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Care Home: Morris Care Centre

  • Holyhead Road Wellington Telford Shropshire TF1 2EH
  • Tel: 01952245521
  • Fax: 01952245523

Wrekin Court and Wellington Court make up the Morris Care Centre at Wellington, which is one of a group of nursing homes run by Morris Company Care Division. The 0 1506112008 home is situated on the outskirts of Wellington, near to the M54 motorway and a local bus service stops near to the home. Car parking spaces are available at the front and side of the home. Wrekin Court is generally used by older people with nursing care needs, Wellington Court is used by people who have physical disabilities and require nursing care. Within the home and next to Wellington Court is an Intermediate Care Unit, operating in partnership with other agencies to provide people with rehabilitative support. The home has two shared rooms and seventy three single occupancy bedrooms all with en-suite facilities. There are bathrooms and showers with equipment to assist people who may have mobility difficulties. There are stairs and a lift between floors on Wrekin Court and there is a wheelchair accessible platform lift to enable access to Wellington Court. People can obtain information about this service from the home`s Statement of Purpose and Service User Guide. The guide included information that there is no fee charged for people requiring support on the intermediate care unit. The guide did not contain information on the range of fees charged for care and support on the other units, therefore the reader is advised to seek information direct from the service. Inspection reports produced by CQC can be obtained direct from the Morris Care Centre or from CQC`s website at www.CQC.org.uk.

  • Latitude: 52.694000244141
    Longitude: -2.5220000743866
  • Manager: Manager post vacant
  • Price p/w: £730
  • UK
  • Total Capacity: 77
  • Type: Care home with nursing
  • Provider: Morris & Co Limited
  • Ownership: Private
  • Care Home ID: 10945
Residents Needs:
Physical disability, Old age, not falling within any other category, Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Morris Care Centre.

Key inspection report Care homes for older people Name: Address: Morris Care Centre Holyhead Road Wellington Telford Shropshire TF1 2EH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rosalind Dennis     Date: 1 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 43 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Morris Care Centre Holyhead Road Wellington Telford Shropshire TF1 2EH 01952245521 01952245523 carecentre@morriscare.co.uk www.morriscare.co.uk Morris & Co Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 77 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 77 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5, Old age, not falling within any other category (OP) 77, Physical disability (PD) 15 Date of last inspection Brief description of the care home Wrekin Court and Wellington Court make up the Morris Care Centre at Wellington, which is one of a group of nursing homes run by Morris Company Care Division. The Care Homes for Older People Page 4 of 43 Over 65 0 77 0 5 0 15 0 6 1 1 2 0 0 8 Brief description of the care home home is situated on the outskirts of Wellington, near to the M54 motorway and a local bus service stops near to the home. Car parking spaces are available at the front and side of the home. Wrekin Court is generally used by older people with nursing care needs, Wellington Court is used by people who have physical disabilities and require nursing care. Within the home and next to Wellington Court is an Intermediate Care Unit, operating in partnership with other agencies to provide people with rehabilitative support. The home has two shared rooms and seventy three single occupancy bedrooms all with en-suite facilities. There are bathrooms and showers with equipment to assist people who may have mobility difficulties. There are stairs and a lift between floors on Wrekin Court and there is a wheelchair accessible platform lift to enable access to Wellington Court. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. The guide included information that there is no fee charged for people requiring support on the intermediate care unit. The guide did not contain information on the range of fees charged for care and support on the other units, therefore the reader is advised to seek information direct from the service. Inspection reports produced by CQC can be obtained direct from the Morris Care Centre or from CQCs website at www.CQC.org.uk. Care Homes for Older People Page 5 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out over two days in total. Two of our inspectors visited the home on the 12th March 2010. They returned on the 19th March with our pharmacist inspector, who joined the inspection following concerns raised by the regulatory inspectors about the management of medicines. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. The purpose of this inspection was to assess all key standards - that is those areas of service delivery that are considered essential to the running of a care home. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the Care Homes for Older People Page 6 of 43 home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). The AQAA is a document that should provide information about the home and how they think it meets the needs of people living there. The AQAA, which had been completed in September 2009 was limited and did not provide us with a satisfactory level of information about the home. We also looked at information which we had received from other agencies, including the local safeguarding adults team. The inspection was triggered following a significant number of referrals which had been made to the safeguarding adults team. We case tracked seven of the people we met during the inspection. Case tracking involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The people we case tracked were not able to tell us about their day to day life at the home and the support they receive from staff. We also met other people during the day, including visitors to the home and spent time in different areas of the home observing staff in their work. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff and a senior member of staff who has taken on the role of acting manager, to establish their views of working at the home and to establish if anything needs to be improved. Representatives of the company were present on both days of this inspection. On conclusion of our first day, we gave the acting manager and company representative feedback (a summary of our findings) from that day. However on the second day of our inspection the company representatives would not enable us to give our feedback to them, this was despite us informing them that we had identified many concerns, including serious concerns with the management of medication. This suggested a lack of commitment by the company to respond promptly to improve outcomes for people and protect their health, safety and welfare. We met with the director of the company a week after the inspection, who acknowledged that they should have received our feedback at the time of the inspection. They told us they would take action to improve the service. Care Homes for Older People Page 7 of 43 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 43 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 43 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying on the Intermediate Care unit have their needs assessed before they are admitted and on an ongoing basis, which means they are supported by staff who know enough about them to meet their needs. People living in other parts of the home are at risk of not receiving the care they need because the home is not ensuring assessment processes are effective in looking at individual needs and how to meet them safely. Evidence: We looked at the care records for people who live in different parts of the home, this included people who have been admitted since the last key inspection in 2008. Overall we found variations in how people have their needs assessed and the level of detail obtained. It is important that enough information is obtained at the time of a persons admission so that staff know how people want and should have their care needs met. Care Homes for Older People Page 11 of 43 Evidence: We looked at the care records for a person admitted to the intermediate care unit and saw there was detailed information about their needs and the level of support and care needed to meet those needs. We saw that their care involves staff at Morris Care Centre working alongside other health and social care professionals to promote their rehabilitation. A member of care staff on this unit was able to provide a good overview of this persons needs since their admission. The care records for a person living on Wrekin Court contained a document intended to assist staff in assessing peoples needs before and on admission to the home. This showed that a staff representative had been to see the person in hospital before they were admitted to the home. However the document was not fully completed and where information had been written it was not sufficient to show the care which would be needed. For example the assessment did not make any reference to the persons dietary needs, despite the person needing fluids of a specific texture. The assessment included a comment heel sore needs pressure relief, but did not identify which heel. For another person we saw that an assessment of their needs had been undertaken at the time of their admission to the home. What had not happened, and which potentially could place the person at risk of harm, was that staff had not looked at the possible risks to the persons health, safety and welfare in sufficient detail since their admission, including the safest way to move the person and monitor and manage the persons medical conditions the home was told about. It is therefore not clear how staff have been able to provide safe and effective care to this person. We spoke with two relatives of people who have been admitted to the home recently and they told us of their satisfaction with the admission process, although they told us how they were not aware of the care which had been planned for their relative. A person who lives at the home told us they have been satisfied with how their care needs have been met although they expressed their disappointment that they have never been involved in the writing or reviewing of their care plan since their admission. Another person gave positive views of the home and described how Morris Care Centre has eased the transition from being at home to being in a care home. When we looked around the home we were shown a bedroom which was being prepared ready for a new admission and saw that people are provided with welcome packs which include a selection of toiletries, which is considered to be a pleasant gesture on the part of the home. We looked at the service user guide, which contains information about the home, although it does not include the fees charged which it should do, so that people know the range of fees. The service user guide does include information that support from the Intermediate Care team does not carry a fee. The Service User guide has not been updated since September 2008 and contains Care Homes for Older People Page 12 of 43 Evidence: incorrect information about the frequency of our regulatory input. Care Homes for Older People Page 13 of 43 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because staff are not effective in ensuring care is provided according to the needs of the person or when risks to the health and welfare of that person are identified. Poor medication practices mean that people cannot be confident that they are receiving the medication they need. Evidence: We received varying feedback about how people and their representatives view their needs are met at Morris Care Centre. Five people visiting the home told us they were satisfied with the care their relative receives. Two people who live at home told us they are happy and satisfied with their care. One of these people and a relative told us how a particular carer provides excellent care, with one describing how that specific carer goes the extra mile. Other comments were received describing most of the staff as having a nice attitude and that basic needs are being met. One visitor we spoke with was disappointed with how their relative looked and they told us how the person has always liked to look well-presented. The visitors comments reflected our own observations in that the person looked unkempt which suggested that staff had Care Homes for Older People Page 14 of 43 Evidence: not paid sufficient attention to the persons hygiene needs. Of significance to our inspection is those people who are unable to feedback their views, and are reliant on staff being aware of their needs and how to meet them. It is therefore important that care records are accurate and contain sufficient information so that staff have guidance to follow on how to meet individual needs and that any risks to the individual are clearly identified. We examined care records for seven people who live on Wrekin and Wellington Court which shows that the home is not adhering to legislation or good practice guidance in how it assesses, plans and reviews peoples care. We found that some people were lacking care plans and that assessments of possible risks to their health, safety and welfare are either not sufficient or have not been undertaken. We found improved recording of information in care records on the intermediate care unit, which shows the involvement of different agencies in peoples care. We saw that care staff from the unit write in the care records on a daily basis and this provides a good overview of the care which has been given. One person living on Wellington Court and whose care we looked at, needs staff to know how to manage a medical condition they have and there was no care plan or risk assessment to guide staff on how to manage this condition. The only document we found regarding this condition was a brief note in the medication room. There was nothing to inform staff when to seek professional advice. We also saw from this persons medication administration record (MAR) that they are prescribed a medicine to help manage their mental health, however when we looked at their care records there was nothing written to indicate they have mental health needs. We spoke with three staff who informed us that the person no longer has mental health needs, which contradicts our observations as the medication the person takes suggests they still have these needs. For a person who was recently admitted to Wrekin Court we saw that their initial assessment identified they need medication to help improve how they are feeling, yet a care plan had not been written to guide staff how they should support the person to improve their well-being. Their relative told us they were happy with the care that was being provided although they also told us they were not aware of their relatives care plan and had not had any discussions with staff about it. We saw bed rails were in place on the side of this persons bed, which are designed to reduce the risk of falls out of bed and their use should be discussed with people and/or their representatives. Their relative told us the use of the bed rails had not been discussed with them. A person with a sensory impairment had nothing written in their care records to show Care Homes for Older People Page 15 of 43 Evidence: that staff had looked at the impact the impairment might have on how they provide care or how to manage the impairment. This persons relative told us staff had not sought their views or discussed the best ways to help the individual feel better and calmer. Of particular concern was that there was nothing in this persons care records to inform staff how to care for a part of this persons body which had sustained an injury. We brought this to the attention of the acting manager and company representative on the first day of our inspection. When we returned on the second day we saw that some information about the injury had been added to a care plan but it still lacked detailed guidance to ensure that staff knew the care which needed to be given until there was a full recovery from this injury. We spoke with a nurse involved in this persons care and they told us that the person had attended appointments at hospital to review the injury however we established that information about all the appointments had not been recorded in the care records. The nurse also confirmed that the home had not contacted the hospital for information about how to manage the injury and that the updated information in the care plan we saw on the second day of our inspection had been written without seeking information from the hospital. We also found in other peoples care records that information to show the action taken following visits by healthcare professionals, including GPs was not always recorded. Another person whose care we looked at did not have anything in their care records to indicate that staff had looked at the safest ways to move them, which is considered a major shortfall as we established that the person was admitted with injuries to different parts of their body and would need skilled management of these injuries. We also saw that the home had been informed, at the time of the persons admission that the person had been found to have an infection. However there was nothing further documented in their care file to indicate staff were aware of the infection. There was no care plan on how to manage the infection or to provide guidance on the infection control practices needed to reduce the risk of spreading the infection to others. We saw bed rails were in place on the side of this persons bed, which are designed to reduce the risk of falls out of bed. The bed rails had been used without a protective padding to reduce the risk of injury. There was nothing written down in the form of a risk assessment to show that the risk to the individual of bed rails being used had been looked at. Other people who we saw, had been assessed for the safe use of bed rails but the risk assessments were brief and did not take into account all the factors which should be considered with the use of bed rails. We found poor recording in respect of wound care and management, such as gaps in recording to show that wounds have been re-dressed, measured or monitored. None of the care records we saw had photographs of the wounds, which is considered a good method to use as a means of monitoring progress. Observation of the homes Care Homes for Older People Page 16 of 43 Evidence: own wound management policy shows that it expects its staff to carry out this task. Of the care records we saw there was nothing to suggest that the home had contacted wound care specialists for advice or guidance on wound management. We saw that people have been assessed for the risk of deterioration to their skin, although we saw that the planned care of how to reduce the risk of pressure sores occurring was limited in information and did not fully reflect the level of care and equipment needed. We saw a person moving around Wellington Court on their own in a wheelchair, using a technique of putting their feet on the floor to help to get the wheelchair to move. When we looked in their care records to see whether the risk of them not using the foot plates on their wheelchair had been looked at or discussed with them there was nothing to suggest it had been. We saw a policy which advises staff to keep daily charts when there are any concerns about dietary and fluid intake/output. However, we found that information which staff record on a daily basis is minimal and is not sufficient to show the care which has been given, including whether people have eaten an adequate diet and have had enough fluids to drink. We saw from looking at one persons care records that they lost 2.6 kgs of weight between 6th January and 2nd February 2010. Their care plan had been updated two weeks after the weight loss was identified but no further records have been made to show that their weight has been taken again or that their dietary needs are being monitored. When we looked at their bedroom we saw they had a specific mattress on their bed designed to reduce the risk of pressure sores occurring. When we looked at the setting of the mattress we found it was at the wrong setting for the persons weight, which means it may not be working at its best capacity. One person living on Wellington Court confirmed their awareness of their care plan, that staff keep him informed and that he is satisfied with how his medication is managed. He also discussed how satisfied he is with his care. Only one of the care records for the people whose care we looked at indicated that the persons representatives have been consulted with or involved in the writing or reviewing of their care plan. Visitors to the home, who are relatives of the people we case tracked, confirmed to us they have not seen or have any knowledge of what is written in their relatives care plans. As mentioned earlier in the report a person living at the home expressed their disappointment that they have not been involved in writing or reviewing their care plan. The pharmacist inspector joined the inspection on the 19th March 2010 following concerns raised on the 12th March 2010 by the regulatory inspectors about the Care Homes for Older People Page 17 of 43 Evidence: management of medicines. We found overall that the management of medicines by the home was poor and as a consequence placed the health and welfare of people whom use the service at risk. We firstly looked at how the home was managing medicines for people who were living in Wellington Court. We found with the first person we looked at that this person had been prescribed oxygen. We found that the oxygen was being delivered using a combination of an oxygen concentrator machine and oxygen cylinders. We found a total of seven oxygen cylinders being stored in this person room one next to the bed and six in the en-suite bathroom. We found that out of seven cylinders only two were secured to prevent them from falling over. The fact that there were a number of cylinders that had not been secured properly and the sheer quantity of cylinders being stored in one place posed a health and safety and fire risk to both the people living and the staff working within this environment. We also found that this person was a diabetic and was being administered insulin by the nursing staff. We found that the container (vial) of insulin being used was stored in the mobile drug trolley. We examined this vial and found that the home had not recorded when the insulin in the vial was first started. Insulin can be stored out of the fridge for a period of between four to six weeks so it is important that the date of opening is recorded to ensure that the insulin does not go out of date. We also found with this particular vial of insulin that the date of dispensing found on the dispensing label was not readable and therefore we were unable to establish whether the insulin being administered from this vial was in date. We also found in the care plan some information that if this individuals blood sugar level dropped below 4 mmol/l the home were to administer some glucose gel called Hypostop but we were unable to find any in the home. We examined the medicine administration record [MAR] charts for this person and found that the home was failing to record the quantities of any medicine that were carried over from the previous monthly cycle. As a consequence we were unable to determine whether medicine in liquid and powder form were being administered as prescribed. We found with some liquid medicine used in the treatment of nausea and vomiting that 900ml had been received. We found that 350ml had been administered so we expected to find approximately 550ml remaining instead we found a total of 950ml present in the home. This persons care records noted on their admission details they are allergic to two medicines, yet only one of these allergies is noted on their MAR chart, which could place the person at risk if their MAR chart is reviewed and they are started on the medicine to which they are allergic to. We looked at the records of a second person who was living in Wellington Court and found a similar situation with the accountability of liquid medicines being carried over from the previous monthly cycle. Again we found with some anti epileptic medicine Care Homes for Older People Page 18 of 43 Evidence: that 1200ml had been received by the home. We found that 460ml had been administered so we expected to find approximately 740ml remaining but instead we found a total quantity of 880ml present in the home. We found that this person was epileptic and both the MAR chart and care plan indicated that rectal diazepam should be used to prevent a serious seizure known as status epilepticus from occurring. We were unable to find any rectal diazepam prescribed for this person on the premises. We also found that the protocol on how to prevent the serious seizure occurring through the administration of rectal diazepam only contained the following information rectal diazepam may be necessary if a fit lasts 4 minutes or more. We found that 9 people who were using the service had difficulties in swallowing and as a consequence were being fed using a percutaneous endoscopic gastrostomy [PEG] tube which allows liquid food to pass directly into the stomach. We found that these people were also having their medicines administered using the PEG tube. The administration of medicines using this tube requires careful consideration because most medicines are not designed to be administered using this route. In order to ensure that medicines are administered safely through the PEG tube the administration of these medicines should be performed under a written protocol. This protocol should for example identify i] the amount of water used to flush the tube between the administration of each medicine ii] the amount of water used to dissolve any crushed medicines and the time it may take to disperse iii] whether any of the medicines are light sensitive iv] whether any of the medicines require an empty stomach and if so how far in advance does the feed need to be stopped and v] any medicines that cannot be crushed. We found that the home did not have any such protocols in place. The home must ensure that these protocol are developed in order to ensure consistency of medicine administration and the safely of the people having medicines administered in this way. We saw that staff had put brief information regarding the liquid feed which needs to be given through the PEG on the wall of a persons bedroom, but this had not been included in care plans or guidance to staff on where they could find the information. We found that some of the people we looked at in detail had been prescribed when required and variable dose medicines. We found very little information about how these medicines were being managed and how decisions to administer were being made. We examined how medicines that required cold storage conditions were being stored. We measured the maximum and minimum temperatures on the day of the inspection and found the maximum to be 8.8 degrees Celsius and the minimum to be minimum 5.7 degrees Celsius. A fridge that stores medicines that require cold storage conditions Care Homes for Older People Page 19 of 43 Evidence: must be maintained at between 2.0 and 8.0 degrees Celsius. We examined the temperature records for March 2010 and found that the maximum fridge temperature had been above 8.0 degrees Celsius on 15 occasions. We found that during February 2010 the home had failed to record the daily maximum and minimum temperatures on 11 occasions. We therefore found that medicines being stored in this fridge were not being stored as required by the manufacturers and the process to ensure the fridge was maintained within the correct temperature range was not being robustly executed. We found that Controlled Drugs being used in this part of the home were being stored in a cabinet that did not comply with the Misuse of Drugs (Safe Custody) Regulations. All care homes must ensure that Controlled Drugs are stored in a cabinet that meets the specifications outlined in these regulations. We examined the process for the handling of medicines on the intermediate care unit and found there to be a number of failings. We found that the unit was not keeping a record of the quantity of medicines received. We found that the care staff were administering medicines to the people who were using the service but were not recording exactly what medicines they had administered. We therefore found that the medication records were not robust enough to demonstrate that people using the service were having their medicines administered as prescribed. We found that although the care staff who were administering the medicines had received training on the safe handling of medicines none of them had been assessed for their competency to administer medicines safely and accurately. We also found that the medicines were not being kept very secure in the peoples rooms. We found that each persons medication was being stored in a locked drawer of the bedside cabinet located in their room. We found that in order to open the drawer in the bedside cabinet the care staff removed the key from an unlocked drawer in the dressing table, which was also located in their room. This meant that any person in the home could gain access to any of these medicines if they wanted to. We also found on a visit to one of the rooms that a medicated cream was being stored on top of the dressing table, so was not being stored securely and could be seen from the corridor which linked all of the bedrooms in this unit. We also looked at how medicines were being managed on Wrekin Court. We examined the medication records for two people living in this part of the home. We found with the first person that the administration records were not able to show that the home had been administering their medication as prescribed by the doctor. We found that the home was failing to record the receipt of some of the medication and account for old stock when transferring to a new monthly medication cycle. We carried out an Care Homes for Older People Page 20 of 43 Evidence: audit of the medicines where a quantity had been recorded and found a number of anomalies. We found that 42 capsules of a medicine used to treat high blood pressure had been received by the home. We found that the MAR chart indicated that 15 capsules had been administered so we expected to find 27 capsules remaining however we found 41 capsules still present in the box. At the time of the inspection the home could not offer a satisfactory explanation for this. We also found evidence to show that staff were signing the MAR charts to confirm that administration had taken place when in fact the medication had not been administered. We found that the home had received 6 tablets of a medicine used to treat anxiety but the MAR chart indicated that 9 tablets had been administered before they went out of stock. We found that this medicine had been out of stock for 6 days prior to the inspection on the 19th March 2010 and we found that there was no written information about whether this persons doctor had been contacted to establish whether this medicine should have been continued. We also found that a variable dose had been prescribed for some analgesic tablets but the records did not show what quantity had been administered. We found with the second person that the home had failed to either record the receipt of medicines or record what medicines had been carried over from the previous month. As a consequence we were again unable to determine whether the medicines for this person had been administered as prescribed. We found that the generic abbreviation O was being used to signify that medicines had not been administered but the O had not been defined so we were unable to establish the reasons for the non administration. We found that some medicines used to treat a disorder of the thyroid gland had not been administered for a period of eight days and at the time of the inspection the home could not offer a satisfactory explanation for this. We also found that the home needs to pay more attention to quantities of medicines being ordered. We found that this person had enough of a liquid medicine used to treat anxiety to last for a period of 320 days. Care Homes for Older People Page 21 of 43 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people are provided with good opportunities to have their social needs met and they receive meals which are based on their likes and dislikes. Other people are not provided with enough opportunities to enhance their wellbeing and there is a lack of evidence to show that their likes, dislikes and preferences are taken into consideration when meeting their daily needs. Evidence: One person who was able to speak with us described how the home has arranged for internet access to be provided in their bedroom. A relative viewed that since the new acting manager started in their role, more social activities have taken place in communal areas on Wrekin Court and that people were meeting more in lounges. They told us how they have experienced very good celebrations of special occasions and they viewed that the home is always looking for new ideas for entertainment. We saw written records which have been made after meetings held at the home and to which some relatives have attended. This shows that there are day visits planned to places away from the home, such as to a local historic house and canal network as well as a presentation at the home from an author, a visit by a theatre company and a gardening club due to start. Care Homes for Older People Page 22 of 43 Evidence: The home produces an activities programme and we saw copies of the programme in different areas of the home. It gives an overview of activities planned for the month, including two Holy Communion services, a coffee morning, complimentary therapies, gentle exercise to movement and visits from a mobile library. Other activities noted included hair and nail care, which are considered to be personal care needs rather than social activities. On both days of our inspections we were informed that the homes designated person for organising and providing activities was involved in promoting individually based activities, for people in the privacy of their bedrooms. No other activities were observed to be taking place during the inspection to cater for individuals seated in any of the communal areas of the home. This was especially apparent on Wellington Court where most of the people who live on this unit were seated for long periods in front of a television in the lounge, with no other apparent stimulation. We saw one person completing a jigsaw and they told us they enjoy doing jigsaws, which reflected what was written in their care records. However of the people whose care we looked at throughout the home, we found that limited information was available about individual likes, dislikes and preferences. There was little to show that staff had explored peoples religious and cultural needs as well as looking at what was meaningful to the individual before their illness and what is important to them now. We asked staff for information about the cultural and religious needs of an individual because their care records were not clear about these needs. The staff we spoke with were not able to provide us with an adequate answer to demonstrate they have looked at these needs. We did not see written records of activities which have been provided for people. This makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. One member of care staff working on Wellington Court, viewed there is not enough going on to meet peoples social needs, which confirms our findings from both days of this inspection throughout the home which indicates that provision of activities is variable and needs to be reviewed to ensure it is inclusive and reflects the varying abilities and needs of people living at the home. Visitors to the home described how they are welcomed by staff and are able to visit when they want to, which means people can maintain relationships which are important to them. People who were able to give us their views, confirmed their satisfaction with the meals at the home, telling us they are provided with choices for each meal and that there are alternatives if they dont like what is on the menu. One person views that Care Homes for Older People Page 23 of 43 Evidence: meals are variable depending on which catering staff are working. On the first day of our inspection we saw that staff were attentive in providing and assisting people with their lunch in the dining room on Wrekin Court. There was a relaxed and cheerful atmosphere and staff regularly asked people if they needed anything else to eat and drink. At the end of the first day of our inspection we observed the evening meal and saw that foods, prepared for people with swallowing or chewing difficulties, had been pureed together, which is not considered to be good practice as it does not promote the sensory experience of tasting different foods. A relative had also made a comment to us about their own observations of how pureed food is prepared. On the second day of our inspection we saw that improvements had been made and that food had been pureed separately. We also saw a nurse sieving soup for a person to ensure it was of the right consistency for them. We spoke with the cook who told us that menus are changed to reflect seasonal variations. They described how they use fresh ingredients and confirmed they have an adequate budget for food stuffs. The cook told us there are currently 13 people with swallowing difficulties and we were informed of a good working relationship with the local speech therapist so that recipe information is provided and along with sheets about meals. The local Environmental Health Department visited the home in December 2009 and found poor level of compliance with food hygiene. The cook and acting manager informed us that action was taken after the visit to rectify the decifits. Care Homes for Older People Page 24 of 43 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure so that people and their representatives know how to raise concerns and complaints. People are not protected from the risk of harm and abuse because processes such as recruitment, care planning, assessment of risk and administration of medication are not robust. Evidence: The complaints procedure is displayed on a notice board in the reception and is also available within the service user guide. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. Two people who live at the home confirmed their awareness of how to complain as did the visitors we spoke with. We looked at the method used by the home to record and respond to complaints, and this shows there is a good process in place, with complaints and the action taken recorded. We also saw that the acting manager responds to complaints sensitively and promptly. Five staff we spoke with could confirm their role in safeguarding adults who live at Morris Care Centre from the risk of harm or abuse and they told us they had received training in abuse awareness. They told us they would not hesitate to report poor practice. There was nothing to suggest that staff have received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act oversees decision Care Homes for Older People Page 25 of 43 Evidence: making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The staff we spoke with were not aware of their roles in respect of the Act. The acting manager informed us that she is currently looking at provision of training about the Act. We saw that the home has obtained checklist documentation to assist staff in making their decision about whether a person has the capacity to make decisions, although we only saw these in two of the care files we saw. We made two referrals to the local safeguarding adults team after the inspection because of specific concerns we identified, which included bed rail safety and medicines management. There have been a significant number of recent concerns raised under the local multi-agency safeguarding process and although the service acknowledges shortfalls and takes action to put things right, it needs to develop a more proactive approach to look at why these situations are arising which have or are placing people at risk of harm. Care Homes for Older People Page 26 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being placed at risk of infection because infection control practices throughout the home are not effective or based on good practice guidance. Some people are provided with an environment which is homely and decorated to a good standard, however other people live in an environment which is less homely and provides little in the way of sensory stimulation. Evidence: We found the reception, lounges, corridors and bedrooms on Wrekin Court to be decorated to a good standard. There are lounges and seating areas on the different floors of Wrekin Court, which provides people who can move around the home or their visitors with different places to spend their time. There is a hairdresser and a room on the ground floor which has a small selection of books. We found the general decor in the corridors on Wellington Court to be clean but not homely. There is one large lounge on this unit which incorporates a dining area and there is a conservatory which overlooks a small courtyard. When we arrived on the unit a group of people were seated facing a television and a window which, as it was steamed up, restricted people seeing out of it. The acting manager informed us they intend to develop a relaxation and sensory area on the unit, which will be a positive development as currently there is nothing on this unit to enhance the sensory experiences of the people who live here. Care Homes for Older People Page 27 of 43 Evidence: There is a choice of stairs or passenger lift to the first and second floors on Wrekin Court and a wheelchair accessible platform lift to provide access to Wellington Court. We saw the home has equipment to help move people safely such as hoists and there is equipment to help people get in and out of the bath. On the intermediate care unit we saw various equipment to help promote and support people to maximise their independence. We observed staff using protective clothing to reduce risk of cross infection and saw that equipment such as aprons and gloves are available. However other observations during the inspection shows a need for improved infection control practices. On Wrekin Court we saw a bedroom for a person whose care we looked at. Their bedroom contained a large amount of liquid feed stored in boxes around their room, which means that parts of their room would not be able to be cleaned thoroughly. We also saw that a pump used to control the flow of their liquid feed was not clean as it was soiled with dried and sticky feed and remained that way during three visits we made to their bedroom. In another persons room there was a strong, offensive odour of urine the first day of our inspection. The odour was also noticeable at the start of our second day at the home, although we saw their bedroom carpet being cleaned later that day. We saw the person had a foam wedge at the bottom of their bed. The foam was not in a protective cover which means that it is likely to absorb liquids and would not be able to be effectively cleaned. We did a random check of bathrooms and toilets on Wrekin and Wellington Court which showed a lack of attention to effective cleaning. We saw that chairs to help people get in and out of the bath had a build up of soap scum and debris underneath them, a commode chair placed over a toilet was soiled and wash bowls and urinals were stained and worn. We showed the acting manager a bathroom where the toilet seat was broken and which had a dented, metal bin which was being used by staff to dispose of paper towels. We saw other bins without a foot operated mechanism to open them. It is considered good practice to use bins which have lids so that rubbish can be contained and to have a foot operated mechanism so that staff do not have to use their hands to open them. We looked at a stretcher used to enable people who are not able to sit up, to have a shower. The stretcher, which had just been used by a person, had a build up of grime and mould on the underside of the trolley mattress indicating it had not been cleaned effectively in between use for some time. We showed this to the acting manager and by the end of the inspection we checked the stretcher again and found it to be in a clean condition. The acting manager confirmed that cleaning of equipment is an area which has not been effective for some time, and is looking at ways to address it. We saw a Memo from the acting manager to staff Care Homes for Older People Page 28 of 43 Evidence: dated February 2010 noting issues with infection control and housekeeping. We looked at the homes laundry and saw there are good systems in place for management of soiled and clean linen and the member of laundry staff we spoke with had a good working knowledge of these systems. Care Homes for Older People Page 29 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not safeguarded from the risk of harm and abuse because the homes recruitment process is not robust and staff do not have the skills to ensure all health and care needs are met. Evidence: The staff we spoke with said they enjoy working with the people who live at Morris Care Centre and view that people receive good care. One member of staff we spoke with viewed that improvements could be made with the provision of activities and more staff could help to achieve that, another described staffing levels as just about OK but that more staff would enable greater opportunity for staff to spend quality time with people. One member of staff commented that staff do not always work together as a team which may then affect how care is being given. Relatives we spoke with viewed that staffing levels at weekends are not always sufficient as did a person who lives at the home, who also viewed there needs to be more staff overall including opportunities for people living on Wellington Court to enhance their physical wellbeing. On both days of our inspection staffing levels at the home appeared sufficient to meet the basic care needs of the people who live at the home, but we did not see care and nursing staff with people apart from when care and nursing duties were needed. There are people living at the home who need a high amount of care and would benefit from increased effort to enhance their physical, mental and social wellbeing, therefore it is a recommendation from this inspection that the home reviews its Care Homes for Older People Page 30 of 43 Evidence: staffing levels in all of the units. We looked at five staff personnel files to look at how the home recruits staff. We found the home has not ensured these staff had all the necessary pre-employment checks undertaken to ensure they are suitable to work with vulnerable people. One member of staff started working at the home in 2009 without any references being obtained. Other staff had only one reference, which was not always from their previous employer, which it should be. The staff had started working before their full Criminal Record Bureau Disclosure (CRB) had been obtained. We saw emails confirming that ISA/POVA First checks (which are checks against a national list of people considered not suitable to work with vulnerable adults), had been completed by the company and informing the home that the staff could start working under supervision. However the staff should not have started working until the company was certain that all other checks, such as references had been completed and was satisfied with them. We became aware that the home had conducted an audit of staff files earlier in 2010. The audit showed that in 2009 nine staff had started work with only one reference being obtained and one member of staff started without any references. Although it is positive that the home has audited staff files to identify deficits, we found the audit was not entirely robust because we found that a recently appointed staff member, with only one reference in their file, had not been identified by the audit. The home has not yet obtained the missing information which means that staff are working at the home without all the necessary pre-employment checks being completed. Two staff we spoke with viewed the induction they had when they first started working at the home as good. We saw checklists to confirm that staff have an induction but did not look for further information about the induction for staff who are new to care, which will be examined at another inspection. We were given a list to show the numbers of staff who have achieved a recognised qualification in care (National Vocation Qualification) which should contribute to ensuring the staff team have an effective knowledge of social care. We were given a personnel file for a staff member as an example of someone who has done a lot of training because they have worked at the home for sometime. We saw that the staff member had attended training and updates in safe working practice topics, such as food hygiene, safeguarding adults, moving and handling and some fire safety training, but there was nothing to indicate that the staff member had completed more specific training such as dementia care, diabetes, caring for peoples skin and prevention of pressure sores. Some of the other staff files we looked at showed that training in dementia care had recently been provided, but these files also did not show more Care Homes for Older People Page 31 of 43 Evidence: specific training to meet the needs of people currently living at the home, such as meeting the needs of people with sensory impairments and learning disabilities. Two care staff we spoke with told us that if they are unclear about illnesses and conditions people may have, they will ask nurses on the shift for more information, but confirmed they had not had additional training. A nurse described how she has been asking for sometime to have training on a particular piece of medical equipment in use at the home, another nurse confirmed that they had received this training and believed that the acting manager is trying to arrange for more training. A nurse considered that updates in their clinical practice would be useful, commenting that nurses currently have to complete their professional updates in their own time. We saw a book which showed that in 2009 a GP had provided two training sessions to nurses on medical conditions. The book also showed that a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. We also saw evidence that training in the safe use of bed rails had recently taken place. As previously noted earlier in the report staff have not training or awareness of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards, we also saw that staff have not had training or awareness around needs associated with equality and diversity in addition to the training shortfalls described above. Our findings in respect of medication practices also show that staff, involved in the administration of medicines, have not had assessments of their competence before they administer medication to people. Care Homes for Older People Page 32 of 43 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Morris Care Centre does not have effective arrangements in place to promote the health, safety and welfare of people who live there; this means people cannot be confident they will be protected from harm. Evidence: Morris Care Centre has been without a Registered Manager for over two years. We did not receive an application form to register the acting manager who was present at the time of our last key inspection to the home in November 2008. A senior member of staff, who has worked at the home for sometime, has recently taken on the role of acting manager on an interim basis. The acting manager was present throughout both days of our inspection and they offered their assistance and co-operation for the inspection. We saw they have a good rapport with people who live at the home, visitors and staff and we received many comments giving very positive feedback about the acting manager. One person who lives at the home was very specific in their view that the management of the home had improved with the new acting manager. Care Homes for Older People Page 33 of 43 Evidence: We saw written records which show that a representative of the company conducts monthly unannounced visits to monitor the quality of the service. We observed two reports produced as a result of visits at the end of 2009. This shows that the process would benefit from being improved as it does not suggest that processes which impact on outcomes for people are looked at in depth. Robust monitoring should be able to identify when improvements need to be made and our observations made at this inspection and evidenced throughout this report indicate the home has not been managed or monitored effectively by the company for sometime. For example there was no evidence to suggest that Medication Administration Record (MAR) charts are audited for their integrity or that care records are checked to ensure that people are receiving the care they need. Representatives of the company were present on both days of this inspection. On conclusion of our first day, we gave the acting manager and company representative feedback (a summary of our findings) from that day. Near the end of our second day of inspecting the home, we attempted to give feedback to the acting manager and two company representatives. We informed them that we had identified many concerns, including serious concerns with the management of medication. Despite our requests to inform them of our findings, the company representatives declined, which suggested a lack of commitment by the company to respond promptly to improve outcomes for people and protect their health, safety and welfare. We met with the director of the company a week after the inspection, who acknowledged that they should have received our feedback at the time of the inspection. People and their relatives are given opportunity to put forward ideas to improve the service during meetings and the acting manager informed us how it is intended to obtain additional views by sending out questionnaires to people, their representatives and staff. We did not scrutinise how the home manages the finances of the people whose care we looked at. We saw documentation for another person, which included clear records and receipts of their spending. We saw from looking at staff files that the home has a staff supervision process in place, although the staff files we saw showed this has not happened as often as it should do. The process used could also be enhanced so that staff are provided with greater opportunity to reflect on their practice. We looked at a selection of documentation which shows that the homes maintenance person undertakes checks of equipment, such as wheelchairs to ensure it is well maintained. We also saw written records showing that the temperature of the water is regularly tested to ensure it is not too hot. Care Homes for Older People Page 34 of 43 Evidence: As identified earlier in the report we were concerned regarding an incident in respect of bed rails, as we saw written in a persons care records, notes describing how they had been found trapped between bed rails. We looked for further information about the incident on the first day of our inspection, but an incident/accident record could not be found and the acting manager confirmed they were not aware of the incident. There was nothing written within the persons care records to say whether the bed rails were reviewed or changed after the incident. We had also not been notified of this incident. The acting manager subsequently notified us in writing about the incident after we had identified it. This indicates that staff had not followed good reporting or recording practices after the incident. We also established that that the home had not kept us informed when a person needed admission to hospital. We were informed by a company representative that the home is in the process of purchasing new beds which have bed rails already attached, thus reducing the risk of bed rails not being attached correctly. The maintenance person demonstrated a good awareness of the safety aspects involved in the use of bed rails and described how the home is starting to put a system in place for the maintenance of bed rails. We saw that 53 staff received training in the safe management of bed rails at the beginning of March 2010. However our findings from this inspection shows this has not been adhered to as we identified a person who had not been risk assessed for the safe use of bed rails and they did not have bumpers in place to reduce the risk of injury from the bed rails. Guidance on the safe use of bed rails has been available from relevant safety organisations for a considerable time, so it is surprising that the company has not yet devised its own effective safe system of work based on the guidance. Our findings from this inspection show that prompt action on the part of the company is needed to ensure management systems and processes are effective so that outcomes for people are improved and the risk of harm reduced. The company must also ensure that a suitable, competent person is appointed to provide leadership and direction at Morris Care Centre to improve the outcomes for the people who live there and an application must be made to register that individual with CQC. This is to comply with our regulations and to ensure people will have the confidence in the home because it is led and managed effectively. Care Homes for Older People Page 35 of 43 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 36 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People must have care that is planned and provided according to individual needs and preferences. This is to ensure people receive the care they need and the monitoring that their conditions require. 10/05/2010 2 8 13 People who need bed rails 10/05/2010 must be assessed for the risks associated with the use of bed rails. This is to ensure bed rails are used appropriately, safely and in accordance with guidance provided by the relevant safety organisations such as the HSE. 3 8 13 Any risks to the health, safety and well-being of people living at the home must be identified, recorded and managed according to the persons wishes and 10/05/2010 Care Homes for Older People Page 37 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action capabilities and on advice from professionals involved in their care. This is to ensure that unnecessary risks to the health and safety of people are identified and as far as possible eliminated. 4 9 12 To ensure that there is an effective system in place to request obtain and retain adequate supplies of prescribed medicines for people. This is so the prescribed medicines can be given to them as and when prescribed. 5 9 13 Controlled drugs must be stored in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations Amended 2007 and the guidelines from the Royal Pharmaceutical Society of Great Britain. This is to ensure they are stored securely. 6 9 13 All medicines must be stored 10/05/2010 securely and in accordance with current health and safety regulations. 10/05/2010 10/05/2010 Care Homes for Older People Page 38 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure people are not placed at risk of harm 7 9 13 Medication must be stored within the temperature range recommended by the manufacturer. This is to ensure that medication does not loose its potency or become contaminated 8 9 18 To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. This is to ensure people receive their medication as prescribed from suitably skilled staff. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required and self administered medication. This is to ensure that all medication is administered safely, correctly and as 21/05/2010 10/05/2010 9 9 13 10/05/2010 Care Homes for Older People Page 39 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action intended by the prescriber to meet individual health needs. 10 9 13 The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate. This is to demonstrate that all medication is administered as prescribed. 11 26 13 The home must develop and 10/05/2010 put in place effective infection prevention and control processes based on evidence based research and relevant guidance. This is to ensure people are provided with an environment and equipment which is clean and free from odour. 12 29 19 Staff recruited by the home must have all required preemployment checks undertaken. This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 13 30 18 All staff must have training appropriate for the work they are to perform. 14/06/2010 10/05/2010 10/05/2010 Care Homes for Older People Page 40 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure staff are competent and have the skills and knowledge to meet the needs of people living at the home (including specialist needs). Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 People and their representatives should be involved in the assessment, planning and evaluating of their care. This is so that people are kept informed of their care needs and so that care is focused on their needs and wishes. People living at the home must be provided with a range of activities that are appropriate and meet their individual needs and capabilities. This is to promote well-being and ensure that the social needs of people living at the home are met. The home should introduce a system of evaluating the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. Staffing levels in all areas of the home and for all shifts should be reviewed to take account of peoples needs, dependency and layout of the home. This is to ensure peopls needs, including their social needs are met. Staff should be provided with training about the Mental Capacity Act and Deprivation of Liberties. This is so that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The Registered person should consider developing how the service is monitored during monthly unannounced visits. This is to show that outcomes for people are monitored 2 12 3 12 4 27 5 30 6 33 Care Homes for Older People Page 41 of 43 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations more closely so that action can be taken to improve the service. Care Homes for Older People Page 42 of 43 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 43 of 43 - 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. 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