Care Home: Morley House

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What the care home does well What has improved since the last inspection? People in the home have Health Action Plans in place, which are being completed. These are to help people keep track of their own health. They are booklets, which they can take to their health care professionals to ensure that information is written down and recorded. People also have Person Centred Plans, which are also being completed. These contain information, which is important to the person and to help staff to support them better. The home used to use a keypad to get in and out of the home. This is no longer being used which allows people to leave and return when they wish. People are seem to be more involved in their home and participate in the development of their home. What the care home could do better: 2 requirements have been made.The heating needs to be improved to make sure that all areas of the home are warm. Some parts of the home were not very clean and need to have a deep clean. This was also an issue from the last visit. Staff need to ensure that they record information about people`s health needs correctly, and evidence that support plans have been completed with the individual. The home`s risk assessment regarding fire safety needs to be updated to ensure that all residents remain safe. CARE HOME ADULTS 18-65 Morley House 1 & 2 Morley Square Bishopston Bristol BS7 9DW Lead Inspector Nicky Grayburn Key Unannounced Inspection 14th November 2007 09:30 Morley House DS0000026542.V352040.R01.S.doc Version 5.2 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 Morley House DS0000026542.V352040.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 Adults 18-65. 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. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morley House Address 1 & 2 Morley Square Bishopston Bristol BS7 9DW 0117 942 6563 0117 942 6563 morleyhouse@freewaystrust.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Freeways Trust Ltd Mr Jason Sanders-Harding Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate persons aged 21 - 64 years Date of last inspection 16th August 2006 Brief Description of the Service: Morley House is operated by Freeways Trust Ltd and is registered to provide personal care and accommodation for up to thirteen people who have a learning difficulty. The house is situated in a residential area and blends in well with the local environment. It is built over four storeys and has a basement for storage and laundry use. There is a pleasant garden at the rear with seating area. The premises would not be suited to residents who have mobility difficulties, as floors are only accessible via staircases. Morley House is located close to local amenities and shops, which are regularly used by residents. There are also two cats, which live at the property and are looked after by residents. The range of fees for the home ranges from £531 to £707 per week. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Morley House’s key inspection. It was unannounced. The inspector visited the home from 11.30am until 8.15pm. The inspector met with many of the residents and staff, and the Deputy Manager. There were a few requirements or recommendations to follow up from the previous visit in August 2006. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s monthly reports carried out by the home’s Area Manager; incident reports; the previous report. The Manager also completed the Commission’s ‘Annual Quality Assurance Assessment’ (AQAA), which is a self-assessment of the home, giving information regarding the service. It also includes details relating to each of the headings below with a description of ‘What we do well’; ‘What we could do better’; ‘How we have improved in the last 12 months’; and ‘Our plans for improvement in the next 12 months’. The inspector looked at key documents; talked with and observed residents, staff and the Assistant Manager on a one-to-one basis; and undertook a tour of the property. An ‘Expert by Experience’, via Bristol’s People First Advocacy group, also visited the home for a couple of hours in the late afternoon and spoke with residents in the lounge. An ‘Expert by Experience’ is someone who has experience of living in a residential care home and then writes a report for the inspector about what they found out. For the purpose of this report, they will be referred to as the expert to maintain confidentiality. Surveys were sent out to the home for residents, relatives and professionals to complete if they wished. The surveys for the residents were being filled out at their day centre, 3 were returned. The inspector received 10 relatives surveys, 2 surveys from General Practitioners and 1 from a health care professional. 3 residents were case tracked and the inspector checked other residents’ records. Verbal and brief written feedback was given at the end of the inspection to the Assistant Manager. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 2 requirements have been made. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 7 The heating needs to be improved to make sure that all areas of the home are warm. Some parts of the home were not very clean and need to have a deep clean. This was also an issue from the last visit. Staff need to ensure that they record information about people’s health needs correctly, and evidence that support plans have been completed with the individual. The home’s risk assessment regarding fire safety needs to be updated to ensure that all residents remain safe. 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. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is good. The home’s Statement of Purpose, once updated, gives information about the home to residents and their supporters. Prospective residents are able to visit the home prior to making a decision whether to move in or not. People’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose is being updated, as stated in the AQAA, to reflect the home’s current practices. It was requested that this be sent to the Commission for Social Care Inspection. One new resident moved into the home this year and appears to have settled in well. Their social worker was involved in the placement and still is. A preassessment was carried out to ensure that their needs could be met at Morley House. The manager informed the inspector of the prospective resident prior to them moving in. They moved in officially after a 3-month trial period. The AQAA confirmed that they followed the admissions procedure but the number of visits was reduced due to the urgency of the move. However, visits and a weekend stay was still managed. The AQAA also stated that the resident Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 10 was shown alternatives by their social worker but choose to live at Morley House. The home has undertaken observations over a couple of months to ensure that staff can support them effectively. 3 out of 3 residents’ surveys stated that they were asked if they wanted to move into the home and did receive enough information about the home prior to moving in so could decide if it was the right place for them. The 2 General Practitioner surveys stated that they were satisfied with the overall care provided to people within the home. 7 out the 10 relatives’ surveys said that the home ‘usually’ meets the needs their relative in the home, 3 put ‘always’. As detailed within this report, the home meets the residents’ needs through, for example, regular reviews; key worker sessions; house and staff meetings; asking for advice and guidance regarding specialist health needs; and then acting on what is agreed. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is excellent. People have individual care plans which are reviewed regularly. People are supported to take risks as part of their everyday life. People are involved in their support plans and in the development of their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative wrote on their survey “they [staff] treat each resident individually, allowing according to capability, freedom of choice.” 3 people’s files were read and other people’s files were spot-checked. Other residents were discussed with the Assistant Manager and members of staff. Each individual has a care plan which is reviewed formally on an annual basis. 2 of the 3 people have had reviews with their funding authority in recent months and the Assistant Manager said that these are booked for other people. When social workers do not attend, the home carries out internal reviews. More evidence could be seen for when the individual is involved or chose not to Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 12 be involved. The previous report recommended that people should read and then sign their care plans to show that they agree with what is written about them. This still needs to be fully implemented. From these, risk assessments and behavioural strategies are written to ensure that people are kept safe and that their needs are met. Each individual has an assigned key worker who writes monthly reports in relation to their needs. The AQAA explained what is recorded in the Key Worker reports, for example, life skills; health appointments; changes in support plans; goals set; what they have done during that month, health and safety issues. Some of these reports were read during the visit. These mostly have good information about the past month. However, it was pointed out to the Assistant Manager that some have the same back page as previous months, therefore, not having current information. It is important for the monthly reports to reflect the annual reviews and reflect current issues and goals for the individual rather than repeated information. The Assistant Manager said that these will be discussed with the staff team and individual members. People also have Person Centred Plans which details things about the individual, which help staff support them, such as ‘who are the people in my life’; ‘favourite things to do’;’ things which are important to me’. The Assistant Manager said that people were given a choice of the format and this was evident from the files. These are still being completed. It was discussed with the Assistant Manager that if staff are writing the details, they need to do it with person, and retain the person centred approach in terms of how they write it. The expert reported ‘I asked a resident if they had a person centred plan. They said they did not but when I explained, they said they have written down what they want in their future.’ Someone told the expert “I have a lot of support.” Some people have specific communication methods which are being ‘piloted’ and evidently have become popular and useful. Risk assessments are reviewed on a monthly basis normally. Some of these were in need of doing but are planned to be done shortly. New residents have had an assessment process over a period of 2 months. All the staff were involved; made observations, and fed back to the managers. People also have reactive strategies in place to counter behaviours, which may harm themselves or others; or challenge other people. These were read for some of the residents. New strategies are implemented as and when necessary. These are also reviewed regularly. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 13 The house holds regular ‘Residents’ Meetings’ where people can voice their thoughts on various issues. The AQAA stated that they are “working hard to diminish institutional views that many residents have regarding their lives”. It was evident from the minutes of the last few the house meetings, these times are also used for a discussion forum for discussing issues such as apologizing to each other; safety issues of answering the front door; complaints; what abuse is; what motivation means, and house jobs. There are very clear notes and seemed that most people participate in the agenda. Freeways runs a group called ‘Our Project’ which is explained under Standard 40. Some of the people living at Morley are part of this group and seem to really enjoy being involved in writing policies for their home. Records are also taken for some people when they make clear decisions for themselves. This good practice needs to extend to all people living in the home. People living at the home have undertaken questionnaires with staff to check if they can recognise and understand monies. These then form the basis of their risk assessment. Some people are able to look after their day-to-day monies whereas others need more support from staff. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. People live a life, which suits their needs and wishes. People are supported to learn new skills and to become more independent. People’s rights are respected. People are offered a healthy and nutritional diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This was the area which the expert did most work on and sent a report of their findings to the inspector; ‘I chatted to a few residents and asked them about living in the home, the choices they have, the activities they do and about the food.’ The inspector also received a lot of information on this area from surveys from residents; relatives and health care professionals and details written in the AQAA. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 15 The AQAA stated that the home “ensures all residents have a lifestyle of their choice and do what they want to do as long as it doesn’t affect anyone else.” Many people living in the home go to local day centres and Freeways Leigh Court day centre. Some people go to college and are accessing work experience placements. Some people have jobs, which they spoke about and were evidently proud of. A relative wrote on their survey “Freeways helps all clients to reach their potential no matter what the degree of disability.” The home now has wireless Internet access and people are waiting for the computers in the second lounge to be set up for use. The expert wrote that ‘there is going to be a life skills day soon to show people how to use the computer [and] they have had other life skills days to work with the residents to help them to be more independent.’ People spoke of their life skills days whereby they are supported to do their household chores such as cleaning their rooms and laundry. It is also a day when they can spend time with their key worker and learn new skills, such as going on buses or cooking. There are rotas on display for people to share tasks such as washing up; cooking, and cleaning. Some people go to church with relatives and 1 person spoke of their bible classes they attend. The AQAA and the home’s Statement of Purpose also confirm these arrangements. Those people who wanted to go have gone on holiday. Groups went to Spain; France, and within England. People said that they had a very good time. “The residents told [the expert] about a pantomime they are doing. They are going to perform it after Christmas for the neighbours and public.” The expert commended the home for this in the report. Some people have regular contact with their relatives and they told the inspector about recent visits and showed photos. 6 out of 10 relatives’ surveys stated that the home ‘always’ helps people to keep in touch with them, 4 said ‘usually’. An added comment was “I’m continually kept informed of any changes effecting my ****. Also, I can speak to the staff at any time.” People can choose whom they would like to see and when. The home used to use a ‘keypad’ (a code system) to get in or out the house. This is not needed anymore; therefore the system is no longer used which is good. It was observed how some people have keys to their front door, whereas some don’t. The expert reported that people said “I don’t have a key to the front door but would like one”; “I have my own bedroom and front door key”. This was discussed with the Assistant Manager and assessments have been undertaken to ensure that people are able to use a key and are safe to access the community on their own. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 16 Both General Practitioner’s surveys and the health care professional both stated that they can see their patient in private and the home ‘always’ respects individual’s privacy and respect. Someone also told the expert “my privacy is respected.” It was also observed and reported by the expert that people can get up and go to bed when they want to. 3 out 3 residents’ surveys confirmed that they can do what they want during the day, evenings and weekends, and can make decisions about what to do each day. Someone told the expert, “If I don’t feel like going out one day I don’t have to.” People can chose whether to spend time with others or be on their own, and have unrestricted access to all the shared areas of the home. Since the last inspection, the home has worked with a dietician and researched healthy eating. The AQAA stated that they have reduced additives and ‘E’ numbers in the food; each week the home’s menu has 2 vegetarian; 2 meat; 1 fish; 1 junk, and 1 roast dinner. All the recipes have been divided up alphabetically and then people are asked to choose a letter then a meal is chosen. This was confirmed during the visit by reading the menus and talking with people. Most people have lost weight or remained stable. There are some people who are still overweight and the staff remain supportive, whilst respecting people’s choice over the food they eat. People told the expert “we are eating healthy food at the moment. I like the food. We have tried new food, including fennel.” The expert observed ‘one resident putting the shopping away after she had helped with buying it for the house. As I was leaving I saw her helping with preparing the meal.’ Someone told the expert “I like helping with the shopping and preparing the meals.” The inspector was invited to eat with everyone for the evening meal and it was evident that it was pleasurable and relaxed time for everyone. Those who have trouble with eating are well supported. A relative wrote that the manager “has done a fantastic job in changing the appalling food culture of the home – he has got everyone eating real food, proper menu planning and the residents say they really enjoy their healthy food.” Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People are supported with their physical and emotional needs. The medication procedures protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home have now individual ‘Health Action Plans’ detailing and promoting health, and enables people, including the staff, to monitor health needs more closely. In one person’s plan, a diagnosis had been mis-recorded and this was discussed with the Assistant Manager who said she would highlight this in the next staff meeting to ensure that this does not happen again. Specialist advice is sought for specific health needs from external professionals, for example speech and language therapist; psychologists, and occupational health therapists. The AQAA stated that the manager has monthly meetings with the psychologist who works with some of the people in the home. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 18 Both General Practitioner surveys answered ‘yes’, the service demonstrates clear understanding of the residents’ care needs; and that specialist advice is incorporated in the plans. The AQAA stated that the home now supports people to have annual checks for breast and testicular cancer. This is very good practice. All residents are weighed on a monthly basis and recorded in the key worker reports. This may seem institutional. Some people have had problems with their weight; both being over weight and under weight. Once people become stable this practice should be reviewed. Within people’s files, health appointments are recorded (opticians; dentist; chiropody; doctors) and it was clear that people are supported to attend these on a regular basis. Any required actions from the appointments (i.e. needing glasses, change of medication) is recorded. It was clear from observations and previous visits that people choose their own clothes and their personality is reflected in their appearance. More detail could be written about how people like to be supported with regards to their personal hygiene. Preferred routines are recorded in people’s Person Centred Plans. The medication cupboard was checked with the Assistant Manager. Most residents have a ‘profile’ of themselves detailing the medication they are taking and a photo identifying them. This is important due to the number of bank staff working in the home. The side effects of the drugs would be useful for staff to know in order to support the residents more effectively, especially with new medication. There are no controlled drugs kept in the home. Medication spot checks, including medication which is taken ‘as and when’ (PRN), were done and all corresponded to the stock control sheets. The Medication Administration Record sheets were virtually all signed. The 2 General Practitioner survey’s answered ‘yes’, medication is appropriately managed in the home. Most staff have received training in the administration of medication through Freeways training programme and are then observed by an experienced administrator to ensure that they know what they are doing. The recent Life Styles day covered ‘medication’ and staff completed a quiz. The manager will be compiling the results. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 19 Since the last inspection, there have been a number of incidents reported to The Commission, however, these have decreased in recent months. Standard 21 was not fully inspected but the previous report and the AQAA confirmed that residents have leaflets in the files called ‘death and dying’. These booklets explain what it all means and gives the resident a chance to state what they would like in the event of their death, or if they get very ill. These were not read during this inspection but will be at the next visit. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People living at the home know how to make a complaint and generally feel listened to. People are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA stated that a complaints procedure is in place. There have been 4 complaints made within the home in the past 12 months, all of which were resolved within 28 days. The home has a complaints logbook, which was read. The Commission have also been informed when these were made as they related to incidents in the home. Immediate action was taken by the management. The health care professional survey stated that the home has ‘always’ responded appropriately when they raised concerns. The GP surveys also stated that they had not received any complaints about the service. 3 out of the 3 residents’ surveys confirmed that they knew who to speak to if they were not happy. Some people added that “I can talk to any of the staff”; “Manager, Assistant Manager and staff at the day centre”, and all 3 stated that they know how to make a complaint. An additional comment was “complaint forms are kept on the notice board in the dining room and the manager and Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 21 staff will help me fill them out”. The expert also reported that someone had said that “I know how to make a complaint”. This was confirmed during the visit; people showed the inspector the forms, which have been updated with the Commission’s new contact details. People spoken with told the inspector that they would speak to the staff if they were unhappy. 2 of the 3 surveys stated that carers ‘always’ listen and act on what they say; 1 survey stated ‘usually’ with an added comment that “sometimes they forget”. Some of the relatives’ surveys stated that “sometimes it takes a long time for staff to action things they said they would do” and that some “people are still afraid of upsetting or crossing staff”. Staff must remember to record and act on issues, which people raise with them. This may be resolved when there is a full stable staff team. The house meeting in July 2007 also reminded people about the complaints procedure. Morley House always keeps the inspector informed of incidents affecting any of the people in the home and takes these seriously. 3 of the 3 residents’ surveys stated that the staff ‘always’ treat them well. Whilst talking with the people in home, it was clear that they feel safe and happy in the home. Some people told the inspector about when they upset others in the home and how they were taught not to do it anymore. There have been incidents within the home, which were reported to Bristol Adult Community (Care Direct) in line with ‘No Secrets’ for the Protection of Vulnerable Adults, ensuring that people living at the home are protected and safe from forms of abuse. These were managed well with positive results. Reactive strategies and behaviour contracts are written with the involvement of the resident. The expert reported that ‘Staff communicated with the residents very well. From what I saw the staff seemed to know what the residents wanted [and] ‘The residents seemed to understand and respect each other.’ There are phone numbers displayed in the office for staff to call if they suspected any form of abuse, and a simplified version of the No Secrets procedure. The home operates a ‘No Restraint’ policy ensuring that people living at the home are not restrained if they challenge staff. People living at the home have ‘client accounts’ with an external bank. Each person receives individual account statements stating their amount and Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 22 interest earned. The inspector checked 3 people’s finances, which were in order, apart from a missing 20p from a ‘purse’, which was later found, and the inspector was informed. The expert reported that “all the residents have financial plans.” The AQAA stated that a recent training day, for both staff and residents, covered areas of abuse, confidentiality, bullying, complaints and behaviour. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 Quality in this outcome area is adequate. People living at the home live in a comfortable and homely environment. Individual bedrooms are personalised but some are in need of redecoration. There are sufficient numbers of bathrooms and toilets, which provide privacy and meet individual needs. The home needs to promote cleanliness and provide sufficient heating to all parts of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour with someone living in the home was undertaken. Morley House is a large property in a residential area in Bristol and blends in with the surrounding area. It is set over 4 floors and would not be suitable for someone with mobility problems as there are many steps even on the ground floor. The AQAA stated that an aim is to “make the home look like a home and give a relaxed atmosphere to the residents so that they feel safe”. It is evident from Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 24 previous visits and discussions with the manger that a lot of work has been done to ensure that Morley house is a home. People living at the home referred to the home as their home and confirmed to the expert that they have had input into the decoration of their home. There are photos of the people living in the home in the hallway and dining room. Consideration needs to be given to the re-painting of the woodwork in the hallway and landing as it is worn and looks tired and old. On the ground floor there is a dining room, which is light and nicely decorated, and also has a fish tank. People use the room to relax in as well as to eat in. The kitchen is need of refurbishment. However, the AQAA and people told the inspector that it is being replaced in January 2008. In the mean time, cupboard doors need to be made safe, (some don’t close and a few are loose), and some cupboards inside need to be cleaned. The two fridges were too cold and there was ice building up on the back walls. The Assistant Manager was told about this and she altered the temperatures. The temperatures haven’t been checked for a while, as the battery needs replacing in the thermometer. This must be replaced and staff to continue with monitoring the temperatures. One of the fridges also has rust in the door seal and must be replaced. One of the fridges needs cleaning. The oven also either needs replacing or deep cleaning as there is a significant build up of dirt. The main lounge has a homely feel and it was evident from observations that people living in the home feel comfortable in there. The expert reported that “the residents chose the wallpaper and the furniture in the lounge when it was redecorated. They did some fundraising so they could buy new sofas.” Some of the cushion covers need replacing, as there are large tears in the material. The carpet under the sofas needs cleaning. There is second lounge on a lower level, which is still being developed. An area of the room has been used as storage for some time now and needs to be sorted out as some people use this lounge more than the main lounge. It was also cold during the visit and residents confirmed that they were cold in there. The shared spaces allow people to meet with their friends or relatives in private. From the second lounge, people can access the fair-sized garden via some steps. There is quite a lot of rubbish, which needs to be taken away to avoid health and safety hazards and to make it look nicer. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 25 There are sufficient numbers of toilets and bathrooms in the home for the people living there. There is a downstairs bathroom, which was clean and soap was replaced during the inspection. There must be soap in all toilets at all times to ensure that people can wash their hands. There is a shower room, which has a walk-in shower cubicle. There are 2 other bathrooms, which were also clean and one was newly tiled. However, in one bathroom, the windowsill had paint flaking away, which needs attention. Some people’s bedrooms were viewed with their permission. All were personalised and had personal effects. One person was proud their new carpet, which they really liked. Some people’s bedrooms were very cold and they confirmed that it was often like that and said that it “needs heating”. One person’s sink had no hot water coming out and the cold tap had hardly any pressure. One person’s wardrobe was broken and needs replacing. They also had an old chair in their room from a previous occupant, which looks tatty and old. If people’s furniture is broken or needs replacing, the organisation must replace these rather than the person. This was confirmed by the Area Manager. The AQAA confirmed that there are 4 bedrooms left to be re-painted and the home is trying to involve the residents more than choosing the colour. Other members of staff also confirmed this. The home also has a basement for storage, a boiler, freezers, fridges, archiving and the laundry room. It was clean and tidy. 2 of the 3 residents’ surveys said that the home is ‘always’ fresh and clean, 1 said ‘usually’. The AQAA also stated under ‘what we could do better’ was to improve the cleanliness of the home by example and explaining to people why they need to clean. People told the inspector about their jobs in their home, there is a cleaning rota system displayed in the dining room, and people were observed carrying out their tasks. The manager must ensure that a deep cleaning system is established to ensure that all areas of the home are hygienic. The boiler system was checked in August 2007 but many people living in the home and staff commented that they were cold or their rooms were cold. A requirement has been made to ensure that all areas in the home are sufficiently heated. Understandably, this is a requirement needing a lot of attention, but the manager must ensure that areas of the home are sufficiently heated until a more permanent solution is found. The other issues raised from this visit have been discussed with the Area Manager during a further phone call. She confirmed that some issues have already been referred to the maintenance contractors and are being actioned, and the others will be; therefore individual requirements have not been made. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 26 The Area Manager or manager has been requested to write to the Commission for Social Care Inspection to confirm the actions taken. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. People are supported by a stable and an effective staff team, who are well trained. People are generally protected by the home’s and organisation’s recruitment practices. Staff are supervised by their managers to support people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Morley House has a relatively small staff team, many of whom have worked there for a number of years, providing people with a committed and reliable team. 3 out 10 relatives’ surveys stated that they felt that the staff team ‘always’ have the correct skills and experience to look after people properly, 7 out of 10 stated ‘usually’. There were positive comments such as: “The staff seem to be very competent” “Has good consistency in staff and know the residents well” Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 28 “They take responsibility for residents and care about the quality of their lives” “Some of the team are brilliant, and one or two are not so good” “They foster a friendly lively atmosphere. Staff seem to have quite good relationships with the residents.” Regular staff meetings are held within the home as a means of communication; training; a forum for discussion, and team building. The minutes from the last 4 were read. The AQAA stated that the home is trying to ensure that staff meetings happen when they are planned. In the office, there was a list of dates for future meetings and staff had signed under which date they could attend. From observations, it was evident that staff could understand people and what they were communicating. As stated earlier, specific communication methods have been adopted in the home to ensure that people can communicate effectively. Sometimes, the home has used staff from the organisation’s ‘bank’ to cover shifts. The Assistant Manager confirmed that they do generally have consistent staff from this system. The home has relatively recently employed 3 new members of staff and one member of staff is starting in the New Year, which will help to provide a more consistent team. One relative wrote “there has been an improvement since agency staff have not been hired.” One of the issues the expert observed, and was also discussed with the Assistant Manager, was that there are not many staff on duty for the number of residents. If an incident occurs within the home, staff are involved and therefore, the other residents are unsupported. The expert reported “I feel they need to have more staff so the residents are able to do things that they want to”. Some people need support to access the community and this limits the activities, which can be arranged, especially in the evenings and weekends. This will improve once the home has a full staff team but does need to be reviewed in the interim. The home has a member of staff who stays awake during the night (‘waking night’) to meet the needs of some people, and another member of staff who sleeps in to ensure that if something happened in the night, staff are there to support people. Induction records for the new members of staff were seen and nearly all completed. Both a manager and the staff member signed these sessions over a period of a few days. The home holds paperwork on each member of staff with regards to their application; references; Criminal Records Bureau checks; and training. 3 staff Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 29 records were read. Some information is held at Freeways head quarters to retain confidentiality. The Commission visited the office to inspect the documentation recently. Good practice was found and a few recommendations were made which were discussed and taken seriously. 2 of the 3 staff had 3 references in place, which exceeds the minimum standard. However, one staff member had no references on file but had a note from the head of personnel stating that he ‘has authorised the references’. This was discussed with the Area Manager after the visit, who later explained the situation satisfactorily. At least 2 references must be sought for each employee. Freeways organisation has a comprehensive rolling programme for training staff, which is commended by staff. Certificates of training undertaken were seen, such as Manual handling; Food Hygiene; Infection control, and administering medication. Confirmation of training booked was seen for the newer members of staff. The Assistant Manager said that staff are also doing training in managing challenging behaviour and learning techniques how to ‘break away’ if someone tries to hurt them. Both managers carry out supervision sessions (one-to-one meetings) with the staff. The AQAA highlighted this as an improvement for improvement to ensure that these meetings occur as per company policy. Some of these notes were read, and do occur relatively regularly. There is a set agenda and both parties are able to raise any other issues they may have. However, if either party has any pressing issue, these are discussed at the time rather than waiting for a formal meeting. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 Quality in this outcome area is good. The home is very well run with an ethos of being open and transparent. People are encouraged to voice their opinions regarding the development of their home. Records are well kept. The health and safety of people is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager was away during this visit but the inspector has met Mr Sanders-Harding previously and he retains good contact at all times. Mr Sanders-Harding has achieved his Registered Managers Award and has a City and Guilds Advanced Management for Care qualification. The previous report stated that all previous requirements had been met and all have been met for this visit. Mr Sanders-Harding completed the Commission’s Annual Quality Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 31 Assurance Assessment to a good standard. An extension to the due back date was agreed and it was still a few days late. The Assistant Manager was available during the inspection and was very helpful; confident in her role; was very aware of all the residents’ needs, and very knowledgeable about the running of the home. She has achieved her National Vocational Qualification level 4, which is very good practice. Both managers have a person centred approach and have an ethos of the running of the home in an open and transparent manner. Added comments from relatives’ surveys were “those in charge have tried hard to make my **** empowered”, and “there is easy access to the manager who is always helpful”. The home’s quality assurance system has improved over the past few years. The AQAA said that 7 residents and 12 families took part in ‘Freeways Service User Inclusion Audit’, which was a questionnaire to gain their views on their home and the service. These were completed from February to April 2007 and some of them were read during the visit and seemed positive. During the recent ‘Lifestyles Day’, staff also completed a questionnaire. It has been requested that once the results from all of the questionnaires are collated, a copy be sent to the inspector. The Area Manager conducts monthly unannounced visits in accordance with Regulation 26. The reports from these visits are duly sent to the inspector and contain much detailed and useful information. Some of the people in the home are part of a group based at Freeways day centre called ‘Our Project’. The group have written policies for people living in homes run by Freeways. Policies they have written include ‘Holidays’; ‘Relationships’ (which is on display in the office); ‘Advocacy’, and ‘Transport’. The group did a presentation at the recent ‘Professionals Open Day’, which was very interesting and, evidently, empowering for the people living in Freeways homes. Records within the home are well kept and reviewed regularly. They are well organised and kept secure in the office. Some areas, written within this report, need attention but generally are very good. The health and safety, and fire folder was read. The AQAA also gave details of when external checks had been carried out. These were confirmed by the certificates held in the home, apart from the gas safety check. This was discussed with the Assistant Manager and Area Manager who sent in the up-todate certificate. Regular checks on fire fighting equipment are carried out and recorded. Fire drills are carried out and the outcome is recorded. Some people living in the home do not respond to the alarm and remain in their rooms. The fire risk assessment must reflect this and ensure that all people are safe in the event of a fire. People spoken with told the inspector what they Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 32 would do if the fire alarm went off. There are pictures in the fire folder of the equipment held in the home and are used to teach people about fire safety. This is good practice. There is 1 member of staff who is in need of fire training. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 3 3 X 3 3 X Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA24 YA42 Regulation 23(2p) 13(4) Requirement Ensure that all areas of the home are sufficiently heated. The fire risk assessment must be updated to reflect current practices and to ensure that all residents are safe in the event of a fire. Timescale for action 28/02/08 30/12/07 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 YA6 Good Practice Recommendations Ensure that residents’ sign care plans and related reviews including risk assessments. Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Morley House DS0000026542.V352040.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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