Inspection on 25/08/09 for Morven House

This inspection was carried out on 25th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morven House 15/05/08

Morven House 29/05/07

Morven House 31/08/06

Morven House 01/11/05

Morven House 20/06/05

Morven House 16/09/04

Morven House 06/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Morven House The Causeway Potters Bar Hertfordshire EN6 5HA The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jan Sheppard Date: 2 5 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 37 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Morven House The Causeway Potters Bar Hertfordshire EN6 5HA 01707662755 01707663634 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.CareTech-uk.com Caretech Community Services Ltd care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: Date of last inspection A bit about the care home Morven House is part of Care Tech Community Services. The building is owned by the National Care Homes for Adults (18-65 years) Page 4 of 37 Trust and leased to Care Tech. It is located within several acres of parkland and gardens, which are accessible to residents. It is within walking distance of Potters Bar shops and town centre and is convenient for public transport links. Morven House provides residential services to 12 young adults with learning disabilities. The house has been divided into two units, one eight bedded unit for residents requiring higher staff input and a four-bedded unit for more independent residents. All bedrooms are for single occupancy and Care Homes for Adults (18-65 years) Page 5 of 37 each unit has access to its own communal areas. The layout of the building makes it unsuitable to residents with reduced mobility. There is a service folder, which includes a copy of the latest Commission for Social Care Inspection report, the complaints procedure and other information concerning the service, readily available in the home. Fees vary according to the unit concerned, ranging on average from just over £1000 per week to £1500 per week. Personal toiletries, newspapers, dentistry Care Homes for Adults (18-65 years) Page 6 of 37 and chiropody services where these are not free are all charged at additional cost, as are some day care services. Care Homes for Adults (18-65 years) Page 7 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 37 How we did our inspection: This is what the inspector did when they were at the care home The last key inspection of this service was made on 15/05/2008. This inspection took place over seven hours on a weekday and was carried out by two inspectors. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to adults. The report is written using accumulated evidence gathered prior to the inspection visit including information contained in the AQAA (Annual Quality Assurance Assessment) completed by the Manager, information given in any prePage 9 of 37 Care Homes for Adults (18-65 years) inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC ( Care Quality Commission) by the home. We made a tour of the building had discussions with the staff on duty and spoke with the homes Manager. We met and spoke with the service users. Spot checks were made on a number of the homes records and care plans. In compiling this report we have also taken into account information given to us by relatives and information received from health and social care professionals associated with the home including those received through any meetings held under Hertfordshire County Councils Safeguarding Care Homes for Adults (18-65 years) Page 10 of 37 procedures. What the care home does well On the day of our visit we found the home to have a calm and relaxed atmosphere. The residents enjoyed showing us their rooms and the garden facilities. During our visit we saw good interaction between staff and residents. The staff appeared to know the residents well and to understand how to meet their needs. It has been acknowledged at recent multidisciplinary meetings that Morvan House is able to help some residents to achieve good outcomes by Care Homes for Adults (18-65 years) Page 11 of 37 helping them to live good quality lives and to build up their confidence and skills. The home gives very good attention to enabling the residents to make their own choices by expressing their preferences and opinions. What has got better from the last inspection Since the last inspection the home has benefited from a number of renovations and redecorations and from the purchase of new furniture and equipment. The period since the last inspection during which the home has had two managers has been a particularly Care Homes for Adults (18-65 years) Page 12 of 37 challenging one both for staff and residents. A serious incident has given particular concern but Care Tech and their Regional Management Team have co-operated fully with the safeguarding processes and this is ongoing. What the care home could do better The person centered care plans must be kept up to date with evidence of how changing needs and risks are to be accommodated. The recruitment and retention of a new Manager and senior support staff will assist in providing people living in the Care Homes for Adults (18-65 years) Page 13 of 37 home with a more stable and settled staff team. It should enable staff to receive more regular supervision and to be more consistently managed. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 14 of 37 If you want to speak to the inspector please contact Jan Sheppard Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4 PA 03000 616161 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have an assessment of their care and social needs and are able to visit and test drive the service before having to make any decision about admission. The home has a Service Users Guide and a Statement of Purpose and prospective residents have all the appropriate information to enable them to make an informed choice. Evidence: Since the last inspection there has been only one new admission to Morvan House and that person transferred from another adjacent Care Tech service which was closing .This service user therefore had the advantage of knowing the home its staff and other residents very well as they used to make frequent visits to Morvan House and to attend social and day activity events with the Morvan residents. The homes pre admission process is thorough and includes the information needed to make a realistic assessment as to whether the applicants needs can be met by the home and provides staff with the details they need to help them provide care in the way they , the applicant wants. The manager told us that the home regards evaluating whether or Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: not any new applicant will be compatible with the existing service users as very important especially as the residents live in quite small groups. At this visit we found that good information had been gathered for this new applicant that they made a number of preliminary visits and that when they did move in they had settled very quickly into their new surroundings and were happy and were planning to extend their range of day activities. The manager is currently reviewing the information on the homes Statement of Purpose and during this visit we discussed the progress made so far with this. The home is aware of the need to take steps to move people on from Morvan House when their changing care needs may mean that these can no longer be met at the home. During this visit we learnt of careful care needs and risk assessments that were in process for one service user whose needs were fluctuating. Care Homes for Adults (18-65 years) Page 18 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in Morven House can be assured that they will be involved in the planning of their care and that they will be encouraged to make their own decisions about their daily activities and lifestyle. However they cannot be assured that they will be consistently supported by a staff team to keep them safe from risk. Evidence: During our visit we saw that staff were supporting the people living in the home in a personal way using various methods of communication which could be individually understood by the service user. An easy rapport was seen to exist between staff and service users and it was clear that the long standing core group of staff and the service users who are all also long standing knew each other well. At the time of our visit the home had a happy and relaxed atmosphere. It was noted during this visit that individual gestures or behaviour patterns of individual residents were understood and were being interpreted by the staff in a manner which supported their independence and wishes in a dignified manner. Staff told us that the regular one to one talk time meetings that they have with each resident ensures that they are all regularly consulted in an individual manner by staff who know them well and can overcome any difficulties that may arise Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: from their lack of or limited speech. All of the people who use this service have a written care plan which is compiled in a person centered format and another smaller plan compiled using visual symbols. The written plans were found to be very bulky and not in an easy to use format and they would benefit from having older out of date information removed so that the current information could be more accessible. Three plans were examined during this visit and although care needs were identified on each only in two of them were the records up to date; no evidence could be seen of service user involvement of the compiling of their plan nor could any regular reviews be seen to have taken place. The plan for one service user who we told had quickly changing care needs and which we were also told were now being assisted by specialist medical intervention had no records of being reviewed for the past three months. No written evidence of this recent improvement could be found. On another plan the need for chiropody had been identified at a review in September 2008 but no record could be found that this had been addressed although we were told that it had been. The missing persons form on one file was not completed this despite the fact that the home had recently had a missing person incident where the service user came to serious harm. Risk Assessments were seen on each file examined but again the recording of these was not up to date and details of reassessments to meet changing needs could not be evidenced. A number of generic risk assessments were found to be in place but these lacked personalization to meet the assessed risk needs of the individual service user and many were found not to have been reviewed for many months. A behaviour observation chart was seen to have been completed on one plan but no staff signatures could be evidenced. During our visit staff were observed to be maintaining a confidential approach to the sharing of service users information. Care Homes for Adults (18-65 years) Page 20 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Morven House can be certain that they will be offered varied opportunities to participate in a range of activities to meet their individual choices and needs and that they will be appropriately supported to use local community facilities and to maintain communication with their families and friends. They can be assured that they will be able to exercise their rights as individuals in deciding the daily routines of the home as they affect them including meals and leisure activities within the home. Evidence: All the people who use this service have an individually planned day activity programme encompassing several weekdays as well as some regular weekend and evening activities. The service users attend a number of Day Centre’s run by Care Tech and by the local authority and classes at two local colleges. Their attendance and activities have been planned to meet individual needs and interests. One service user who had previously not had a positive attitude towards any day activity programme is now looking forward to commencing classes at a local college in September. Two other service users are assisted by staff to maintain a work role in the local community at a Charity Shop and in a Garden Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: Nursery. The activity programmes showed that most of the service users had regular evening and weekend social events that they enjoyed including attending social clubs and visiting the local pub. All the service users are assisted to maintain contact with families and relatives and the home holds regular family meetings to seek their views and comments and photographic evidence was seen of their involvement with parties and social events garden BBQs recently attended. Several of the service users are able to make staying visits to their families at weekends on a regular basis. All the service users are encouraged to take an annual holiday some had enjoyed a stay in Corfu and others had visited Turkey. Plans for other holiday’s one to be taken in Northern Ireland where one service users family had come from were seen to be well under way. During our visit we saw that service users who were on an at - home day were assisted to go out to the local shops to buy their lunch and were then helped with making themselves coffee and were able to enjoy a relaxed lunchtime with their friends. They told us that they did their laundry on this day and sometimes went out to pay bills and evidence of this was seen during our visit. Menu planning is undertaken on a weekly basis using where needed pictorial menu cards. Service users told us that they are able to make good choices and that they enjoy their meals. In the first floor kitchen visual symbols have been placed on storage cupboard doors to assist one service user know where to find ingredients and equipment. This kitchen was seen to be clean and tidy and to be arranged with good order. Care Homes for Adults (18-65 years) Page 22 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Morven House can be assured that they will receive personal and health care support in a way that takes full account of their individual needs preferences and rights and that they will have good access to the full range of community and associated specialist health care services as and when needed so as to maintain their physical and mental well being. The home has sound policies and procedures for dealing with medication but these were not being fully followed and this could put the service users at risk. Evidence: Personal care is provided for the people who use this service in a way that meets their needs and takes account of their own preferences and expressed or known wishes. We found that service users were being consulted about their particular wishes and the events of the day for them were being planned with them. One was heard to be asked are you ready to go out now? Care plan documentation that we saw included detail about appointments with doctors and specialist health services including the community nursing service, psychology, the epilepsy service, dental services offered at Harperbury hospital, an optical service has recently visited the home and assessed all the service users and the incontinence advisory service is booked to make an assessment visit to the home later in the month. Service user’s weights are monitored with the GP giving advice. The home has worked hard to establish good working relationships with other health Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: professionals and to listen and act on comments and criticisms that they may make about the service delivery in the home. The home is aware of the constant need to keep the service users free from risk and to ensure their safety at all times. Since the last inspection written risk prevention strategies compiled to meet individual needs have been put in place but these have not been consistently followed and this has left the service users’ at risk. The home continues to use a MDS (monitored dosage system) for the storage and administration of medication. All the staff who administer medication have attended training to do this. The home stores its medication in two separate wall hung purpose designed medication cabinets one in the main ground floor office and the other in the kitchen area of the first floor Morven Garden Unit. These are appropriate and secure locations and it was seen that attention was being given to maintaining good temperature control in both sites. The MAR (medication administration record) sheets were found to have been (with one or two exceptions in the upstairs unit), correctly signed for regarding the administration of the medication. However the records relating to the numbers of medication bought forward and disposed of were not recorded consistently so that it was not possible to carry out a reconciliation audit. Handwritten entries on the MAR sheets were not signed. Phenobarbital which is a controlled medication was not being kept in a Controlled drugs cupboard. This poor practice in maintaining storage and administration records for medication could leave the service users at risk. Care Homes for Adults (18-65 years) Page 24 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident that they will be listened to and that complaints will be taken seriously. However inconsistent care practice means that they cannot be assured that they will be fully protected from harm and abuse. Evidence: People living in Morven House have access to a clear and effective complaints policy and procedure which is available in picture format to ensure that they can have a good understanding of it. Staff speak regularly with the service users in their one to one talk time meetings and ask them if they have any concerns or complaints that they wish to raise. Staff told us that the felt that this was a good way to pick up early signs of disagreements or issues that might other wise become much bigger problems. The home has a better practice Suggestions Box in the entrance hallway and this is bought to the attention of service users’ relatives and visiting professionals. Since the last inspection two complaints have been received from other professionals concerning inconsistent staffing support arrangements for service users in enabling them to attend punctually for external medical appointments. The requirement made at the last inspection that all the staff in the home should have further training concerning safeguarding and whistle blowing has been met. Staff said Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: that they felt they had a good understanding of the different kinds of abuse and the need for them to be watchful for these with this vulnerable group of service users many of whom do not have full speech. Staff had an awareness of what their role should be in reporting any concerns that they may have. However since the last inspection they have been a number of incidents where service users have been put at risk and these have led to safeguarding investigations some of which remain ongoing. The inconsistent way in which the home has carried out its own surveillance and care practice supervision procedures have left some service users at risk and has not prevented them from coming to serious harm. Care Homes for Adults (18-65 years) Page 26 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst Morven House provides a spacious and attractive environment for the people who live there the physical design and layout of the home cannot ideally meet their needs or ensure their safety. Care needs to be taken to ensure repair works and maintenance is undertaken in a timely manner to ensure people can live comfortably in the home. Evidence: Morven House is an early Georgian listed house owned by the National Trust and leased to Care Tech Community Services; it is surrounded by several acres of parklands and gardens. The unique character of this environment and the constraints of the building provide a particular challenge for those responsible for its maintenance and adaptation of the facilities to meet the increasing and changing needs of its service users. The home provides individual bedrooms for all the residents these are personalised with furnishings of their choice and provide comfortable and homely accommodation which reflect their interests and tastes. One service user told us about how they had chosen new decorations and furnishings for their room in colours of their choosing. The home provides generous communal spaces. On the ground floor there is a large dining room and a very large lounge both these rooms have high ceilings large full length windows and period feature fire places and wall and ceiling moldings. These are both very well decorated and furnished in colours and in an attractive style that accommodates the period design of the rooms. Staff explained that since the last inspection works to Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: refurbish these areas including redecoration the provision of new leather sofas new carpeting and soft furnishings had been carried out. Another smaller lounge room also on the ground floor which staff said was the preferred sitting area for many of the residents as it was a smaller room that felt more intimate and cozy whilst being attractively decorated and appropriately furnished had two sofas both with broken springs making them very uncomfortable to sit on. A shower and toilet facility close to this lounge accommodation was found not to be able to be used as it needed refurbishment. On the upper floors the sofas in the sitting area of the Garden View apartment were in need of cleaning and the extraction systems in the laundry and bathroom on that floor were broken resulting in overheating and an unacceptable smell in that area. The main kitchen on the ground floor which has recently been subject to a satisfactory Environmental Health Inspection report was found to be modern with good provision of facilities and to be kept tidily and except for the cooker and extractor hood which were both very greasy, otherwise to be kept clean. Overall the home was found to be basically clean but the manager explained that because of the difficulty the staff and residents found in keeping such a large building clean themselves a part time cleaner was being appointed to help maintain these standards. Many areas of the exterior of the building were in need of redecoration and many of the windows throughout were rotten and although some patching repair works could be seen these did not really fully address the problems. The grounds surrounding the home are extensive and new fencing has recently been provided to ensure better security in some areas. The lawns are cut by contractors and these were neat and tidy but other garden areas were overgrown and had an untidy and unkempt appearance. Weeds and brambles were growing across pathways which lacked sufficient shingle. Garden furniture and BBQ equipment was left laying about haphazardly. We discussed with the manager how a one off garden clear up exercise might be economically arranged so that good environmental dignity might be maintained for the service users. The manager showed us the large greenhouse areas and explained his plan to bring these back into use to provide meaningful day activity for some of the service users and to provide vegetables for the home. Care Homes for Adults (18-65 years) Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Morven House are cared for by experienced and trained staff who are robustly recruited. However the lack of regular staff supervision and the frequent changes and shortfalls in the homes management and senior staff numbers have negatively affected all aspects of the home. Evidence: Service users are fully involved when prospective new staff visit the home and are interviewed. The service retains a small stable core group of support staff who are experienced and who have good training opportunities. They have been robustly recruited with all the necessary legal and safety checks made to ensure the safety of the service users. However vacancies continue in the senior support team and one senior manager is not currently able to work in the home. These shortfalls mean that supervision is still not at the required frequency to adequately support staff and meet the requirements of the standard. The manager told us that the schedule of planned staff supervision meetings was not being met. Five staff have attained NVQ qualifications at level 2 and a senior support worker is Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: studying for NVQ at level 4. Staff spoken with gave details of the training they have received and this together with the standard of personal care seen to be given during our visit did suggest that staff have the necessary skills and experience required to provide people living in the home with a good standard of care based upon their individual needs .However poor supervision and lack of senior staff monitoring appears to be leading to the inconsistencies with care practice that have been referred to earlier in this report which have left some service users at risk. Since the last inspection all staff have undertaken refresher Safeguarding training, Dementia training has been attended and courses on Autism and Diabetes also accessed. Staff are routinely trained in Epilepsy Awareness and undertake mandatory basic First Aid training. All staff that do not hold an NVQ qualification are expected to complete the LDQ (Learning Disability Qualification) within three months of commencement of employment. Care Homes for Adults (18-65 years) Page 30 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service cannot be confident that the frequently changing management of the service will fully protect them. The frequent changes within the senior management team detract from the promotion of the welfare of both residents and staff and the effective operation of the service. Evidence: At the last inspection in June 2008 the home had no registered manager in post and a number of interim arrangements involving peripatetic managers and Care Tech Area Managers were in place. Since then two new managers have been appointed and have worked at the home for varying periods but the service is again to be without a permanent manager from the beginning of September 2009. The Care Tech company is committed to appointing a new manager as soon as possible providing that a suitable experienced and qualified candidate can be found. They recognize the importance of providing a stable senior management team and leadership in the home and the demoralizing effect that the continual management shortages and changes have on staff mood and performance. The Manager in post for the past few months is a qualified and experienced manager who Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: has had many years experience working in this field. One of their initial tasks was to assess the strengths and weaknesses in the service and to compile an Improvement Plan to address these issues and they shared this plan with us. They told us that despite the difficulties of having both a deputy manager and senior care post currently not filled they and the remaining staff team had worked together to understand and meet the needs of the service users so that care could be delivered in a manner which will enhance their quality of life. We saw that they have given priority to regularly consulting with staff and with residents and their families. Information from a family member given to us confirmed that the home was very willing to meet with and speak with them but said that they had found it difficult to keep having to establish relationships with new managers. We found all the staff on duty on the day of the inspection to be dedicated to the care of the residents and that the residents looked happy and some told us that they enjoyed their lives at Morven and had good opportunities to do nice things. We saw that priority to promoting the health safety and welfare of the service users and staff through the regular maintenance of safety checks, training and record keeping had been given. We found that records relating to the monitoring of water temperatures were kept and that these remained within prescribed limits to ensure that people were kept safe. We also saw that regular fire bell testing was carried out and an evacuation practice held on 19th August resulted in an evacuation time of only two and a half minutes. The company has all the policies and procedures for the safe running of the service and these were clearly identified in separate files and were seen to be kept in the main staff office where staff had easy access to them. Information given to us on the AQAA indicated that many of these policies had not been reviewed since 2006. The records relating to the company management visits under Regulation 26 were seen and the manager told us that they felt had been well supported by the company Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes  No  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, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 37 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 Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 The Registered manager must ensure that all the residents have person centered care plans which are kept up to date You must do this because the staff need direction on how to meet the current needs of the residents. 30/09/2009 2 23 13 The Registered Manager must ensure that the residents planned care and risk procedures are adhered to in accordance with their written policy You must do this to ensure that service users are not put at risk of harm or neglect. 30/09/2009 3 24 23 The Registered Manager 30/09/2009 must ensure that the health and dignity of the residents is promoted by ensuring that the home is kept in good repair, clean and free from Care Homes for Adults (18-65 years) Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action odours. You must do this to preserve the dignity and health of the residents and to prevent the spread of infection. 4 33 18 The Registered manager 30/09/2009 must ensure that there are sufficient staff of appropriate senior grade employed in the home. You must do this to meet the needs of the residents to meet the management needs of the home and to ensure the smooth running of the service. 5 36 18 The Registered manager must ensure that all staff receive supervision at least six times a year. 30/09/2009 You must do this so as to be able to give guidance to the staff to enable them to safely meet the needs of the residents and to enable them to progress professionally. 6 43 13 The Registered Providers 30/10/2010 must ensure that the people who live in the home benefit from a well run home run by a consistent Manager and senior staff team. Care Homes for Adults (18-65 years) Page 35 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action You must do this because the people who live in this home must live in a well managed home that meets their needs and is managed in a proactive manner that will ensure their safety. 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 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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