Care Home: Mornington House

Similar services:

• Clover House
• Parkside
• Park Lodge
• Mere Hall View
• St Bonaventures
• Hudson Road
• Whitewalls
• Home Farm

What the care home does well The staff team were committed, enthusiastic and motivated to providing a high level of care to the people whom they supported. Comments made by service users included, "The staff are great", "I really like my key worker", "You can go to Alex anytime if you have a problem" and "They`ve really helped me to do more for myself so that I can get my own place". Service users were not able to come into the home until a full care management assessment had been done and the service user had been visited by one of the management team. This meant that the manager could be sure they would be able to meet the needs of the person and that they would fit in with the other people living there. Service users were being encouraged and supported to be as independent as possible and good progress had been made, especially with the people who had lived at the home for a long time. The manager and staff valued the role that relatives and friends could continue to play in the lives of the service users and they were encouraged to visit whenever they wished. The provision of leisure activities and community presence was really good and people were able to do both individual and group activities. There were good systems in place for the manager and owners to check how well they were meeting the needs of the people living there. This is called a quality monitoring system. The manager had worked hard over the last 12 months in respect of developing the staff team, improving care plans and risk assessments, sourcing training and ensuring the identified needs of each of the service users were being met. What has improved since the last inspection? Each of the service users had been given a copy of the service user guide, which contained a copy of the complaints procedure. The care plans were much more detailed and gave a very clear picture of the needs of each person living at the home. This information also included things like religion, culture, likes/dislikes, routines and weekly planners.Where staff had identified that service users might be at risk when doing certain tasks, they had written assessments showing what action needed to be taken to reduce the risk. Some of the more independent service users spoke positively about their key workers and the help and support they were giving them. The owners were continuing to improve the home by buying new furniture, carpets and soft furnishings, having a new kitchen fitted and continuing to keep it well decorated. More external training courses had been arranged for the staff, especially the two newest employees. All the staff had now either completed or been booked on protection training. In some cases this had been in-house training. Four of the eight support staff had achieved NVQ Level 2 or above training and two more had recently signed up to do it. What the care home could do better: Although all the staff who gave out medication had been on training courses, they were not always following the home`s policies and procedures so that the service users would receive their medication safely. One new support worker had started working at the home before all the right checks had been made. Whilst this person worked alongside another support worker, they should not have started work at all, as this could have put service users at risk. CARE HOME ADULTS 18-65 Mornington House 10 Ashfield Lane Milnrow Rochdale OL16 4EW Lead Inspector Jenny Andrew Unannounced Inspection 30th October 2007 07:30 Mornington House DS0000066122.V352505.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 Mornington House DS0000066122.V352505.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. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mornington House Address 10 Ashfield Lane Milnrow Rochdale OL16 4EW 01706 633777 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Bell Mrs Janet Kinsella Mrs Alexandra Charlotte Evans Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 7 service users, to include: up to 7 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th June 2006 Date of last inspection Brief Description of the Service: Mornington House is a privately owned, small care home accommodating up to seven younger adults with learning disabilities who need support to lead independent lives. The home is a spacious detached house, close to local community facilities and the motorway networks. Bedrooms are situated on the ground and first floors and a lift is fitted for people who have mobility problems. Car parking space is available at the side of the house and there is a small garden area provided. The weekly fees, are calculated on an individual basis, dependent upon each person’s individual financial circumstances. Additional charges are made for hairdressing, newspapers and toiletries. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the Commission for Social Care Inspection (CSCI) inspection report is displayed within the home. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit took place over ten hours, with the inspector arriving at 07:30am in order to speak to the night support worker. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, looked at the way medication was given out and stored and watched how the staff cared for and supported people. The files of three members of staff were also checked to make sure the manager was doing all the right checks before she let the staff start work. In order to obtain as much information as possible about how well the home looks after the service users, one of the owners, the manager, one night support worker, three day support workers, eight service users and two relatives were spoken to. Before the inspection, comment cards were sent out to service users, staff and relatives asking what they thought about the service. Five staff, four relative and five service user questionnaires were returned and this information has also been used in the report. Before the inspection, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management see the service they provide the same way that we see the service. Upon its return, it was evident the manager had spent time and effort in completing it and had highlighted good practices in respect of equality and diversity. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. Since the last visit, the home had made some alterations to the building in order to be able to take an additional service user. A variation application had not, however, been received by us and therefore this increase in numbers had not been formerly approved. The manager was requested to submit a variation application to the registration team immediately so that this could be considered through the right procedures. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Each of the service users had been given a copy of the service user guide, which contained a copy of the complaints procedure. The care plans were much more detailed and gave a very clear picture of the needs of each person living at the home. This information also included things like religion, culture, likes/dislikes, routines and weekly planners. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 7 Where staff had identified that service users might be at risk when doing certain tasks, they had written assessments showing what action needed to be taken to reduce the risk. Some of the more independent service users spoke positively about their key workers and the help and support they were giving them. The owners were continuing to improve the home by buying new furniture, carpets and soft furnishings, having a new kitchen fitted and continuing to keep it well decorated. More external training courses had been arranged for the staff, especially the two newest employees. All the staff had now either completed or been booked on protection training. In some cases this had been in-house training. Four of the eight support staff had achieved NVQ Level 2 or above training and two more had recently signed up to do it. What they could do better: 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. Mornington House DS0000066122.V352505.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 Mornington House DS0000066122.V352505.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users were assessed in full, being coming into the home, thus ensuring staff were able to meet their identified needs. EVIDENCE: All the resident comment cards that were returned said they had been given sufficient information about the home before they had moved in. The most recently admitted person said his admission process had been as good as it could have been, given the circumstances and that he was settling in. The manager said they tried to arrange admissions gradually, which would usually involve visits for meals, followed by overnight stays. One person said, “I met and spoke with Alex when she came to see me to tell me about the home before I moved in.” Two relatives were spoken to during the visit and they said the whole admission process for their son had been handled extremely well. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 10 The file for this person was checked and it contained a full care management assessment. The Social Services Department had funded the placement for this service user and the care manager had completed a detailed assessment, which gave the reader a very clear picture of the person’s needs. The other two files that were checked also contained assessment documents. The manager said that as well as receiving a care management assessment, unless it was an emergency admission, she or one of the owners would visit the person in their own setting to do their own assessment. These visits were not however, recorded. Discussion took place about formally recording these assessment visits so that the information gathered could be added to the person’s care plan when it was written. This would also assist if it was felt the home could not meet the person’s needs or if the person doing the assessment felt that they would not fit in with the other service users living at the home. The manager said there had been the odd occasion when this had happened. Once the service user was admitted, a full in-house assessment took place over a period of approximately four weeks, which included risk assessments. These assessments were seen on the files that were checked. When service users had any particular needs or medical conditions that the staff were unfamiliar with, then training was arranged. The staff training files showed several examples of this. In one instance, training had been done in preparation for one service user’s admission and, on another occasion, specialist training had been provided so that the staff would better understand a resident’s medical condition. One service user said he had been involved in training staff about his own condition and felt that this had worked well. Staff were also trained in the management of challenging behaviour. Mornington House DS0000066122.V352505.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Care plans and risk assessments were detailed and contained the right kind of information so that the staff team would be able to care and support them to meet their identified goals. EVIDENCE: The service catered for people with varying needs and abilities. Three care plans were looked at for the people currently using the service. Two were for people who had come to live at the home since the last inspection and one for a resident with specific cultural needs. Observation of records and care plans indicated the service users were being encouraged and supported to be as independent as possible within their capabilities. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 12 The initial assessments formed the basis of the plans and these had been fully completed. The care plans identified service users’ strengths and needs and, achievable goals had been discussed with each person. These were monitored on a regular basis. Service users who could sign their plans and risk assessments had done so and, from discussions, it was clear that the service users were involved in the care planning process. One file recorded: care plan read to (service user name) on 19 July 2007. All three files had been reviewed and updated. Since the last inspection, the care plans were greatly improved and contained social histories, likes/dislikes, weekly timetables and a sheet on each person’s immediate needs. They also addressed equality and diversity and the information contained on one person’s file was very informative and showed the staff had consulted different people in order to try and find out as much as they could about the person’s cultural needs. From speaking to the service user, it was clear that the staff were upholding his wishes in respect of the lifestyle he chose to follow. “Listen to Me” care plan booklets were on the files, which could be more easily understood by the service users. Some had not been fully completed. The returned comment cards from relatives indicated general satisfaction in respect of the home meeting the needs of the people living there. One person commented, “that a few minor things still needed ironing out”. Although the staff team was small, a key worker system was in operation and it seemed to be working well. Three of the service users spoken to were able to say who their key worker was and all were happy with their workers. Observations made during the visit showed the staff had a good understanding of the service users’ support needs and positive, trusting relationships had been formed between service users and support workers. Staff spoken to were enthusiastic and motivated about their key working role and it was evident that the more dependent service users had benefited greatly from the time the staff had spent with them on an individual basis. One person, who made his wishes known by facial expressions and body language, was far more confident and happy than seen on previous visits and he had really benefited from the time staff had spent with him. The more independent service users spoken to felt they were able to make daily decisions about their lifestyles and routines. Some of the more dependent people relied upon staff or family for making decisions on their behalf, but these were recorded on the care plan files. Those service users who were able to manage their own money were encouraged to do so with the necessary staff support. One of the owners was the corporate appointee for seven of the service users. All the service users had some contact with family and there was no need, at this time for the involvement of advocacy services. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 13 Any restrictions on choice or freedom were recorded and detailed risk assessments and behavioural/management strategies were in place. Challenging behaviour was monitored and recorded in order that staff could establish whether there were any triggers or particular patterns leading up to behavioural issues. These forms were seen and had been completed. Risk assessments had been written for all perceived risk areas and staff signatures at the front of the assessments showed that the staff had read and understood them. Staff meetings were used to talk about any problems experienced with individual service users, so that ideas of what worked and did not work could be discussed as a team. Regular service user meetings took place so that they could put their points of view forward in respect of daily routines and other issues that they wanted to discuss. Returned comment cards all indicated they could make decisions about daily routines. One person said, “If I want to go out, I go out”. Mornington House DS0000066122.V352505.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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Choice and independence were encouraged and the range of opportunities available for service users to pursue leisure and intellectual activities, reflected their diversity and social, intellectual and physical capacities. EVIDENCE: The staff team had a very good understanding of the service users’ support needs and really tried to assist them to achieve their full potential. Staff encouraged and supported the service users to take part in meaningful daytime activities. One person who was spoken to said he went to college four days a week and another person said they went once a week on a personal development course. Another service user attended college once a week for “Cook and Eat”. One person went to college for social life skills. Two people attended a local day centre and as part of a fitness programme, one service user walked there with a support worker. One service user was preparing to Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 15 move on to more independent living and he was being encouraged to increase his independence skills by doing his own shopping, washing, cleaning, etc. During the visit, the manager made an appointment to see the Bury College Co-ordinator to find out what other suitable courses may be available. She said possibilities were photography, gardening, media and arts/creativity and these were to be discussed with the people concerned. From speaking to the service users and checking other records, it was apparent the people living at Mornington House enjoyed full and active social lives in the community. Service users made mention of going to the local shops and supermarkets, swimming, having meals at cafes, going to the local pub and playing pool, visiting their friends at the other two group houses, visiting family, meeting their girlfriends and going to the Gateway Club or to O’Gradys which was another club. Some service users had bikes which they enjoyed riding in the better weather, under staff supervision. Trips out to the cinema, ten pin bowling and go-karting had also been enjoyed by some of the people living there. One service user said he really looked forward to going to watch the local football team. Several of the people spoken to were looking forward to going to a Halloween party, which was being held at one of the owner’s other homes. Five of the service users had enjoyed a short holiday break at Pontins in Blackpool supported by three staff. One service user was planning a short break to the races in November. The more independent people had a bus pass so they could access public transport and be more independent. A seven-seater mini-bus was also used and one of the service users had his own car with wheelchair access. One of the returned relative questionnaires made mention that, on occasions, it was felt that service users did not always have the right to choose not to join in arranged activities. From checking staff rotas and speaking to staff and service users, it was identified that whilst people were encouraged to join in, they were not forced to and that arrangements were always made to have enough staff on duty so that people could remain at the house. Two of the support staff said that sometimes encouragement was needed with some people so that they could try out new experiences. However, if it were felt they had not enjoyed themselves, then they would not be pushed into going again. They said it had been their experience that once service users had tried different social events, they had really enjoyed themselves and were keen to go again. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 16 There were two lounges, one of which had a new large screen television in. This gave people a choice of sitting area and meant that other activities could be arranged in the second lounge. Eid had recently been celebrated and the staff had really made an effort to make this an occasion that could be enjoyed by all the people living at the home. Birthdays were always celebrated and one had recently been arranged. One service user was enjoying playing with the balloons that were left from the party. Other in-house activities, that some of the service users enjoyed, were games, jigsaws, watching videos and music. Smoking for service users was allowed in the corridor between the laundry and the kitchen. Whilst doors could be closed to both areas and a window could be opened to ventilate the area, during the visit, the doors were kept open which allowed smoke to drift into these communal areas. Discussion took place about this and the manager said she would reinforce to the person concerned that they must always keep the doors closed and the window open. Service users’ cultural and religious needs were identified as part of the assessment process and recorded on the care plans. The religious and cultural needs of the service users were being well met. One service user of a different ethnic culture was having his needs well met and a member of the Mosque was making regular visits to the home to see him. Feedback from staff and service users, indicated staff supported service users to maintain family links. Four relative comment cards were returned and all felt the manager and/or staff kept them informed of important matters affecting their relative. One person commented, “Regular phone calls home are made”. All the service users were supported to keep in regular contact with their friends and family. In addition, a support worker would ring families on a weekly basis to give updates on the service users and to see if they wanted to speak about anything. Invites were also sent out six monthly to invite all relatives to a general meeting. She felt this format assisted people to make informal networks so they could discuss any problems or issues with each other as well as with the staff. From speaking to the service users and interviewing staff, it was apparent that furthering service users’ independence skills was a high team priority. Three of the service users described examples of the way staff were encouraging them to be independent. One person said he was particularly pleased to have learnt how to operate the washing machine, look after his own medication, do his own shopping and clean his room in readiness for more independent living. He said, “Staff have been really helpful and supported me to learn how to care for myself for when I move into my own place”. Another service user said he made his own breakfast and washed up his own pots. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 17 Since the last inspection, one of the more dependent service users had made good progress in this area and was now able to make himself a drink and do other tasks. Rules and regulations were kept to a minimum, ensuring that service users had control over their lifestyles. All the service users were able to make choices about their daily routines, within the restrictions of timings to go to college, day centres, etc. At weekends, they could be more flexible. It was noted, that the people who had lived at the home for several years were continuing to gain new independence skills and this was really pleasing to see. There was an expectation that all the service users would help around the house, as far as possible, within the constraints of risk assessments and washing-up, tidying bedrooms and doing other small household chores was encouraged. A bonus scheme was in place, which helped to encourage people to undertake daily living skills as the person who had assisted the most was awarded by additional personal allowance monies. The staff were mainly responsible for the cooking of the evening meals but the more independent service users were encouraged to assist. The planning of weekly meals was usually done on a Tuesday evening when everyone would sit around the kitchen table to decide what they would like to see included on the menu. Staff encouraged them to try and choose healthy options and would give advice and assistance in this. Cultural and special dietary needs were taken in to account. The freezer contained a good supply of vegetarian and low fat options and Halal meat was purchased. The menus seen reflected healthy eating with plenty of meat, fish, vegetables and fruit being offered. Desserts were also healthy, as staff were trying to make sure that service users did not increase their weight. Usually, fruit yoghurt or fresh fruit was offered after the evening meal with Ryvitas, toast or fruit being available during the evening. A comment had been noted in the compliments file from a GP stating, “the staff seem to be managing a client’s diet better and that he is looking well”. All the service users spoken to were very satisfied with the meals provided. On return from swimming, one person was observed enjoying a healthy salad sandwich, with the two support staff eating with him at the dining table. Supermarket shopping was usually arranged for a Wednesday and the weekly planner showed that different service users assisted with this. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 18 One returned relative comment card highlighted the fact that the kitchen was kept locked which was felt to be an institutional practice. This was seen during the visit, first thing in the morning and late afternoon. The manager and staff said this was a health and safety precaution as a minority of the service users would enter the kitchen unsupervised and may eat food that was not suitable for their dietary needs. The independent service users spoken to did not see this as a problem and knew the reason why it was locked at certain times. One person said, “we get plenty to eat and can always ask for a snack if we want”. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the service users were well met with evidence of good multi-disciplinary working taking place. EVIDENCE: All the service users were given the appropriate level of support and assistance to ensure their personal care needs were being met. This was evidenced during the inspection. Upon arrival at 07.30, two of the service users were up as they were going to day care. They looked clean and well dressed and their hair was tidy. Throughout the day, other service users were prompted to wash their hands and have a shave. Support workers gave assistance to the more dependent people with bathing/showering but service users were encouraged to be as independent as possible in this area. Rising and retiring times were flexible, dependent upon the individual’s weekly planner. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 20 Since the last inspection, the male support worker had left, but the manager had recruited two male support workers, one of whom was working on nights. This meant that if a service user did wish for a male support worker to assist them in personal care tasks, the rota could be accommodated to meet their needs. The home was equipped to meet the service users’ individual needs. There was a passenger lift in order to access the first floor level so that those who were less ambulant could easily use the first floor bathroom/shower facilities. The bath hoist was no longer being used and a risk assessment had been written. A shower chair was available for the wet room, but the person for whom it had been bought had chosen not to use it and preferred his own way of managing in the wet room. The day following the visit, one service user was being assessed for a new hoist. The care plan files showed that service users were supported to attend healthcare check-ups and attend appointments with GP’s, dieticians, psychiatrists and behavioural specialists. Any visits were recorded on the care plan, together with the outcome of the visits. The service users confirmed they felt their health care needs were being well met. Two of the service users were attending a clinic so their weight could be monitored. One person had made really good progress with losing weight as a result of the dedicated help and support of the staff team. When any problems were identified, either emotional or physical, the manager was knowledgeable about whom to seek help and advice from. The home had excellent links with a community behaviour management worker who was able to give advice and training to the staff. Where service users needed staff assistance with very personal intimate care, this section of the care plan was on a “need to know” basis only. Diabetic diets were being followed as necessary and risk assessments were in place so that the staff were clear about what steps to take should high levels of blood sugar be identified. One service user had been supported to manage his own medical condition in readiness for more independent living. Feedback from relatives in respect of the staff giving the right support and care to service users was generally satisfactory. One person commented usually this was the case and said the only concerns they had were about only one care staff being on duty at night. This is addressed in the staffing section below. Other comments included, “We’re really happy with the care and support our son is receiving” and “the staff are very good at keeping us up to date on important issues”. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 21 Since the last inspection the Boots monitored dosage system of medication had been introduced to the home. All the staff, responsible for the giving out of medication had received Boots medication training so they would understand the system. During the visit however, it was noted that the home’s medication policy and procedures were not always being followed. Staff gave one person his medication, which he did not take immediately. He left it on the kitchen table and went out and it was not until this was brought to the attention of another staff member that the medication was put away. The person responsible for giving out medication must always check the person has taken it before moving on to another task, so that the health and safety of all service users is protected. When checking the system in place, it was also noted that the stock of tablets for one person did not correspond with the medication received, which meant that one tablet could not be accounted for. When checking the medication administration records, it was noted that, on occasions, staff were not signing when the medication had been given. The manager must make sure that all the staff follow the home’s procedures. Some stock of previous medication was being held in the drug trolley, awaiting return to the pharmacist. The manager said this was as a result of changing over the systems. She said she would do a full medication audit and confirmed the day after the inspection that this had been done and all unused medication had been returned to the pharmacy. There was no-one on any controlled drugs and all medication was safely stored. GP’s or specialists regularly reviewed medication and this had recently been done. Following a risk assessment, one service user had taken control of his own medication in readiness for moving on to more independent living. He said this had worked out “really well” and that staff booked in the drugs when they arrived. They then handed over the medication to him and checked from time to time that he was taking it properly. This was all recorded on his care plan file. He was really pleased about being able to order his own medication, but again said reminders were sometimes given to make sure he did not run out. He said he kept his bedroom door locked so that other service users would not be able to reach it. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. Staff had received training in protection issues, so they would know what to do if they suspected service users were not being properly treated. EVIDENCE: The service user guide and statement of purpose contained a copy of the home’s complaints procedure. Since the last inspection, all service users had been given a copy. When asked who they would go to if they were unhappy about anything, replies varied. Some people named their key worker or another member of staff they liked and others said Alex, the manager. Returned comment cards also made it clear they knew how to complaint. Comments included, “I would speak to any staff”, “If things need putting right we get together and put things right”, “I would speak to Alex or another staff”, “Would speak to Alex or Linda and Janet”. There was a very open and inclusive culture within the home and everyone seemed to feel they could confide in or seek help and support from the staff and manager. Information on the Annual Quality Assurance Assessment form recorded that future plans were to provide a pictorial complaints procedure which would be more understandable by the dependent service users. We have not had cause to investigate any complaints in the home, since the last inspection. The home’s complaint book was checked. Several complaints had been logged, all of which had been actioned appropriately. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 23 As well as complaints being logged, so were compliments. Many positive comments had been made from outside agencies, Social Services Departments and other visitors to the home about the care the service users were receiving. The Rochdale MBC Protection of Vulnerable Adult training had been done by the manager and the two owners. Following this training, the manager had done in-house training for the staff team. The Learning Disability Award Framework (LDAF) training also covers abuse and six out of eight of the staff had done this training. Three further places on the Rochdale MBC protection training had been booked for the two newest employees and for a new starter and these were arranged for November and January 2008. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The owners had continued to make improvements to the house so that it provided a homely, clean, comfortable and safe place for the people living there. EVIDENCE: The home was situated near to local community facilities and the service users were able to walk to the newsagents and to the local pub. It was also close to the railway station and public transport so that people could easily get to Rochdale or other places of interest. The owners had a planned maintenance and renewal programme in place and it was evident this was being followed. Since the last inspection, several areas around the home had been re-decorated, a new kitchen had been fitted, a large screen television bought, which the service users really liked, new bedding and towels supplied for all bedrooms, new lighting, carpets and curtains in the communal areas, new lounge furniture, new cooker and freezer Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 25 and a garden shed. Cupboards from the kitchen had been fitted in the laundry, which was now much tidier and office cabinets had also been supplied. One of the newer service users spoke enthusiastically about his bedroom, which was in the process of being decorated to his own taste. He was an avid football fan and the staff were painting the football crest of the team he supported on his wall. From speaking to the staff, it was clear they support each person to personalise their bedrooms to their own taste. Every other month, the manager walked around the home, checking equipment, lighting, appliances, etc. Following this, she wrote a house report, identifying anything that needed to be put right. This ensured the home was kept well maintained. In order to improve bathing/showering arrangements, an assessment had been done last year, by an Occupational Therapist, resulting in the first floor shower room being converted into a wet room in order to better meet the needs of one of the service users. Infection control policies/procedures were in place. However, during the inspection, when visiting the staff toilet, it was noted there was no liquid soap or paper towel bin in place. These shortfalls were addressed during the visit. Disposable gloves and aprons were supplied and these were seen to be used. The laundry was clean and tidy and more cupboards had been fitted. The equipment was in working order. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A team of committed and caring staff, who had received the right training, were supporting the service users to lead fulfilling lifestyles. EVIDENCE: Information contained in the Annual Quality Assurance Assessment document recorded a good age mix of staff that reflected the age groups of the service users. There were two male support workers which was an improvement from the last inspection, given the all male client group. The staff team was all white British. One service user of a different ethnic background was living at the home. From speaking to staff and recordings made on this person’s care plan file, it was evident the staff had been pro-active in learning about his culture in order to ensure they could meet his identified needs. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 27 From checking rotas and speaking to the staff, it was clear that staffing levels were flexible, dependent upon the individual activities that the service users wanted to do. Sometimes, three or four staff were on duty, so that people could do different things. A returned relative comment card recorded they felt that one staff on at night was insufficient. This visit was arranged so that the night support worker could be spoken to before he went off duty. He described the care and support needed by each of the service users and said one staff was adequate to meet their identified needs in the night. He was aware of the fire procedure and said that the evacuation process involved assisting the more dependent people first. The home was equipped with all the correct fire appliances and the home complied with the requirements of the Greater Manchester Fire Department. The manager said the night cover arrangements had been agreed with Rochdale Social Services Department who felt one waking night staff was sufficient. Only one service user was said not to sleep very well. Fire risk assessments were in place. The current staff team were enthusiastic and motivated to providing the right care and support needed by each service user. Both the owner and manager felt they now had a team of workers who were working with them with the interests of the service users being paramount. The staff interviewed demonstrated their knowledge and awareness of the needs of the people they looked after. It was clear they had real commitment to offering the right care to each person and were aware of people’s individual likes/dislikes. The key-worker system was working well and good relationships had been built up between workers and service users. Throughout the visit, staff spent time with the people staying at home, engaging them in conversation or encouraging them to do small jobs around the house. The staff spoken to said they felt the new team were working well and that communication between them was good. Specialist training was given which had included, epilepsy, behaviour awareness/physical intervention and specific training to raise awareness of certain medical conditions. Of the eight staff currently working at the home, four had achieved NVQ level 2 or above. One support worker was a newly qualified Occupational Therapist. This meant the home had achieved 50 of qualified staff. A further two support staff had recently signed up to take their NVQ level 2 training. The home had a training and development programme which included all mandatory training as well as challenging behaviour/intervention techniques. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 28 From talking to the owner and manager and checking the training file, it was identified that the two most recently employed staff had not yet done their Learning Disability Award Framework (LDAF) training. This was because the training course was not currently available. Their training files were seen. Training they had both done comprised medication, managing aggression, first aid, moving/handling and fire. Places had also been booked in the next few months for care planning, dignity in care, abuse and infection control. Both the owners had completed their LDAF Level 4 in challenging behaviour and were able to pass some of their knowledge on to the staff team. In July 2005, they had completed their LDAF Assessor’s course. The deputy manager had been booked on a course looking at the Mental Capacity Act. Regular staff meetings took place and minutes of the meetings were seen. Records showed that the staff were receiving regular one to one supervision sessions and they also confirmed this was so. The home had its own induction training programme and evidence of this training having been done was seen on the files of the two most recently recruited staff members. One worker said, induction training is thorough and as this is my first care job, the team is very supportive of me. I was given lots of information about the service users and what would be required of me”. Another comment made was, “I was sent on lots of training as soon as I was given the job”. The manager said they were currently piloting induction booklets which were due to be returned on 5 November 2007. These were to test the staff’s knowledge after completing induction. As the LDAF induction training course was currently unavailable, the manager needed to implement the Skills for Care training for all new staff. Discussion took place about how this could best be done and she was advised to obtain all the relevant information from the Skills for Care website and complete the training for the two new employees. The training they had already undertaken could then be cross referenced into the Skills for Care induction record. Where staff were employed who had already attained NVQ qualifications, this training could also be cross referenced. The staff training matrix showed that the staff had completed the necessary mandatory training or had already been booked on courses. Training certificates were seen on the files that were checked. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 29 The AQAA recorded that the home had recruitment and selection policies/ procedures in place. Three staff files were looked at to see if the correct documents were in place. All three files contained evidence of application forms, two satisfactory references and Pova First/Criminal Record Bureau (CRB) checks. However, when checking the start days against the Pova first check dates, it was noted that one support worker had been started before a Pova First check had been returned. Whilst it was recorded in a letter to them that they would not be able to work unsupervised or attend to the personal care needs of anyone until the full CRB check had been received, they should not be working in the home at all until at least the initial Pova first check has been done. The manager said she would ensure this did not happen again. Upon starting work new staff were issued with induction packs and guidelines, including some policies and procedures. They were also given the General Social Care Council’s “Code of Practice” booklet. One of the service users said he had recently assisted in the recruitment of staff. This good practice was something new the manager and owners were introducing gradually. Mornington House DS0000066122.V352505.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, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager was experienced, qualified and committed to ensuring that the service was meeting the needs of the service users. EVIDENCE: The manager was experienced and had completed her NVQ level 4/Registered Manager’s Award. She had also recently undertaken refresher training in Protection of Vulnerable Adults and first aid. Since the last inspection, it was evident that the manager had worked hard to address the shortfalls identified at that visit. She had slowly managed to recruit a team of workers who were keen and motivated and wanted to work with her to improve the standards of care to the service users. The staff were also clear about their roles and responsibilities, enabling the manager to spend Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 31 more time managing the day to day running of the home. Care plans, risk assessments and other personal care related documents were detailed and up to date and reflected the present needs of the people living at the home. The owners had supported the manager in respect of providing resources for refurbishment, replacing aids/adaptations and arranging more outings and activities. Feedback from returned staff comment cards and speaking to staff, indicated they felt the manager was supportive and always happy to give advice and listen to their ideas. One person said, “I really enjoy my job, the management and staff are fantastic, it’s a really homely place and I’m lucky to be a part of the team I work with”. Another person said, “The manager is friendly and approachable and makes you feel valued”. Service user feedback was also positive about the manager’s approach. One person said, “I’d always go to Alex to help me sort out my problems” and another person said, “Alex has given me a lot of help and support”. The home had an effective quality assurance system in place. They had recently had a re-assessment for their Investors In People award, which they had retained and some very positive remarks about the management and staff team had been made. Monthly visits were being made by one of the providers, quality questionnaires were regularly sent out to families and other visitors to the home and service user meetings were held. In addition, weekly telephone calls were made to all parents or carers so they could be given updates or discuss any problems or issues. Regular staff meetings and supervision sessions were arranged as well as annual appraisals. The manager also wrote an end of year report about the home and a copy of the report was sent to us. The providers have always co-operated with us in progressing any requirements within the agreed timescales and had made further improvements to the environment, which benefited the people living there. Information from the Annual Quality Assurance Assessment showed that all the necessary maintenance checks had been undertaken. Random samples of records relating to fire, gas and electrical appliances were all found to be up to date. The manager was responsible for making sure the environment was a safe place for both staff and service users. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 32 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 X 2 3 3 X 4 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 X X 3 x Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The manager must make sure that all the staff follow the home’s procedures when giving out medication so that the service users health care will not be compromised. This particularly applies to signing MAR sheets, supervising people to take their medication and keeping accurate stocks. New staff must not start work at the home until at least a Pova First check has been done in order to try and ensure that unsuitable staff are not employed to work with vulnerable people. Further until a full CRB check has been done and they have completed their induction training, they must not work unsupervised in the home. Timescale for action 09/11/07 2 YA34 19 23/11/07 Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA16 YA35 Good Practice Recommendations The designated smoking area should have the doors closed and the windows open to prevent smoke from spreading into other parts of the home. The home should introduce the Skills for Care induction training programme for all new staff. Mornington House DS0000066122.V352505.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Mornington House DS0000066122.V352505.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!