Random inspection report
Care homes for older people
Name: Address: Morton House Nursing & Rest Home Grange Lane Fernhill Heath Worcestershire WR3 7UR two star good service 04/02/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 0 2 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Morton House Nursing & Rest Home Grange Lane Fernhill Heath Worcestershire WR3 7UR O1905754489 01905754489 asanghera@mortonhouseproperties.co.uk None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Narinder Sanghera Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 0 32 0 dementia old age, not falling within any other category physical disability Conditions of registration: 17 0 32 The maximum number of service users who can be accommodated is: 32 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 (OP) 32 Dementia (DE) 17 Physical disability (PD) 32 Date of last inspection 0 4 0 2 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home 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 Worcestershires Northern Link Road, making travel from the Midlands and surrounding areas easy. The manager is Mrs. Roberta Quarterman. 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. For details about the range of fees charged along with what is, and what is not included within the fee, please contact the home. Care Homes for Older People Page 3 of 11 What we found:
The reason for this inspection was to assess the training and competency of new staff to meet the individual needs of people who live at the home together with the conduct of the manager following complaints made by three people anonymously. We spoke to ten members of staff, the manager and provider. Some people living in the home were asked if they would like to speak with the inspector and their response was that they did not have any concerns and or issues to share with us at this time. We reviewed some care plans, risk assessments and daily records of people living in the home. We saw records about staff including how training is planned and the manager. We also looked at how staffing levels are planned, staff and residents meetings, how complaints are recorded and the complaints procedures. Findings below were discussed with the management team by the inspector at the time of our visit. Care Planning and Monitoring Health, Welfare and Safety We saw the care records of some people who lived in the home. Individuals care, health and social needs are documented into care plans and risk assessments. We were told by staff and the manager that all care plans have been reviewed and rewritten where appropriate to make certain that individual plans and risk assessments are up to date. This task has been achieved since the manager came into post in April 2009. The care plans and risk assessments that we saw noticed that a persons changing needs had also been reflected so that staff have the guidance and information they require to meet each persons needs. Staff told us that they have access to each persons care records at any time of day and night. Also staff said that each person living in the home now has a named member of staff so that consistency in meeting individuals care needs are able to be maintained. This way of working enables staff to form close relationships with individuals so that people who live at Morton House are able to feel comfortable in disclosing any concerns and or issues. Recording, Complaints, Incidents We saw some complaints that have been received by the manager and recorded in the complaints log. Each complaint has been investigated and action taken where appropriate to resolve any issues and or concerns that have been raised in a timely manner. The manager has made certain that they have responded to the person raising the complaints and where needed referred any issues that need to be assessed further to external professionals, such as, on one occasion the speech and language therapist. This shows that the complaints procedure is used to analyse or learn from people and to prevent recurrence. Staff Training We looked at staffing records of some staff which included relatively new members of staff. The relevant checks had been completed to make sure that staff are able to work with vulnerable people. We saw training certificates which included relevant subjects, such as, moving and handling, health and safety, infection control, protection of vulnerable adults and so on. It was good to hear from staff that they are always supported and encouraged to undertake training. The manager makes certain that as well as mandatory training staff are also supported to complete more specialist courses which reflect the individual needs of people who live at this home. For example, end of life care, syringe drivers, incontinence and so on.
Care Homes for Older People Page 4 of 11 We were told that recruiting staff to work at the home had been rather difficult but recently this has now been achieved. Staff who had worked at the home for some years confirmed that new members of staff who had recently commenced working at the home are very caring and always ask for assistance where needed. At first there were some difficulties in relation to staff being able to communicate effectively with individuals. However, it was confirmed to us that this has now improved with training, supervision and shared experience from staff who have worked at the home for some years. All staff spoken to without exception said that they felt that the needs of each person living in this home are met effectively and in a timely manner. We looked at a sample of staffing rotas and found that what staff and management told us about how many staff should be on duty was being maintained. However, we did share with the manager that we share the concerns of staff in relation to one trained nurse completing morning shifts at weekends with care assistants. This is because nurses complete all administration of medications to all people living in the home on both the ground and first floor. Therefore if there was a medical emergency the nurse would have to leave the administration of medications to attend to this. This practice does not fully promote peoples health and safety. The management team told us that they are looking at this and considering ways this can be improved upon so that people are in safe hands at all times. Staff shared with us that on the afternoon shifts there is sometimes a need for one member of staff to work in the kitchen and this means there is a shortage of staff to provide direct care to people. However, we were informed that this will now improve as this is also being resolved. We were told by staff that we spoke with that they find their supervision sessions useful in supporting staff within their roles and responsibilities. Staff said that regular supervision is now happening as this was not the case prior to the manager coming into post. This should provide confidence to people living at this home in knowing that their needs are being met by staff who are being supervised and their performance monitored. However, we could not find any supervision documentation and the management team acknowledged this shortfall. We were told that the office area was going to be organised so that information and records can easily accessed. This should assist in ensuring confidential records such as supervision notes can be located at all times as these will be needed so that the manager and staff member are able to measure outcomes. Staff meetings are being held which provide staff with the opportunity of sharing their views and gaining information about practices within the home. All staff spoken with confirmed that this was the case. Management The manager of Morton House has been in their current position since April 2009. The manager does have the appropriate experience and training to be able to discharge their duties and responsibilities. Changes have been implemented since the manager came into post and at first this process was difficult for staff. The provider could have managed and promoted the manager coming into post in a more positive way so that staff were not left feeling anxious as this does not benefit people who live at the home. However, staff told us that they feel more positive now as they have recognised that the changes that have been made have resulted in improved practises that promote
Care Homes for Older People Page 5 of 11 the best interests of people living at Morton House. From our findings we note that action has been taken since the manager came into post that benefits people and the manager has expressed a willingness to improve further. The health and wellbeing of people living in the home is now being promoted, monitored and reviewed with appropriate clinicians. People are protected as far as is possible by the homes procedures in care planning, risk management, human resources and staff training. We did not find that people are at risk as staff are receiving appropriate ongoing training. Any risks to people living in the home in relation to staff meeting their individual needs is now being effectively managed so that they are minimised. The manager is promoting training opportunities to all staff so that people benefit from receiving care and support from knowledgeable and skilled staff team. The manager has an Open Door policy and people who live there, their families and staff can see her at any time to discuss concerns, issues or new ideas. The manager has also commenced meetings for all people in the home and their families to discuss changes in the home, and to share ideas for further improvements. We did discuss with the management team that the homes complaints procedure needs to be displayed so that it is accessible to all. We acknowledged that the homes complaints procedure is detailed in the statement of purpose and service user guide. We could not find any records that show that the provider and or their representative visit the home each month and write reports about the quality of service being provided. None of these reports were available in the home and they should be available for us to see when we visit. We spoke with the management team about these reports and it was acknowledged that these visits have not been completed since about March or April of this year. A definite date in relation to when the last visit was completed could not be verified at the time of our visit. It is now a requirement that the provider and or their representative complete these visits. We were told that these visits will now be completed once a month and we will look at these when we next inspect this service. What the care home does well:
The arrangements for care plans and risk assessments has been reviewed and improved in order that all new and emerging care needs are identified, assessed and addressed in the documentation. The manager is making certain that care plans are implemented as working documents to guide all staff so that the overall care delivery can be improved to make sure all of peoples needs are met. The manager takes a proactive approach to encouraging and supporting all staff to complete both mandatory and more specialist training so that people living in the home can be confident that all of their individual needs can be met whilst living at Morton House. Staff who we spoke with appear to be dedicated and committed, who want to provide good care to people living at the home. Care Homes for Older People Page 6 of 11 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 27 18 Suitably qualified staff in 06/11/2009 sufficient number must be on duty at all times that matches peoples needs, the statement of purpose and the homes layout. The manager must assess and arrange for the appropriate numbers of nursing staff to meet individuals needs at weekends. People need to have confidence that their needs will be met 24 hours a day, with appropriate assistance in an emergency. 2 33 26 The Provider must carry out monthly unannounced visits to the service in accordance with this Regulation. To monitor the quality of the service being provided to the people who live in the home. 06/11/2009 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 36 Staff should be clear on their roles, be supervised at least six times a year, and have meaningful regular appraisals of their knowledge, performance, and development needs. All supervision sessions must be recorded and show any actions to be taken to improve or increase knowledge. Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
