Inspection on 29/08/07 for Morton House Nursing & Rest Home

This inspection was carried out on 29th August 2007.

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 & Rest Home 02/11/09

Morton House Nursing & Rest Home 04/02/09

Morton House Nursing & Rest Home 19/02/08

Morton House Nursing & Rest Home 09/01/07

Morton House Nursing & Rest Home 09/12/05

Morton House Nursing & Rest Home 25/07/05

Morton House Nursing & Rest Home 12/01/05

Morton House Nursing & Rest Home 28/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Morton House Nursing & Rest Home Morton House Droitwich Road Fernhill Heath Worcester Worcestershire WR3 7UR Lead Inspector Yvonne South Key Unannounced Inspection 29th August 2007 08:45 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.V339934.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.V339934.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.V339934.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. 9th January 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. It was stated on 29.08.07 that the current fees were between £1568 and £2044 per month. Additional charges were made for newspapers, hairdressing, private chiropody and massage therapy at market prices. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection incorporates information received by the Commission for Social Care Inspection (CSCI) since 09.01.07 and the information obtained during fieldwork on 29.08.07. The fieldwork extended over ten hours during which the inspector spoke to six residents and five staff. The registered manager was not on duty therefore she was assisted by the registered nurse in charge in the morning, and the deputy manager in the afternoon. Three residents, demonstrating a range of different needs, were case tracked. Their care was assessed and their documents were inspected. A partial tour of the premises was undertaken. Prior to the fieldwork the CSCI sent questionnaires to ten residents, their relatives and their General Practitioners (GPs). These sought opinions on the quality of the service provided. Eight responses were received from residents, six from relatives and three were received from GPs. Also prior to the fieldwork an Annual Quality Assurance Assessment (AQAA) document was sent to the registered persons. This was completed on 21.06.07 and returned to the CSCI. This document sought the registered manager’s opinion of the service provided, and data concerning the home. This was an unannounced key inspection, which focused on the key National Minimum Standards and the requirements and recommendations that arose out of the previous inspection. What the service does well: The home responds well to inquiries from prospective residents and their supporters. They are visited from someone from the home and they are invited to the home to look around and ask questions. A relative described Morton House as being friendly and homely. A good standard of personal and health care is provided. Relatives say that good personal attention is provided and ‘The home provides all the care my mother could wish for.’ Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 6 A new activities organiser has developed a wide range of individual and group activities and people are welcome to participate if they wish. New garden furniture enables residents and their visitors to enjoy the lovely gardens in comfort. People are able to receive the people from the church of their choice and attend services in the community if they wish. The residents praise the quality of the food and the choice they are offered. What has improved since the last inspection? What they could do better: Following the last inspection five requirements and seven recommendations were made. These had not all been met in full. The Statement of Purpose that provides prospective residents and representatives with information about the home was still not available. Minor improvements to medication records were still needed. Information is not always available regarding the residents’ end of life wishes. It is acknowledged that this is a sensitive subject but one that must be broached if the home is to act in accordance with the residents’ wishes when the time comes. The home does not have a quality assurance system or development plans. These would enable an annual audit of the service to be conducted so that plans can be formed to address any weakness that are identified and develop the service. Health and safety is not well managed. Staff have not all had relevant training. Systems and equipment are not regularly checked and serviced. There are no risk assessments for the building, service and work practices. Staff training is incomplete and they do not receive regular individual structured supervision and support from the senior staff to enable them to develop their personal skills, knowledge and expertise. Individual training records are not kept up to date. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 7 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.V339934.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.V339934.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): 3 (Standard 6 was not assessed as this home does not provide this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation is not available concerning the home so prospective residents and their families are not able to take away information to assist their decision. However they are made welcome, their questions are answered and they are offered a tour of the home. Needs are assessed before a place is offered to ensure the appropriate care can be provided. EVIDENCE: The manager stated in the AQAA that: ‘Our pre admission assessment takes into account all areas of diversity and care plans are compiled with this information. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 10 Our Statement of Purpose provides information on the home’s policy on equality and diversity. We have revised our admissions assessment documentation to include more information on service users’ preferences. All prospective service users have an assessment of needs and an open discussion with other professionals and relevant persons with the service user’s consent, prior to admission. Prospective service users and their representatives are invited to visit the home to assess the facilities and suitability of the home to meet their needs. Following the last inspection we have reviewed the home’s Statement of Purpose. We have extended our assessment of the service users’ needs to base an initial care plan. Following the last inspection a requirement was made that a copy of the Statement of Purpose should be supplied to the Commission and copies of it be made available on request for inspection by every service user and any representative of a service user. This requirement had not been met. The inspector was informed that the document was not available as it was being put onto the computer. The home was asked to send a copy to the Commission for Social Care Inspection as soon as possible. However in the questionnaire responses six of the eight respondents considered that they had received enough information about the home to help them make a decision regarding their admission, and they received the care and support that they needed. One respondent commented that: ‘On inspection of the home pre-entry, I was impressed by the atmosphere of friendliness and homeliness’. During this inspection three residents were selected to ‘case track’ one of these being a person who had recently moved into the home. The documents demonstrated that a pre-admission assessment of needs had been undertaken before a place had been offered to the prospective resident. Residents told the inspector that they were happy in the home and their needs were being met. Morton House Nursing & Rest Home DS0000004126.V339934.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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Medication is managed safely so that residents received their prescribed medication to maintain and improve their health and well-being. EVIDENCE: In the AQAA the manager stated that: ‘Care plans are very detailed and personalised to reflect the individual needs of the service user. Providing information to advise and guide staff in the delivery of their individual care. Care plans are supported by risk assessments. These are reviewed regularly to ensure the plan continues to address the problem. We keep service users’ relatives fully aware, involved and informed of their care according to the service users’ wishes. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 12 The nursing staff are a team of highly experienced trained professionals who provide a high standard of person centred care. We ensure that the service users’ privacy and dignity is respected at all times. The manager stated that they were aware of a need to increase the frequency of care plan reviews, to gather information relating to end of life wishes, to document service users and relatives’ involvement in care and to improve the accuracy of medication documentation. The records of three people were assessed during the fieldwork and these contained detailed and informative care plans that were well evaluated and reviewed. It is recommended that there be evidence maintained of involvement by the resident or, with their consent, their relative. A new form had recently been introduced into the file on which to record contact with family and representatives. It was suggested that if residents and relatives did not wish to be fully involved in the care planning process a monthly contact could at least be made and recorded confirming that they were satisfied with the care provided. A few documents had not been fully dated and signed and not all topical medication had been identified in the plans. The practice of regularly evaluating care plans had resulted in some changes being absorbed into these records rather than being easily identified in the care plan itself. Care must be taken that the care plans are kept clear and up to date. It was observed that staff had opportunities to access training in palliative care and a very good standard of care was being provided. Relatives were well supported. A recommendation was made following the last inspection that the residents’ wishes concerning terminal care and arrangements after death should be discussed and carried out. However in the three documents that were assessed there was only such information for one person. The deputy manager said that they were hoping to convert a double room into a single room specifically for palliative care. The room was light and spacious and ideally situated. It was a difficult room to use as a double bedroom. Due to the location of the washbasin, doors and windows furniture for two people was difficult to arrange to achieve a pleasing, safe and comfortable room. In the questionnaire responses residents commented favourably on the standard of care and support they received. One relative stated: ‘The staff are always pleasant and professional. They always go out of their way to make Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 13 visiting family members very welcome. My mother has been bedridden for over a year and good treatment ensures no bedsores etc.’ Communication with families was considered to be good. Examples given in the questionnaire responses were: • My husband or I are always informed of anything, which might affect our relative either in person as I visit frequently, or by telephone’. • I sometimes chat to the sister on duty. They are very friendly and keep us up to date with events. • We were informed one evening that our relative had been taken ill and were able to reach the home before the ambulance. We are informed when a doctor has been sent for and what has been prescribed. The documentation demonstrated good links with a range of health care professionals that were concerned in the care of the residents and this was appreciated by the residents and relatives who commented positively on this aspect of care Questionnaire responses included; • The residents are receiving the appropriate medication for their condition. • Senior staff ensure that I have attention and I have had numerous GP visits in the short time I have been here. • The staff always increase doctors’ visits frequency when necessary. The questionnaire responses from General Practitioners (GPs) indicated that they were pleased with the service. One doctor said; ‘Staff are always helpful and friendly’. Following the two previous inspections it was noted that although medication was generally well managed there was a few minor discrepancies in the recording methods. During this inspection it was observed that storage, stock levels and key security was good. However hand written entries on the medication administration sheets (MAR) were still not always signed by two people to ensure accuracy. Although allergies were clearly recorded, when there were no known allergies this had not been stated. Codes used for the explanation of non-administration were not always identified, and some medication instructions read ‘give as directed’. Such directions are not in accordance with the guidance given by the Royal Pharmaceutical Society of Great Britain and should not be accepted by the pharmacist or the home. A good example was observed that care was taken in obtaining adequate supplies to meet the needs of residents and to ensure that their pain relief was well managed. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 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: The manager stated in the AQAA that: ‘Activities of daily living are flexible and varied, taking into account personal 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. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 15 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 demonstrated an awareness of residents’ individual interests, and involvement in a wide range of activities that took place in the home and the community. The questionnaire responses indicated that residents were kept informed and their choices and decisions were respected. For example one person stated: ‘Residents who are reasonably mobile are often taken out by family or friends. Anyone can sit in the garden when it is fine – mix with others or be on their own if they prefer. Some have hobbies e.g. knitting, crosswords, and reading. My relative sometimes does not want to leave her room preferring to watch her TV and there is no problem with that’. Another person said that: ‘In spite of encouragement from all the staff I prefer not to participate so far’. A relative acknowledged the improvement in this part of the service with the comment: ‘Since my mother has been in bed – 2 years in Nov. her care has been adequate. Prior to this I was disappointed in the stimulation of residents and felt that mum deteriorated mentally on arrival’. Residents were observed by the inspector to be reading, knitting, listening to audio books and socialising in the lounges and garden. They told the inspector that they were happy in the home and felt able to do as they wished. A resident said that she enjoyed feeding the birds and squirrels from her bedroom window and was looking forward to her turn for a massage. The visitors’ book indicated that many people came to the home and during the afternoon a vicar called to conduct a service of Holy Communion and visit any parishioners that wished to see her. Another resident said that he received regular visitors from the Baptist church. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 16 All residents who spoke to the inspector 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. However a relative commented in the questionnaire response that: ‘My mother’s needs appear to be met. Occasionally she complains about the lack of variety of meals but you could argue that this is a personal preference’. Another relative stated: ‘I have found my relative in need of being tidied upespecially food left around her face after being fed’. It was observed that residents were addressed with respect and courtesy. People knocked on doors and waited to be invited to enter. The mail was delivered to residents or retained for relatives according to the residents’ wishes. Some residents’ financed their own private telephones and others were able to take and make private calls on the home phone. Keys to lockable storage and bedroom doors were offered on admission subject to a risk assessment. However it was observed that some door locks on bathrooms and toilets did not work. This put privacy and dignity at risk of being compromised. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 17 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. 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 and they raise any concerns they may have in the confident expectation of a fair hearing and response. Staff are well recruited and appropriate action is taken when necessary to protect the residents from harm. However to protect the people in the home further all staff need to undertake formal training in how to recognise the different forms that abuse might take and the policy and procedure they must use. EVIDENCE: In the AQAA the manager stated; ‘Service users feel confident that they are listened to, taken seriously and their concerns raised will be discreetly investigated and addressed. A complaints procedure is given to all service users and their representatives on admission and open discussion and explanation of the topic is discussed’. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 18 The AQAA indicated that no complaints were received in the past twelve months. However since this document was completed a complaint had been received concerning the loss of property and an investigation was underway. The deputy was reminded that the because of the nature of the loss the CSCI should have been informed. No complaint, concerns or allegations have been received by the CSCI concerning the service since the last inspection. Residents and relatives confirmed in the questionnaire responses that they knew how to raise their concerns and make complaints. Comments made included: • • We were given this information as soon as our relative moved into the home’. Have never been unhappy or had reason to complain. Residents told the inspector that they had no complaints and they were observed approaching the staff with questions, queries and requests and were well received and assisted. Three staff were interviewed and one of these was a care assistant from an agency. Two of them demonstrated that they had gone through an acceptable recruitment process and this was supported by their documentation. Appropriate checks had been made and references obtained. The agency care assistant confirmed that she had gone through a similar process with the agency she worked for. 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. The training matrix indicated that in a team of 31 staff 15 people had had training in the Protection of Vulnerable Adults (PoVA) or Abuse Awareness. This training is essential for all staff to ensure they are aware of and can identify the different types of abuse The manager demonstrated in the AQAA that the abuse of people in the home was not tolerated as following an allegation of abuse within the home two members of staff were dismissed after a thorough investigation. Concerns regarding racial abuse had been investigated and appropriate action taken. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 19 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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to arrange their bedrooms to their liking and needs. There are a variety of communal rooms that they can choose to use if they wish. There are several areas that have a negative effect on infection control and this puts the health of people at risk. Although a redecoration and refurbishment programme is underway progress is slow and this has a negative impact on the environment, the residents and staff. EVIDENCE: The manager stated in the AQAA that; ‘We provide the accommodation, facilities and equipment that the service users need to provide a high standard and quality of life. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 20 Service users are encouraged to furnish their rooms with suitable personal items. The home is fresh and clean and odour free. The garden is attractive and well maintained. Service users are encouraged to use the facilities as they wish. There has been provision of a new shower/wet room for service users comfort. There is an on going decorating programme. An ongoing programme to replace furniture and equipment as considered appropriate for individual care. We have replaced beds to meet individual requirements. A mechanical bedpan sterilizer has been installed. New dining chairs and tables have been ordered and new garden furniture has been purchased.’ The questionnaire responses indicated that people considered that the home was fresh and clean although ‘Carpets could do with a good clean at the home’. One relative said: ‘A visitor’s room or private room would be appreciated sometimes’. A partial tour of the home was undertaken. It was observed that the entrance hall was dark and items of equipment had been left there as storage space was limited. The gloss paint in many areas had been damaged over the years especially the skirtings and doorways. The conservatory was light comfortable and pleasant. Several residents agreed that it was a nice room to sit in. The largest lounge was not so appealing. Although the décor and quality of the furniture appeared acceptable the large size of the room made it difficult to arrange the furniture in a homely way and the room had an institutional appearance and atmosphere. A small lounge was available for those who preferred to use it and it could also be used for visitors or family parties. The room was also used for hairdressing, activities and training sessions It was disappointing to observe that there had been no improvement to the area near the back stairs. At the bottom of an unused staircase a storage project had been commenced and then abandoned leaving unsightly bare woodwork. The walls in the corridor were inappropriately tiled half way up, and the floor covering was damaged. Nothing had been done the address the situation since the last inspection. Work was in hand where damp had affected a wall. The cause was being identified and corrected, and then the wall was to be replastered and decorated. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 21 The sluice on the ground floor was in a very poor condition. The odour was particularly offensive. The surface of stainless steel sink was damaged to the point that it could not be effectively cleaned. The floor mop did not appear clean and the door squeaked. The condition of the sluice and the sink upstairs was also poor. The waste bin did not have a lid but there was no offensive smell. It was observed that a pleasant shower room was available and the deputy manager said that this was much appreciated by the residents and staff as a hygienic and less stressful way of maintaining personal hygiene. One bathroom had a Parker bath installed but the seal appeared faulty. Several toilets and bathrooms had faulty door locks and personal toiletries and property had been left behind, including prescribed creams. Several sets of bedrail bumpers were observed to be worn out. This made them difficult to clean and unfit for their purpose. Therefore the risks of cross infection were increased. The dining room had recently been redecorated and new furniture had been ordered. It was hoped that this would improve the appearance, as currently it appeared utilitarian, although the manager said that it was visually improved when the tables were laid with linen and flowers at meal times. It is to be hoped that new floor covering is also part of the refurbishment plan as seams were split in the current floor covering and it will become a hazard. A spacious well organised laundry was in the cellar. There were two domestic size washing machines and two domestic size tumble dryers. The home was constrained to use this size of machine because of the location and access to the laundry. However the demands on the equipment put considerable pressure on them. Residents’ bedrooms were observed to be clean, well decorated and furnished. Personal possessions adorned each room according to the wishes of the occupant. However their appearance would be improved if unwanted picture hooks were removed from the walls. The garden was pleasant and well cared for. New garden furniture had been provided and the residents were observed enjoying the dry weather. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 22 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New staff are properly recruited so that residents are not put at risk however the training is not complete so that knowledge and skills are not kept up to date. Therefore there is a risk that the residents’ care may be compromised. EVIDENCE: In the AQAA the manager stated; We aim to recruit persons who compliment our team of happy enthusiastic staff who deliver high standards of care with integrity and compassion. Our recruitment programme meets all the criteria in minimum standards. Care staff are actively encouraged to join NVQ2 or NVQ3 training programmes. Three staff were interviewed and their documentation confirmed that they had been appropriately recruited. They were aware of the needs of the residents and emergency procedures. The acceptability of staffing levels were said to be dependent on the needs of the residents. At ‘bad’ times staff were put under considerable pressure and they wished they had more time to spend with residents. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 23 A trained nurse said that there were usually 5 or 6 care staff on duty each morning. The sixth person made a great difference, as so many residents needed two people to help move them. If the trained nurse was constantly helping with moving and handling she was unable to undertake her own work without interruption. The demands on her were increased when the clerk was not at work. A relative said in the questionnaire response: ‘Patients were often left quite a while before being toileted even though there were constant requests from others too.’ Other comments made were: • I cannot praise the staff enough. They have been so caring. • I have thought how well the staff cope and how friendly and cheerful they always are. • The staff are very caring and loving. The sisters are very efficient. • Perhaps more staff would alleviate any problems. The ladies work very hard. • More staff would ease the pressure on the hard working carers, The residents who spoke to the inspector complimented the staff without reservations. A clerk was employed to work half a day, three days a week. The registered provider’s son was becoming more involved in the home and it was hoped that in time he would take some of the administrative burden from the trained nurses. The office was congested with files many of which contained obsolete information and caused confusion and added to the difficulty in locating documents. A large number of agency care assistants had worked shifts during the past three months due to the holiday season, sickness and staff vacancies. There were vacancies for one night care post, one full time day care post and one part time day care post and a relief kitchen assistant for the weekend. The posts had been advertised and responses were being received and application forms were being posted on the day of the fieldwork. Part of the data in the AQAA concerning staff was missing as it had been provided to ‘Skills for Care’ and the CSCI does not yet have the expected link with this organisation. The Manager did state in the document that Induction training did not meet the National Minimum Standards and there was no staff development programme. 29 staff were white British and there was one person from the Caribbean. 75 catering staff and 51 of care staff had training in safe food handling and only two staff had received training in infection control. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 24 During the fieldwork it was requested that a training matrix be sent to the CSCI as soon as possible. This was received and it demonstrated that in a team of 31 people there were nine trained nurses. Five had training in health and safety, seven had first aid training, five had food hygiene training, nine had moving and handling training, two had dementia care training and three had training in the protection of vulnerable adults. There were no records of training in infection control, challenging behaviour, communication or pressure care. There were twenty-two care assistants listed. Ten had health and safety training, ten had first aid training, eight had food hygiene training, eighteen had moving and handling training, eight had dementia care training and three had training in the protection of vulnerable adults. Only eight of the twenty-two people had National Vocational Qualifications. This fell below the 50 that is considered to be good practice in the National Minimum Standards. However eight people were on courses. Evidence was maintained of induction to the home when trained nurses from agencies undertook shifts in the home, however evidence was not available that agency care assistants had been similarly inducted. However an agency care assistant confirmed that she had been inducted to the home. She said that it had been detailed and informative, after which she had felt confident and able to be of use. Individual training records were being compiled but those that were assessed were not complete. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 25 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, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of regular structured supervision for staff restricts the development of the skills they bring to their work. The lack of some policies and procedures results in information being unavailable for staff to consult and receive guidance. Health and safety is compromised by the lack of training, regular checks of systems and equipment and risk assessments. This puts everyone in the home at risk of harm. The weakness in receipting of residents’ personal monies places the management at risk of allegations of mis-management. Without a structured quality assurance system the home is failing to identify where it can improve and develop. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager had been employed at Morton House as Matron for 8 years following 14 years experience as a senior ward sister/manager on an 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. However there was no formal supervision programme in place. A recommendation was made in the last report to this effect. Following the last two inspections it was identified that the home did not have effective quality assurance and monitoring systems that were based on seeking the views of service users and providing information for a systematic cycle of planning – action and review. There was no structured annual development plan and no programme of routine maintenance, renewal and redecoration of the premises. 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. Three samples were checked during the fieldwork and this situation was unchanged. This places the senior staff at risk of allegations of mis-management. Following the last inspection requirements were made that: After consultation with the Fire Authority arrangements should be made for persons working in the home to receive suitable training in fire prevention and ensure by means of fire drills and practices at suitable intervals that the persons working in the care home and so far as is practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. No evidence was seen that this had been done. During the fieldwork it was observed in the records that the automatic fire detectors were last checked on 09.05.07, self-closing devises on doors were last checked on 18.04.07 and the emergency lighting was last checked on 24.10.05. In the past guidance given by the Fire Authority was that these systems should be checked at least once a month by a competent person in the home. The deputy was unable to find other records that indicated more up to date checks. On 03.09.07 a fax of a document was received that indicated that emergency lighting had been checked each month and repairs carried out as necessary. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 27 In the past the Fire Authority also advised that all staff should receive fire safety awareness updates every three months. The records indicated that this was not being maintained. The records had not been updated and it appeared that some staff had not received training this year. If a home does not wish to follow the guidance given by the Hereford and Worcester Fire Authority in the past, they must demonstrate through robust risk assessments the level of risks and the frequency of checking and training that they believe will manage those risks. However in a fire risk assessment, professionally undertaken by Michael Downing on 01.011.05, training and risks were mentioned but there was no statement made on the frequency checks and training should be undertaken to manage the risks. Similarly in a risk assessment undertaken by the manager on 30.07.07 these details were not specified. Immediate requirements were made that fire safety systems and equipment be checked and staff training be updated within one week. Following the last inspection the registered manager was required to ensure all staff had received updated training in first aid, moving and handling, infection control, food hygiene and fire. The training matrix demonstrated that this had not been achieved in full. A number of the staff remained untrained in these health and safety areas. Following the last inspection it was noted that the home did not have risk assessments relating to the premises and the operating of the service. In order to ensure that all parts of the home are maintained and operate with due attention to health and safety risk assessments for the premises should be available. However only two very old out of date risk assessments were found. Routine checks of such systems as water safety and equipment did not appear to be undertaken as no records could be found. The deputy manager said that approximately ten residents were using bedrails. However no risk assessments or care plans were in place. The Deputy said that work had commenced to address this lack. An immediate requirement was left by the inspector that this be undertaken within three weeks of the fieldwork. The AQAA demonstrated that some policies and procedures were not available in the home such as first aid, individual planning and review, pressure relief, Induction training, Record keeping and sexuality and relationships. Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 28 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 1 X 1 Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 29 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 OP18 Regulation 13 (6) Staff must receive the training in the recognition and response to suspected abuse so that they can take appropriate action to protect people from the risk of harm. 2 OP26 13 (3) The risks of cross infection must be appropriately managed in the sluices and communal bathrooms and toilets and maintenance of equipment such as sluice sinks, bath seals and bedrail bumpers. This is to prevent the spread of infection between people in the home. 3 OP22 16 (2) (c) Suitable equipment must be provided in peoples bedrooms to ensure their safety and comfort; specifically appropriate bedrail bumpers must be available and in good condition. 30/09/07 30/09/07 Requirement Timescale for action 30/09/07 Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 30 4 OP38 18 (1) (c) All staff must receive up to date training in moving and handling, infection control, food hygiene and fire safety appropriate to the work they are to perform in order to safeguard people from the risk of harm. This requirement was not met in full. The timescale set (01/02/07) had not been met. 01/03/08 5 OP33 24 (1) A system must be established and maintained to review at appropriate intervals, and improve the quality of care provided. This is to ensure that the service develops in keeping with the needs and wishes of the people living in the home. Outstanding from the previous inspection report. The timescale of 01/06/07 had not been met. 01/12/07 6 OP38 23 (4a) A system must be established to ensure compliance with the requirements of the Regulatory Reform (Fire Safety) Order 2005 This is to ensure the safety of the people living in the home. This requirement is outstanding from the previous report. The timescale of 09/02/07 had not been met. All new staff should undertake Induction Training that meet the standards stated by Skills for Care so that they have the basic training necessary to provide care. 30/09/07 7 OP30 18 (c) (i) 30/03/08 Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 31 8 OP38 13 (4) All parts of the home must be maintained and operate with due attention to health and safety. Therefore risk assessments for the premises should be available All parts of the home must be maintained in good working order therefore the systems and equipment should be regularly serviced and maintained. 30/09/07 9 OP38 23 (2) (c) 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations An up to date Statement of Purpose and Service Users’ Guide must be available at all times and all residents must be given their own copy of the Service Users’ Guide so that information regarding the service is always available. Care plans and risk assessments should be reviewed with the resident, or with their consent their representative, at least monthly and updated to reflect changing needs so that the staff have the guidance and information they need. The residents’ wishes concerning terminal care and arrangements after death should be discussed and recorded so that they can be carried out. It is recommended that medication records are regularly audited to ensure they are acceptably and safely maintained. A minimum of 50 of care staff should have a National Vocational Qualification at level 2 or above so that competent qualified staff are always available. 2. OP7 3. OP11 4 OP9 5 OP28 Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 32 6 OP36 Care staff should receive formal supervision (1:1 support) at least 6 times a year so that they receive support and their knowledge and skills develop. In order to ensure that all parts of the home are maintained and operate with due attention to health and safety, risk assessments for the premises should be available and the systems and equipment should be regularly serviced and maintained. It is recommended that previous guidance given by the Fire Authority relating to checks of fire safety systems and equipment and staff training for registered homes be followed. 7 OP38 8 OP38 Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton House Nursing & Rest Home DS0000004126.V339934.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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