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Inspection on 19/02/08 for Morton House Nursing & Rest Home

Also see our care home review for Morton House Nursing & Rest Home for more information

This inspection was carried out on 19th February 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mrs. Silk has considerable experience and qualification to fulfil her responsibilities. She has worked at Morton House for a number of years. People who use the service receive good attention to their personal and health care needs. The way that staff go about this work has the confidence of relatives and involved health care professionals. The staff are offered relevant training opportunities to help them in this work. Medications are managed safely. The staff know how to recognise and deal with any indications that people who use the service are not being treated properly. This sometimes means working with other professionals. New staff are not employed until they have been carefully checked to be sure they will be suitable to work with vulnerable adults.

What has improved since the last inspection?

Mrs. Sanghera has updated the information literature that describes the service. She has also purchased more aids and equipment to help the staff work safely with the residents and has purchased more bed linen so that there is now an adequate supply. Mrs. Sanghera has employed consultants to help her assess and record an assessment of the safety of the premises. There has also been more attention to routine maintenance arrangements at the home. A formal quality assurance system is being implemented to help Mrs. Sanghera and Mrs. Silk monitor the performance of the service. There is better written evidence of consultation with relatives when staff are making decisions about individual care plans.

What the care home could do better:

The information literature should be advertised and distributed more effectively. All people who use the service should have a copy of the service user guide. The home is not always clean enough to satisfy the people who use the service and/or their relatives. The lack of any laundry or cleaning support for staff providing care during some weekends is particularly concerning and needs to be reviewed. Staff do not yet receive a structured programme of one to one support and supervision as a means of monitoring their performance, professional development etc.There must be more dedicated space for storage at the home in order to avoid using accommodation intended for the use of people who use the service or staff utilities for this purpose.

CARE HOMES FOR OLDER PEOPLE Morton House Nursing & Rest Home Morton House Droitwich Road Fernhill Heath Worcester Worcestershire WR3 7UR Lead Inspector Wendy Barrett Key Unannounced Inspection 19th February 2008 09:00 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 & Rest Home DS0000004126.V354368.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 & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton House Nursing & Rest Home Address Morton House Droitwich Road Fernhill Heath Worcester Worcestershire WR3 7UR O1905 754489 F/P 01905 754489 asanghera@mortonhouseproperties.co.uk None Mrs Narinder Sanghera 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) Mrs Sheila Janette Silk Care Home 32 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 24 people for nursing care. 29th August 2007 Date of last inspection Brief Description of the Service: Morton house is a Georgian property that has been converted for use as a nursing and residential care home. There are 23 single bedrooms of which 3 have ensuite facilities and 4 double rooms none of which have ensuite facilities. In addition there are 2 communal bathrooms, 1 shower room and toilets, which are fitted with special aids to assist the less mobile, two lounges and a conservatory and two dinning rooms. There is a shaft lift between floors and handrails are fitted to assist the residents. The detached property is surrounded by 2.5 acres of well-stocked mature level gardens, and is located on the main A38 between Droitwich and Worcester. It is close to open countryside and yet convenient to the M5 via Worchester’s Northern Link Road, making travel from the Midlands and surrounding areas easy. The registered manager is Mrs Silk who is a first level registered nurse. Mrs Narinder Sanghera is the registered provider. The home is registered to provide care for a maximum of thirty-two older people of either sex who have personal and health care needs. A maximum of seventeen people may have needs relating to a dementia illness and a maximum of twenty-four people may have nursing needs. At the time of this inspection the fees ranged from £392-00p. to £525-00p. Additional charges were made for newspapers, hairdressing, private chiropody and massage therapy at market prices. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. An Annual Quality Assurance Assessment (AQAA) document was completed by the care manager on 21.06.07 and returned to the Commission for Social Care Inspection. This document sought the registered manager’s opinion of the service provided, and data concerning the home. Some of the details were referenced as part of the current inspection. Mrs. Sanghera was required to submit an improvement plan to the Commission. This was received in November 2007. It detailed her intended actions to comply with requirements arising from an inspection undertaken in August 2007. The improvement plan was also referenced as part of this inspection. Survey forms were sent out to a sample of staff, relatives, visiting health care professionals and service users. Several of service user surveys were returned uncompleted with comments that the recipient had already completed a questionnaire in the recent past. An unannounced inspection visit to the service was undertaken on 19th February 2008. A second visit took place on 28th February 2008. What the service does well: Mrs. Silk has considerable experience and qualification to fulfil her responsibilities. She has worked at Morton House for a number of years. People who use the service receive good attention to their personal and health care needs. The way that staff go about this work has the confidence of relatives and involved health care professionals. The staff are offered relevant training opportunities to help them in this work. Medications are managed safely. The staff know how to recognise and deal with any indications that people who use the service are not being treated properly. This sometimes means working with other professionals. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 6 New staff are not employed until they have been carefully checked to be sure they will be suitable to work with vulnerable adults. What has improved since the last inspection? What they could do better: The information literature should be advertised and distributed more effectively. All people who use the service should have a copy of the service user guide. The home is not always clean enough to satisfy the people who use the service and/or their relatives. The lack of any laundry or cleaning support for staff providing care during some weekends is particularly concerning and needs to be reviewed. Staff do not yet receive a structured programme of one to one support and supervision as a means of monitoring their performance, professional development etc. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 7 There must be more dedicated space for storage at the home in order to avoid using accommodation intended for the use of people who use the service or staff utilities for this purpose. 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 & Rest Home DS0000004126.V354368.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 & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is up to date information literature that describes the service but this isn’t being distributed as widely as it should be. The home makes sure that admissions are carefully planned so that they have the best chance of being successful. EVIDENCE: There is information literature that describes the service and this had been revised recently so that it contains the essential details people need to know. Although there were 5 copies of a service user guide displayed around the home, each resident should receive a copy and this wasn’t being done. A sample of signed contracts of residence was seen at the home. The documents appropriately specified the fee being charged and were signed by the person using the service, or their representative. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 10 Written records included reports of pre-admission assessments. This work is completed by senior staff at the home and involves collecting as much information as possible about prospective residents’ care needs and expectations. It helps the staff decide if Morton House will be able to respond to these needs, and it gives the prospective resident an opportunity to ask questions about the home and find out what service they can expect to receive. This pre-admission work helps to avoid unsuccessful placements. Emergency admissions are not accepted at the home. Morton House Nursing & Rest Home DS0000004126.V354368.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people who use the service are being met through individual plans of care. This is managed in a way that satisfies the residents and their relatives and takes into account their views and suggestions. EVIDENCE: Information is available to instruct and guide staff in the delivery of care so that residents receive the personal and health care that they need. There is now better evidence of the way that staff consult the people using the service and their relatives when care programmes are being planned and reviewed. One such record referred to a discussion with a daughter to encourage her to read her mother’s care records and to comment on them if she wished. This is sensible because, when residents can’t represent themselves, relatives are Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 12 most likely to know what approach would be acceptable to them. Their advice helps staff work in a way that will be comfortable and will respect the resident as an individual. The care plans are being reviewed regularly to make sure they are always relevant. A G.P. recently wrote and complimented the staff on the care they provided for one of his patients. People who use the service, and their relatives, made supportive comments about the quality of personal and health care at the home - “They are always here to help you if you want to talk about anything’, ‘friendly, competent staff who look after my mother well’. Questionnaires were sent out to people who use the service and their relatives in a consultation exercise organised at the home in the autumn of 2007. This resulted in a lot of positive comments about the personal and health care provided at the home-‘pleased with mother’s care and happy to know the doctor attends regularly’, ‘my mother is very well attended’, ‘we have absolutely no concerns about our mother’s care’. A nurse at the home spoke about how she was supported by the home in obtaining a Palliative Care Diploma. The home works closely with the hospice and has identified a particular bedroom at the home for admitting people who are at the end of their life. This room is spacious and comfortable so that staff have enough room to work, and relatives have a comfortable environment to spend time with the resident. Medication is managed safely so that residents receive their prescribed medication to maintain and improve their health and well-being. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to participate in individual or group events in the home and in the community. This enables them to live an interesting and stimulating life within their preferences and abilities. Religious convictions are supported and help is given so that residents attend the services of their choice. A choice of nutritional food is offered and enjoyed. EVIDENCE: One or two comments from residents expressed the wish that sometimes they feel staff are rushed as they go about their work and that they should ‘Give the more elderly and more disabled people a little more understanding of how they might be feeling when they are more or less dependent on the staff for nearly everything in their lives.’ The manager stated in the annual quality assurance assessment (AQAA) that: ‘Activities of daily living are flexible and varied, taking into account personal Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 14 preferences. Service users are encouraged to make choices in relation to social activities, meals, religious and spiritual activities, family, friends, and contacts. We arrange individual and group activities to encourage all service users to participate and enjoy activities as they wish. Residents are able to choose food they enjoy. We aim to provide a nutritious, balanced diet made from fresh local seasonal produce where available. Service users are served meals in an appropriate dignified manner so as to maintain independent eating. When this is no longer possible staff are supervised so as to offer assistance in a discreet, sensitive way. Snacks and drinks are available at all times and nutritious supplements offered when assessed as necessary. Service users are able to continue exercise choice and control over their lives. Individual care plans are discussed with service users and their representatives where possible and reviewed on a regular basis. We encourage and welcome people into the home from religious and cultural organisations. We celebrate religious festivals according to service users’ beliefs and wishes. Holy Communion is celebrated monthly. A new activities organiser has been employed. She has instigated a great diversity in group activities. She has spent time with individuals planning and discussing potential and possible activities, which are meaningful and stimulating. Meetings are now organised to enable service users to be involved in future planning of activities.’ The care records demonstrate an awareness of residents’ individual interests, and involvement in a wide range of activities that take place in the home and the community. People who use the service said that they were happy in the home and felt able to do as they wished- ‘They organise regular craft days and outdoor tea parties during the summer months’, ‘This is a lovely home and I am quite happy here.’ There was one request for more activities for the less able residents and a staff member felt that there should be more time for social care. All residents who spoke to the inspector at the last inspection complimented the standard of food. In the questionnaire responses comments included: • We get plenty of vegetables with our meals. • Meals are of a good standard, which I enjoy. • Good balanced diet. Five veg. at lunchtime. More variety required in the evening meal. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information and support that they need to raise any concerns they may have in the confident expectation of a fair hearing and response. New staff are carefully checked to be sure they will be suitable to work with vulnerable adults. Appropriate action is taken, when necessary, to protect the residents from harm. EVIDENCE: Two staff described the way they were selected for work at Morton House. Both confirmed that they were subject to all the necessary checks to be sure they would be suitable to work with vulnerable adults e.g. criminal records bureau checks, references. The staff demonstrated that they knew the correct action they should take if they were in receipt of a complaint or have any concerns relating to the safety and well being of a resident. A resident said ‘they are always here to help you if you want to talk about anything’. The home has a complaints procedure so people know how to raise concerns and have them looked into. This was confirmed in the survey responses from Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 16 people who use the service and their relatives. There haven’t actually been any complaints raised with the Commission or at the home since the last inspection. Nine staff received training in abuse awareness in December 2007. Training records showed that there had been similar training in April 2007 and in 2005, and the majority of staff have now attended one of these sessions. A recently recruited care assistant was able to describe the types of abuse she may come across and she knew how to report any related concerns to be sure they would be investigated. Senior staff have experience of working with other professionals in investigating allegations of abuse. This has shown that they are committed and competent to take appropriate action to protect the people who use the service. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service do not feel that their accommodation is maintained to a satisfactory standard, and this view is supported in the findings of inspection visits. The redecoration and refurbishment programme must be progressed more quickly to achieve a satisfactory quality environment. The staff know how to work in a hygienic way. EVIDENCE: There has been quite a lot of work done since the last inspection to improve the physical environment at the home. For example, a corridor area had been re-decorated and surfaces ‘made good’. An upstairs sluice facility had racks fitted so that commode pans could be dried hygienically. New linen had been Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 18 purchased and a senior nurse confirmed that there was now a satisfactory supply of bedding. New aids and equipment have been purchased since the last inspection e.g. six profiling beds, new bed rails and bumpers. Two new hoists had been ordered. It was noted that some commodes were rather stained and rusty in parts. They would soon need to be replaced. A parka bath had been fixed by having a new seal fitted, but a chip in the side of the bath was being covered by tape to avoid injuries. The bath would probably need to be replaced in the near future and the risk of residents hurting themselves on the damaged edging would need to be carefully monitored meanwhile. The above detail describes actions taken in response to inspection findings, rather than a result of a maintenance programme designed by the Provider. In future, the service should demonstrate its ability to maintain and improve the quality of the environment through an effective quality monitoring and business planning structure. There are already indicators of areas where future investment will have to be targeted e.g. replacement of old commodes, replacement of parka bath, decoration, replacement of furnishings and fittings. There was obviously a problem with storage space at the home. This is a longstanding situation that has not yet been addressed. Plastic chairs were stacked in the main entrance (a potential hazard if a resident attempted to sit on them). Sit on scales were also in the main entrance area. A pile of cushions and pillows were stacked in the corner of the residents’ lounge. The residents’ dining room contained staff lockers in the corner of the room. Staff handbags, cardigans etc were on the floor next to the lockers. The corner of a second dining room was being used to openly store equipment used by the activities organiser. Other examples of inappropriate storage were found throughout the home e.g. 2 large extractor fans and other bits and pieces stored on the floor of the clinic room. Areas of the building used by residents should not be used for general storage. This practice can introduce additional hazards and detracts from what should be a ‘homely’ appearance. Using utility areas e.g. bathrooms etc. for general storage also creates problems for staff who need the rooms for the purpose the space was intended. A survey response included the comment ‘decoration is a bit shabby’ The survey (conducted in the autumn of 2007) also identified some concerns about the general cleanliness of the home –‘more frequent cleaning in toilet areas’, ‘general cleanliness of rooms, corridors, carpets and stairs could be improved’. It was noted that a few commodes needed more thorough cleaning at the point of this inspection visit. A nurse and two care assistants demonstrated a good awareness of infection control procedures. They were proud of the way the home had managed an infectious outbreak at Christmas. This good practice had limited the spread of infection. The staff are provided with protective clothing and antibacterial cleaning materials to help them maintain everyday hygiene measures Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are generally enough staff to meet the basic care needs of the people who use the service but there should be more cleaning/laundry support over weekends. The arrangements for staff training have been strengthened to make sure all staff receive the instruction they need to work safely and competently. EVIDENCE: People are generally satisfied that the care they receive meets their needs but sometimes the staffing levels make this difficult. A resident commented ‘I think that they are sometimes too busy with doing what they have to, that they forget we are not always there because we want to be through choice, more because we need 24hr care.’ A few survey responses refer to staff ‘sometimes’ listening and this could suggest staff are rather rushed. Comments from staff suggest that they do feel they need more ‘social’ time to spend with the residents. There are weekends when no cleaning or laundry staff are on duty to support the staff involved in direct care. This isn’t acceptable because the laundry and Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 20 cleaning can’t wait until Monday in a home accommodating so many frail people. The number of care staff who either hold a national vocational qualification (NVQ) or are working towards one has been maintained at over 50 since the last inspection. Two care staff described the way they were checked before being offered work at the home. This was satisfactory because it included things like criminal records bureau checks and obtaining two written references as a means of confirming their suitability to work with vulnerable adults. The most recently recruited member of staff felt well supported by the more experienced staff. She worked with second staff member for a while and the nurses supervised her practice e.g. manual handling. She had completed an induction programme that meets national specifications. There has been additional attention to training programmes and individual staff training needs. A staff training policy and induction programme has been reviewed. Interviewed staff spoke about various training opportunities since the last inspection e.g. Fire awareness in October, abuse awareness at the end of last year. A sample of staff records included details of completed induction programmes. These included reference to an example of a new staff member being given a copy of an abuse policy in August of last year. A training matrix showed satisfactory attention to health and safety training. Manual handling skills were particularly well addressed. A matrix listed practical and personalised instruction and showed how all care staff had been instructed in specific moves they have to use during their duties. Given the nature of the service it would be advisable to increase the number of staff who have infection control training. The matrix listed just over half the staff team who have received this training. A qualified nurse was pleased that her employer had supported her in obtaining a palliative care diploma. Other staff were also receiving training relevant to the needs of people who use the service e.g. 12 staff attended training in dementia care in May of last year. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs. Silk, Care Manager/Matron has the experience and knowledge she needs to manage the everyday care of the people who use the service. Mrs. Sanghera has taken action to comply with many requirements arising from the last inspection. Progress will have to be maintained to achieve a satisfactory situation overall. EVIDENCE: The registered manager has been employed at Morton House as Matron for 8 years following 14 years experience as a senior ward sister/manager on an Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 22 elderly care ward. She also had qualifications as a registered general nurse, ONC, and a National Vocational Qualification at level 4 in management and care. The staff said that the home was well managed and the senior team were lovely, responsive and supportive. Although there was no regular programme of supervision meetings with individual staff there was an annual appraisal exercise just implemented. Staff described regular practice discussions with senior staff and records of these were seen at the home. The managers were considered to be ‘very approachable’ and all staff spoken to were happy with their support. It would still be advisable to implement a more formal system of one to one supervision because this is most likely to ensure that performance issues are addressed effectively. At the time of the last inspection it was observed that receipts were not always given when residents’ money was deposited with the home for safe keeping and management. The current situation was not inspected this time. The previous inspection identified a number of requirements relating to the general management of the service. This inspection confirmed that these requirements had been complied with or were being addressed. A quality assurance system has been introduced. This is the Blue Cross Mark of Excellence Quality Management System and the first consultation exercise was underway. Attention to health and safety training for staff has improved. A fire safety consultant produced a premises fire risk assessment in October 2007. A letter from the fire safety officer and written in January 2008 confirmed a satisfactory situation. An external consultant was also employed to write premises risk assessments in October 2007. A diary of routine checks had been implemented since the last inspection and a maintenance book was being used to record work needed e.g. a T.V. had been brought in for a resident. The maintenance book confirmed that it had been checked for electrical safety. A record of monthly bed rail checks was being maintained. There were also records seen that related to regular checks of fire safety equipment, flushing water and random water temperatures, cleaning of drier vents etc. An Aquatide chlorination certificate had been obtained in October 2007. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 23 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 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 & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 5(2) Requirement Each person who uses the service must be given a copy of the Service User Guide so that they have essential information about the service readily available. There must be suitable and separate storage facilities provided at the home in order to avoid cluttering areas intended for use by residents and staff for other purposes. The home must be kept clean at all times. Timescale for action 30/04/08 2. OP19 23(2)l, (3)a ii, 30/06/08 3. OP26 23(2)d 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 Good Practice Recommendations There should be additional cleaning and laundry staff hours to ensure adequate support is provided over weekends for staff providing direct care. Future refurbishment plans should address the DS0000004126.V354368.R01.S.doc Version 5.2 Page 25 OP26 Morton House Nursing & Rest Home 3. OP36 replacement of some commodes that are ‘past their best’. Staff supervision arrangements would be strengthened with the addition of a programme of structured one to one supervision sessions for all staff. Morton House Nursing & Rest Home DS0000004126.V354368.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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