Inspection on 07/03/06 for Morton House Nursing Home

This inspection was carried out on 7th March 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 25/09/06

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 7th March 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.V281131.R01.S.doc Version 5.1 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.V281131.R01.S.doc Version 5.1 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.V281131.R01.S.doc Version 5.1 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. 4th November 2005 Date of last inspection Brief Description of the Service: Morton House is a care home providing nursing care and accommodation for 27 older people. It is owned by Mission Care, 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.V281131.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out over one day. The registered manager was present for the duration of the inspection. In addition, seven service users and two staff members were spoken to. Other inspection methods included inspection of care records and a partial tour of the premises. It should be noted that some standards for which requirements were stated at the last inspection the timescale given had not fully expired at the time the inspection was held. What the service does well: What has improved since the last inspection? Service users’ care plans have improved with more details around service users needs being included particularly in respect to personal preferences around daily routines, social interests and hobbies. There is a closer working relationship between the Lewisham’s Intermediate Care (LINC) team and the nursing and care staff of the home to ensure service users are receiving a better continuity of care. For potential service users, information is being obtained by the home to make sure that the home can fully meet their needs before the service users are admitted. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 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.V281131.R01.S.doc Version 5.1 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 Potential service users still do not have all the information they need to make an informed choice about where to live. Service users still need to be issued with a contract/terms of conditions with the home. A full needs assessment has been obtained for service users moving into the home. EVIDENCE: Subject to a previous assessment, an updated Statement of Purpose and Service User Guide were still not available for inspection. It was reported these are still in the process of being drawn up. Therefore this is to be restated as a requirement (See Requirements). A previous requirement that service users are issued with a contract/ statement of terms and conditions has been partially met. A draft contract/statement of terms and conditions has been drawn up which was seen but this is yet to be issued to service users (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 9 Eight service user files were inspected including those of permanent and intermediate care service users. There was evidence that a full needs assessment had been obtained for all recent admissions meeting the previous requirement stated in the last report. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 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 &11 There have been improvements in the details provided within individual plans around personal and social care. Health care needs are still not being fully addressed within individual plans and risk assessments are not comprehensive. There are inconsistencies in the way that medication systems are being used. Service users need to be consulted about their personal wishes and instructions at the time of death. EVIDENCE: Eight service user plans were inspected. At the last inspection the home had only recently introduced a new format for care plans. This consists of a daily living plan that addresses service user’s 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 user has written it themselves. Positively, the strengths of service users are addressed within the plans in that those aspects of daily living they can manage themselves are identified as opposed to only those with which they require assistance. A new form has also been added which addresses other “specific goals” to be achieved with service users. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 11 A previous requirement in respect to service user care plans has been partially met. Generally, it was evident that there has been an improvement in the details provided within the plans in terms of service users’ personal and social care needs. Individual preferences are specified around daily routines such as times for getting up and going to bed, assistance required with carrying out personal care, assistance required with mobilising and transfers amongst others. Social interests are also specified in good detail as well as dietary needs and food preferences. Communications needs of service users are not clearly addressed within the plan although it is addressed within the home’s assessment and this requires attention. There was also evidence that the plans have been reviewed more regularly on a monthly basis with a new daily living and clinical plan being drawn up on each occasion. However, service users, their relatives and/or a representative where appropriate had not signed the plans to indicate their involvement in the care planning process (See Requirements and Recommendations). For intermediate care service users despite there being evidence that the home had carried out their own assessment of service users needs, a daily living plan or a clinical plan had not been drawn up with service users. The care plan drawn up by the LINC (Lewisham Intermediate Care) team that specifically details their interventions was the only information available. Previous requirements have been stated that there needs to be 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. Some measures have been taken to improve communication between the LINC team and staff working within the home. For example, a member of LINC team now attends staff handover meetings, which was subject to a previous recommendation. However, it is also important that all intermediate care service users have a clear plan in place in respect to the care to be provided by the home’s care and nursing staff in addition to the care plan used by the LINC team (See Requirements). In respect to health care needs there was more evidence of liaison with a range of healthcare professionals such as chiropodists, opticians, dietician and referrals to memory and pain clinics. The home’s assessment is also very comprehensive and addresses areas such as nutrition, mobility and falls, control of pain, skin and pressure area care amongst others. However, a previous requirement that health care needs must be fully met by the home and risk assessments need to be more comprehensive remains unmet. It was evident from some of the care plans looked at that information provided within the full needs assessments obtained for service users and also information within the home’s own assessments were not accurately reflected within the clinical plans in place. For example, for one service user requiring palliative care it was noted from the needs assessment that psychological support was required and concerns were identified regarding weight loss, poor appetite and pressure sores. In addition, the home’s assessment that includes a scoring tool to screen for depression assessed the service user as having a score of four Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 12 with a score of three or more being suggestive of depression. Yet apart from pressure area care none of the other needs had been addressed within the clinical plan or the risk assessment. Similarly, for another service user information was included in a report that outlined concerns of the service user’s mental state and the need for stimulation through social interaction and social activities. The home’s assessment also identified the service was at high risk of falls and there were concerns about weight loss. However, none of these issues were fully addressed within the clinical plan or the risk assessment and neither had any weight monitoring taken place for this service user. In respect to two intermediate care service users whose files were looked at it was noted that parts of the assessment carried out by the home had not been completed (See Requirements). Due to ongoing concerns about errors being made in the administration of medication a referral was made to the regulatory pharmacist following the inspection who carried out a more detailed inspection of the home’s medication systems. As a result the home was issued two immediate requirements that specified the home must 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 (See Requirements). A previous requirement with regards to service users being assisted to self – administer medication has been partially met. The home has now included a self- administration risk assessment in the assessment form to be carried out with intermediate care service users. However, of those assessments inspected only one had a self- administration risk assessment completed. The home also has a new arrangement for medication returns. This involves placing all unused medication in a plastic bin that is then collected by a clinical waste company. During the inspection it was noted the bin that contained a considerable amount of medication had been left by the medication trolley unattended. This should be kept locked away at all times when not in use (See Requirements). A previous recommendation that staff should try to consult with service users around their personal instructions and wishes for death and dying has not been addressed. Of those care plans inspected only one had any evidence of this being recorded (See Recommendations). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 13 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 &14 Although the home generally provides a good range of activities for service users the home still needs to demonstrate more clearly that the individual needs of service users who are bed bound or less able to engage with group activities are being met. Service users need to be provided with more information around accessing advocacy services to ensure they can fully exercise choice and control over their lives. EVIDENCE: Group activities were looked at the last inspection and it was identified that the home does ensure service users are given opportunities to be involved in a range of different activities and to go out on outings to various places of interests. On the day of the inspection some of the service users were taken out shopping. In addition, as mentioned the care plans of service users do provide more detail of service users’ individual preferences around daily routines and social activities. Subject to a previous requirement that the home must ensure the social care needs of those service users who are less able to engage in group activities such as those who are bed bound and /or suffer with dementia are being met, this has not been addressed. It was reported that the home do try to ensure individual time is spent with all service users and a service user who was being Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 14 given a manicure by a staff member was observed during the inspection. Yet, apart from this, evidence to indicate that individual time is spent with service users was not available. The home needs to demonstrate more clearly within service users’ care plans the need for individual time to be spent with them to ensure they receive an appropriate level of stimulation and interaction. The activities to be carried out with them should be specified and a record of how often this occurs should also be kept (See Requirements). There was evidence to indicate that service users are able to exercise choice and control over their lives. Service users’ files are kept in their rooms giving them full access to see their personal records and bedrooms inspected were suitably personalised. Yet, information for service users around accessing external advocacy services to act in their interests was not available. It is advised that this information is obtained and that service users are made aware of that this service is available to them (See Recommendations). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 15 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): 18 Although the home has a robust policy on whistle blowing, the adult protection policy is in need of being reviewed and updated and training needs to be provided for all staff on adult abuse. EVIDENCE: There has been one adult protection investigation since the last inspection. The home reported this to CSCI and details of the investigation that had been appropriately carried out by the home were also sent. Social Services were informed. The matter has been concluded with the allegation that was made being found to be unsubstantiated. The home has a robust whistle blowing policy but the adult protection policy seen was not very comprehensive. It listed different types of abuse “as defined by Mission Care” but did not detail procedures to be taken by staff in a situation where abuse may be suspected or identified. This needs to be reviewed to address the issues of adult abuse and procedures around adult protection more comprehensively in reference to recent legislation. The home does have a copy of London Borough of Bromley’s interagency guidelines on adult protection but it is advised those guidelines of the local borough, Lewisham where the home is located are obtained for staffs’ reference (See Requirements and Recommendations). It was reported that in respect to staff having training around adult abuse and awareness, it is included in the induction programme and the home carries out some in –house training on abuse awareness. However, it was acknowledged that not all staff have had training in this area and there was no evidence Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 16 available to identify how many had received training. Two staff members spoken to had differing levels of knowledge around abuse issues but only one specifically stated they had received training. This needs to be addressed (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 17 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): 20 & 25 The home has sufficient communal facilities which overall are safe and comfortable but the communal lounge dedicated to intermediate care service users is being inappropriately used for storage. Generally, service users live in safe and comfortable surroundings but the home needs to provide evidence that water temperatures are checked. EVIDENCE: A previous requirement that the communal lounge for intermediate care service users should be made more attractive and items being stored in there should be removed remains unmet. The lounge is still being used to store equipment, boxes of the home’s supplies and items belonging to service users no longer living in the home. It was reported that storage is a problem for the home. There is a large outside storage room but this is shared with the LINC team restricting the amount of items the home can store. This needs to be addressed with alternative storage space being looked into to prevent this issue impeding on service users living in the home. It also potentially presents a health and safety issue (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 18 In respect to a standard 25 this was largely assessed as met at the last inspection. However, a previous requirement that evidence must be produced that the home is checking water temperatures monthly to prevent risks of scalding has still not been met. Details of this must be sent to CSCI (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 19 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 There are sufficient levels of staff with the required skills to meet the needs of service users. Over 50 of staff have achieved a National Vocational Qualification Level 2 in care. Improvements are still required in the home’s recruitment practices to ensure service users are fully protected. There are still gaps in staff training and induction that need to be addressed. EVIDENCE: The home’s rota was examined which accurately reflected the numbers of staff on duty the day the inspection was carried out. The home has two nurses on duty and six care staff on an early shift, two nurses and four care staff on an afternoon/ evening shift and one nurse and two care staff doing a waking night. It was reported that out of nineteen permanent care staff presently working at the home twelve have achieved the NVQ Level 2 in care, two staff members are in the process of undertaking it and two staff members have achieved a NVQ Level 3. Therefore, the home has exceeded the 50 target that care staff must be qualified by the end of 2005. Two new members of staff have been recruited since the last inspection. The files of these staff members were checked and it was identified that both had been allowed to start working within the home without a new Criminal Record Bureau (CRB) check having been received. Neither had POVA First Checks been Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 20 carried out. Instead, portable CRBs from a previous employer had been accepted although for one of the staff members there was evidence that a new CRB application form had been completed and sent off. However, this is not acceptable practice. An immediate requirement was issued following the inspection that new CRB applications and POVA First checks must be completed for both staff members. An immediate requirement was also issued at the last inspection regarding the home ‘s failure to carry out the required checks for staff working within the home. This remains outstanding. To date no evidence has been provided to CSCI that new CRB applications or POVA First checks have been completed for all those staff presently working within the home for whom portable CRBs have been accepted. Failure to continue to comply with this requirement may lead to enforcement action being taken (See Requirements). Other documentation required by regulation in respect to recruitment such as two references, passport/birth certificate for identification purposes were in place although a health declaration/medical questionnaire was only evident for one member of staff (See Requirements). A previous requirement that all staff should receive an induction and a training plan should be drawn up to identify training needs and ensure staff receive regular training including mandatory training being updated has been partially met. There was evidence that one of the new staff members has started an induction programme and it was reported the other was due to commence their induction shortly but this does not meet with NTO (National Training Organisation) specifications. However, a training plan has not been drawn up. Staff spoken to stated they had both undergone an induction programme and have had various training in dementia intermediate care, manual handling infection control and recent training around activities and venepuncture has taken place. Yet, as mentioned there are gaps in adult protection training being provided and there was insufficient evidence to demonstrate all staff are regularly having mandatory training updated. A comprehensive training plan with individual training needs being recorded needs to be put in place to ensure any gaps are addressed (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 21 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 Generally, the home is well run and the manager is experienced with relevant qualifications. The home should consider implementing a formal effective quality assurance system to ensure the home is run in the best interests of the service users. The home’s policy on the management of service user finances needs to be reviewed. Staff are not presently being supervised on a regular basis. Aspects of health and safety practice need to be improved to ensure that the health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager is experienced and is committed to running the home to a good standard. He is a qualified nurse and holds an MSc in Inter professional Health and Community Studies. He has also recently completed a course run in conjunction with Royal College of Nursing and Department of Health completed in “ Leadership Development Programme for Nurses Working Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 22 with Older People” demonstrating willingness to undertake periodic training to update knowledge and skills. As the manager does not hold a separate management qualification, it has been raised at previous inspections whether or not his present qualifications are equivalent to a NVQ Level 4 in Management. This is an ongoing issue that requires clarification. However, it has been agreed that CSCI will look into the matter. Therefore, a previous requirement that the registered manager should provide this evidence is not to be restated. The home does have some systems in place as part of quality assurance. For example, statistics are maintained and regularly updated and monitored in relation to intermediate care, resident meetings are held to which relatives are invited of which minutes were seen at the last inspection. However, the previous requirement that the home should carry out regular consultation with service users, their relatives and other stakeholders involved with the service by using customer satisfaction surveys as part of self –monitoring to look at ways of improving the service remains unmet. Customer satisfaction survey forms were seen on the files of intermediate care service users but these were issued by the LINC team. From the last inspection it was reported that a customer satisfaction survey was completed by an independent agency last year but evidence of this was still not available. An annual development plan for the home was not in place. Furthermore, monthly provider reports have still not been carried out with copies of reports sent to CSCI. It is important that the home addresses this. It is also advised that a formal and externally recognised quality assurance system is given consideration by the registered provider (See Requirements and Recommendations). In respect to service user finances it was reported that the home is appointee for one service user only and the home’s administrator takes overall responsibility for managing and maintaining the records of this service user’s finances. The home does not support any other service users with managing their personal allowance. The administrator was not present the day the inspection was held and the registered manager reported he could not access the records kept in respect to the finances of this service user to enable this to be inspected. Consequently, this will have to be looked at the next inspection. The home’s policy on ‘Resident’s Monies’ was inspected. This was drawn up in 2001 and needs to be updated. The policy needs to fully outline the home’s policies and procedures regarding service users’ monies and financial affairs and also needs to fully address measures to be taken by the home to protect service users from financial abuse. For example, the staff handbook does include some information about staff not accepting gifts or money from service users but there is no mention in this or the home’s policy about precluding staff involvement in the assisting of and in the making of or benefiting from service users’ wills (See Requirements). It was evident from records that staff have not received supervision regularly. Records of supervision seen were only dated form the beginning of this year. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 23 The registered manager acknowledged that there have been difficulties with ensuring staff receive supervision and with maintaining records (See Requirements). It was identified that the home needs to make some improvements around health and safety practice. For example there was evidence that the home has an up to date fire safety risk assessment in place records around testing call points indicated they had not been carried out weekly neither had regular fire drills with only two being carried out over the last year. There was no evidence available that the home has drawn up a comprehensive building/environment risk assessment and apart from a policy around Control of Substances Hazardous to Health Regulations (COSHH) that was seen other health and safety policies were not accessible. It was reported that the home’s administrator who as previously mentioned was not present for the inspection keeps records of maintenance certificates in relation to the gas boiler and central heating systems, electrical systems and equipment including hoist equipment and the passenger lift. Copies of this need to be sent to CSCI (See Requirements). Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 24 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X 2 X X X X 2 X STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 Page 25 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 Requirement Timescale for action 30/06/06 2. OP2 4&5 & Sch The registered person must 1 ensure that a statement of purpose and service user guide are drawn up for the home that include all the information required by regulation and these are accessible for all prospective service users and those presently living within the home. (Previous timescale of 28/02/06 not met) 5 (1)(b) 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 partially met) 12 & 15 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) DS0000007035.V281131.R01.S.doc 30/06/06 3. OP7 31/08/06 Morton House Nursing Home Version 5.1 Page 26 4. OP7 12(1)(a) &(b) 5. OP8 13(4)(c) 15(1) 6. OP9 13 (2) 7. OP9 13(2) 8. OP9 13 (2) 9. OP9 13(2) The registered person must ensure that further integration is developed between the LINC team’s interventions and the home’s care provision in order to fully maximise the support available to intermediate care service users and ensure all their needs are being met, specifically that all intermediate care service users have a care plan in place that is drawn up by the home in addition to the care plan drawn up the LINC team. (Previous timescale of 30/04/06 not fully expired) 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. (Previous timescale of 30/04/06 not fully expired) The registered person must ensure that service users receive all medication as prescribed and all administration is documented. (Immediate requirement issued by Regulatory Pharmacist 16/03/05 & Previous timescale 28/02/06 not met). The registered person must ensure that logs are kept for all medication for disposal. (Immediate requirement issued by Regulatory Pharmacist 16/03/06) The registered person must ensure that the medication returns bin is kept locked away at all times when not in use. The registered person must ensure that where appropriate DS0000007035.V281131.R01.S.doc 31/08/06 31/08/06 21/03/06 21/03/06 30/04/06 31/05/06 Page 27 Morton House Nursing Home Version 5.1 10. OP12 16 (m) 11. OP18 13 (6) 12. OP20 23 (2) (g) 13. OP25 13 (4) (b) & (c) 14. OP29 19 & Sched 2 service users are able to take responsibility for their own medication if they wish within a risk management framework. (Timescale of 28/02/06 partially met) The registered person must ensure that the social needs of those service users who are unable to leave their rooms and for those who are less able to engage with group activities are catered for, specifically that this need is clearly evidenced within individual care plans and time spent with service users and activities carried out with them recorded. (Previous timescale of 30/04/06 not fully expired) The registered person must ensure that the home’s policy on adult protection is reviewed and made more comprehensive and all staff receive training around adult abuse/protection. 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 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 requirement of 28/02/05 & 28/02/06 not met). The registered person must ensure that all required documents are obtained and all necessary checks are carried DS0000007035.V281131.R01.S.doc 31/08/06 30/09/06 31/08/06 30/04/06 30/04/06 Morton House Nursing Home Version 5.1 Page 28 15. OP30 18 (1) (c) 16. OP33 24 &26 17. OP35 16 (2) (l) prior to staff being employed to work in the home. (Previous requirement of 28/02/05 not met. Immediate requirement of 8/11/05 not met. Immediate requirement issued 8/03/06) Failure to continue to comply with this requirement may lead to enforcement action. The registered person must 30/06/06 ensure that all staff receives an induction to National Training Organisation (NTO) specifications 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 timescale of 28/02/06 partially met). 31/08/06 The registered person must ensure that there is evidence to demonstrate that as part of self monitoring regular consultation is being carried out with service users, relatives and other stakeholders involved with the home and that feedback on the results is given in the form of a report. Also, as part of quality assurance that monthly provider visits are conducted and copies of the report sent to CSCI. (Previous timescale of 28/02/05 partially met & 30/04/06 not fully expired). 31/08/06 The registered person must ensure that the home’s policy on the management of resident monies is updated to include making staff aware of their responsibilities in the prevention of service users being financially abused. DS0000007035.V281131.R01.S.doc Version 5.1 Page 29 Morton House Nursing Home 18. OP36 18 (2) 19. OP38 13 (4) (a) & 23 (4) The registered person must ensure that all staff receives supervision at least 6 times a year and records of supervision sessions are kept. The registered person must ensure that – - Health and Safety policies covering all aspects of Health & Safety practice are accessible within the home. - In respect to fire safety call points are tested regularly and fire drills carried out regularly. - A comprehensive building/environment risk assessment is drawn up. - Copies of maintenance certificates for gas boiler, central heating, electrical systems and equipment are sent to CSCI. 31/08/06 31/05/06 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. 2. Refer to Standard OP7 OP11 Good Practice Recommendations The registered person should consider altering the daily living plan/ clinical plan to make sure the communication needs of service users are addressed. 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 access information about external advocacy services and make this accessible to service users. The registered person should consider obtaining a copy of the London Borough of Lewisham’s interagency guidelines on adult protection. The registered provider should consider using a formal externally recognised quality assurance system for the DS0000007035.V281131.R01.S.doc Version 5.1 Page 30 3. 4. 5. OP14 OP18 OP33 Morton House Nursing Home home. Morton House Nursing Home DS0000007035.V281131.R01.S.doc Version 5.1 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.V281131.R01.S.doc Version 5.1 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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