of agency. The average use of agency staff in the home is 30 . On the off duty there were a number of shifts covered by agency staff although there were none where the agency staff were in charge. Dependency of residents was also cited as a reason why staff felt very hurried and understaffed. Within a residents questionnaire the following comment was made, to the question – “are the staff available when you need them “ The answer, “always during the day, not always at night”. This needs to be investigated. Staff files were sampled evidence of identity checks references, CRB clearance and Person Identification Numbers (PIN) as confirmation that the member of staff was on the nursing register, were available. In the first staff file the PIN number card indicated that it had expired 7 July 2008. The manager was unable to locate evidence of her new PIN number except by speaking to the nurse herself. Records of PIN checks and regular checks on expiry dates, needs to be undertaken and retained. The second file contained similar recruitment records. The top of the CRB form was in the file as a record that this had been received and was satisfactory, although it was unclear who the senior person was who confirmed this information. Staff are subject to occupational health clearance prior to employment. Job descriptions contracts terms and conditions are provided. Staff confirmed induction periods using the Skills for Care standards. Sickness is monitored by the manager and any staff who has frequent sickness is referred to occupational health. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 22 The activities file was inspected and this had the Criminal Records Beaureau check of one person. This is confidential information and needs to be stored correctly. The manager was working hard to address staff issues including staff training. It was difficult from records provided to establish if all statutory training is addressed within the given time frames for updates. Staff spoken to confirmed that manual handling and health and safety topics had not been addressed in the last year. There is no manual handling trainer in the home one is awaiting an updating session. Please see requirement 5 and 6. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 23 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 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home, the residents, relatives and advocates benefit from having a qualified, competent, accountable, and committed manager and management structure in place. The home has open and transparent quality assurance systems in place ensuring that the aims and objectives can be measured and are achievable. The home has systems in place to ensure the health and safety of the residents, relatives and staff. EVIDENCE: Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 24 The manager facilitated the site visit. The manager has been in post since April 2008 and has applied to the CSCI to become registered. She is currently waiting for CRB clearance. She has had experience of management in this type of setting before and is a qualified nurse. She has worked hard to address the issues identified at the last inspection although some of these such as staff training and recruitment will take a longer period of time. The management structure in the home includes not only the manager, but two clinical team leaders who have some hours of their working week, supernumerary where they work 9am – 5pm. A selection of health and safety records were seen and found to be satisfactory evidencing that maintenance and servicing of the building and the equipment was conducted. The fire risk assessment was in place as was the emergency plan. Fire drill records contained staff signatures as confirmation of attendance. Fire equipment including the alarm system and the emergency lights are tested and serviced, although the emergency light records indicated testing in August 07 then March 08. The manager must look at the guidance provided on the frequency of testing for all equipment related to fire. There is no manual handling trainer in the home as one staff is waiting for an updating session. There is a health and safety officer, although they have not been provided with extra training to fulfil the role, this needs to be organised. Evidence of training on the mandatory topics is referred to in the staffing section. Two resident’s finances were checked and found to be correct with supporting receipts and records on the balance sheet. All expenditure is invoiced including that for chiropody. Finances’ are audited weekly by the manager and the administrator. Money and valuables are safely stored in a safe. The manager had conducted a resident’s survey May 08. Nineteen responses were received with generally good feedback on the care received, meals and the environment, although poor on activities. A relative’s meeting was planned for the day following the inspection. Staff meetings are split between care and qualified staff and there is one general one for as many as possible to attend. . Residents meetings are minuted. Reports for Regulation 26 visits were on site although gaps evident for some months. Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 25 Please see requirements 7 and 8 Morton House Nursing Home DS0000007035.V364280.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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 x x 2 Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15( 1) Requirement Care plans need to fully reflect social and leisure aspects of individual residents to ensure they receive the support they need. All of the medication records must be fully completed to include the quantities of medications received and full instructions for the administration of “as required “medicines. Oxygen must be safely stored at all times and securely attached when not in use to The manager must ensure all appropriate information is referred to adult protection and the matter investigated appropriate. Supporting records including a statement as to whether the complainant is satisfied with the outcome must be retained. All information must be securely to afford safety for residents, staff and visitors to the home. The manager must ensure that all staff receive training on a DS0000007035.V364280.R01.S.doc Timescale for action 30/11/08 2 OP9 13( 2) 10/11/08 3 4 OP9 OP16 13(2) 13(6) 30/10/08 30/10/09 5 6. OP29 OP30 17 18 (1) (c) 30/10/08 30/11/08 Morton House Nursing Home Version 5.2 Page 28 7 8 OP38 OP38 23 18 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. Fire equipment must be checked at the intervals specified Staff who have responsibility for health and safety must be sufficiently trained. 30/10/08 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Morton House Nursing Home DS0000007035.V364280.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V364280.R01.S.doc Version 5.2 Page 30 - 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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