Care Home: Morton Grange

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What the care home does well People told us, "I am happy and content" "The standard of nursing care is excellent" "I am supported in every way possible from managers to carers" "I have communication difficulties, the staff are very patient and encourage me to make decisions" "I feel confident Mum is well looked after" "Mum is in safe caring hands" People told us they were "always treated with respect". People said the staff were "very patient and kind". We observed a calm, respectful approach by staff to people living in the home. People told us "There is something every day for me to be involved in. I particularly enjoy games night every Thursday and all the singers we have", "There is entertainment every week and some wonderful evening entertainment which residents and relatives really look forward to", and "lots of opportunities for social interaction". People told us they always liked the meals at the home. They said, "the choice is very good", and, "I enjoy the roast dinners". People told us "a warm, clean, well decorated home", " its always nice and clean", "my bedroom is great because I enjoy spending time in there", and "the physical surroundings are excellent. It is very well maintained". We received many positive comments about staff, including: "staff are always nice" "Staff are lovely and helpful always" "The staff are very attentive, cheerful and welcoming" "very happy with the staff at Morton Grange and their caring attitude"From the AQAA, discussion with the manager and providers, discussion with other people, and observation, it was clear that there was strong leadership and a proactive approach to the management of the home. What has improved since the last inspection? The manager and deputy manager provided seven days supernumerary management cover between them. This ensured that they were easily available to people living in the home, visitors and staff. It also ensured that the manager and deputy manager could supervise care and ensure good standards were maintained. The range of activities and events had been increased to ensure that the needs and preferences of all people living in the home were catered for. A garden room had recently been added to The Beeches. This provided a large room for functions and social activities, complete with a licensed bar. The staff training programme had been further developed so that more staff were working towards National Vocational Qualifications (NVQ). CARE HOMES FOR OLDER PEOPLE Morton Grange Stretton Road Morton Alfreton Derbyshire DE55 6HD Lead Inspector Rose Moffatt Unannounced Inspection 12th August 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton Grange Address Stretton Road Morton Alfreton Derbyshire DE55 6HD 01246 866888 01246 861757 carelineservices@btconnect.com www.mortongrange.co.uk Inverhome Limited 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 Doreen Teanby Care Home 66 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2006 Brief Description of the Service: Morton Grange care home is located in the village of Morton with shops, pubs and other amenities nearby. The care home consists of three units in two buildings. The Beeches unit is a converted building and The Poplars and The Willows units are purpose built. Each unit is separately staffed and organised to run as an individual home, although the registered manager retains responsibility for the whole home. The home has recently added a large garden room to The Beeches with a bar to use during social functions. Fifty-four of the homes bedrooms comprise single accommodation, with twenty of these providing en-suite facilities. Six of the bedrooms offer shared accommodation, with two of these providing ensuite facilities. Passenger lifts are provided. There are extensive gardens that are well maintained and easily accessible. Car parking space is to the front of the building. The current fees range from £364.31 to £510.87 per week. The providers gave this information on 12th August 2008. Information about the home, including CSCI inspection reports, is available from the home. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The focus of our inspections is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the provider’s ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Surveys returned to us by people using the service and from other people with an interest in the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • What other people have told us about the service. We carried out an Annual Service Review (ASR) of the home in January 2008. The ASR looked at all the above information. The ASR showed us that the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over eight hours on one day. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 65 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The providers and the manager were available and helpful Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 6 throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. ‘Case tracking’ was used during the inspection visit to look at the quality of care received by people living in the home. Six people were selected and the quality of the care they received was assessed by speaking to them and /or their relatives, observation, reading their records, and talking to staff. What the service does well: People told us, “I am happy and content” “The standard of nursing care is excellent” “I am supported in every way possible from managers to carers” “I have communication difficulties, the staff are very patient and encourage me to make decisions” “I feel confident Mum is well looked after” “Mum is in safe caring hands” People told us they were “always treated with respect”. People said the staff were “very patient and kind”. We observed a calm, respectful approach by staff to people living in the home. People told us “There is something every day for me to be involved in. I particularly enjoy games night every Thursday and all the singers we have”, “There is entertainment every week and some wonderful evening entertainment which residents and relatives really look forward to”, and “lots of opportunities for social interaction”. People told us they always liked the meals at the home. They said, “the choice is very good”, and, “I enjoy the roast dinners”. People told us “a warm, clean, well decorated home”, “ its always nice and clean”, “my bedroom is great because I enjoy spending time in there”, and “the physical surroundings are excellent. It is very well maintained”. We received many positive comments about staff, including: “staff are always nice” “Staff are lovely and helpful always” “The staff are very attentive, cheerful and welcoming” “very happy with the staff at Morton Grange and their caring attitude” Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 7 From the AQAA, discussion with the manager and providers, discussion with other people, and observation, it was clear that there was strong leadership and a proactive approach to the management of the home. What has improved since the last inspection? 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. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were given enough information about the home and there was a satisfactory assessment process so that people were confident their needs could be met. EVIDENCE: We received completed surveys from six people living in the home and from eight relatives of people in the home. Five of the six people living in the home said they received enough information about the home – one person said they received “excellent information” from the home. One person said they visited the home twice, and staff from the home visited them in hospital, before they decided to live in the home. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 10 The six people living in the home all said they always received the care and support they need. Seven of the relatives said the home always met the person’s needs, one said their needs were usually met. We spoke to three people living in the home and four relatives during the inspection visit. All the people we spoke with told us people living in home always had the care and support they needed. One person said, “I am supported in every way possible from managers to carers”, and a relative said, “I feel confident Mum is well looked after”. Many people living in the home were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We observed that people’s needs appeared to be met. There were sufficient staff available and staff were aware of people’s needs and preferences. The AQAA gave details of the admission process and said, “Pre-admission assessments are conducted for all service users to ensure their needs are understood and can be adequately met”. The AQAA said the home planned to update their pre-admission process to ensure compliance with the Mental Capacity Act. Also, that the home planned to launch a new website to give prospective clients a better insight into their facilities and activities. We looked at the records of six people. All the records included assessments by the home, and by hospital and / or social services staff. Standard 6 did not apply as there was no-one receiving intermediate care in the home. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There was a consistent, purposeful approach to care provision so that people received effective personal and healthcare support to meet their individual needs and preferences. EVIDENCE: All of the six people living in the home who returned completed surveys to us said their needs were always met. Four of them said they always received the medical support they needed, and two said they usually did. The people we spoke to told us their personal and healthcare needs were met at the home. Most of the relatives we spoke to or who completed surveys said the person’s needs were always met at the home. People told us, “I am happy and content”, “The standard of nursing care is excellent”, “They have worked very hard to improve the physical condition of a very frail under-nourished old lady”, and “Mum is in safe caring hands”. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 12 We looked at the care records of six people. Each person had an individual care plan that covered all of their assessed needs. The care plans had been signed by the person, or their representative, to indicate their involvement and agreement. The care plans had all been reviewed monthly and updated as necessary. The care plans had good details of the action required by staff to meet people’s needs. Some of the care plans lacked details of how staff should ensure people’s privacy and dignity. There were appropriate risk assessments in place and all had been reviewed monthly. The care records included details of visits by the GP, chiropodist, optician and other healthcare professionals. The home had good relationships with the local GP surgery, community matron and nurse advisors, so that people had good access to healthcare advice and support, and were referred promptly for specialist treatment. The management team at the home were keen to ensure that care provided in the home was based on current good practice and research. For example, they had recently taken action to ensure people in the home were drinking sufficient water after recent research had indicated that this could help reduce the number of falls. Medication was stored securely on each of the units within the home. All controlled drugs and any medication needing refrigeration were stored in The Poplars. The medication administration records seen were all correctly completed. Records were seen of the receipt and disposal of medication. Medication was only administered by qualified nurses at the home. The medication policy included all the required information and was available in each unit. There was also information about covert administration of medication, including the Nursing and Midwifery Council guidelines, and information from the Mental Capacity Act 2005. We saw that covert administration of medication was well managed for one person, with documentation of the agreement and involvement of the GP and pharmacist. The person’s care plan had details of when and how medication could be given covertly. The six people who returned surveys told us that staff always listened to them and acted on what they said. People we spoke to told us that people living in the home were treated with dignity and respect. People told us, “I have communication difficulties, the staff are very patient and encourage me to make decisions”, and “always treated with respect”. People said the staff were “very patient and kind” and “lovely and helpful”. We observed a calm, respectful approach by staff to people living in the home. We observed that staff knocked on bedroom and toilet doors before entering. The AQAA said, “ A person centred care planning approach is used and reviewed at regular intervals. We work with service users, relatives, carers and Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 13 outside agencies to ensure the best support and care for each individual”. The AQAA said the home had improved by working with other healthcare professionals “to deliver best practise”. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were encouraged and supported to make choices and to take part in a range of activities so that the lifestyle in the home met their needs, preferences and expectations. EVIDENCE: Four of the six people who returned surveys said there were always activities in the home they could take part in, one said there usually were, and one said there sometimes were. People told us “There is something every day for me to be involved in. I particularly enjoy games night every Thursday and all the singers we have”, “There is entertainment every week and some wonderful evening entertainment which residents and relatives really look forward to”, and “lots of opportunities for social interaction”. One relative said they were pleased that they could go out on trips with the person living in the home, and said they had enjoyed visiting places they had never been to before. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 15 There was a full-time activities coordinator employed at the home. A range of activities was provided, including trips out, visiting entertainers, games, social evenings, and a regular church service. The programme of activities for the week was displayed, as well as posters for future events. There was an ‘Indian Evening’ planned with staff showing traditional dress and dances. People went out on a trip to a local garden centre on the day of the inspection visit in the home’s own minibus. The home had recently had a garden room added to The Beeches and this provided a large space for social activities and functions with a licensed bar. One person said they would like “background, soothing music for the residents in the lounge, on a regular basis. Details of day/month/year and weather displayed. More contact with outdoors, (in good weather). Displays of planters, bird tables and feeders so that the residents can see these easily”. We observed that background music was used in two of the lounges on the day of the inspection visit. The care records included details of the person’s family and social history, including their preferences regarding routines, and their spiritual needs. Seven of the eight relatives who returned surveys to us said they were always kept up to date with important issues affecting people in the home, one said they usually were. The four relatives we spoke with said they were always kept informed about the person’s general health and any changes or concerns. Two relatives who returned surveys, and three that we spoke to said they were given good support by staff at the home. One relative said, “The staff have given me a lot of support for which I am very grateful”. Visitors said they could visit at any reasonable time and were always made welcome. One relative was pleased that they could have a meal with the person in the home. In each bedroom, there were communication books for relatives or visitors to put in any comments, information or questions about the care of the person in the home. People living in the home and their relatives were invited to the monthly meetings of the Friends of Morton Grange where activities and fund raising were discussed. Surveys were used to find out people’s views and opinions, including ideas for activities and menus. The analysis of the surveys was published in the monthly newsletter with details of action taken to address any issues raised. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 16 There was information about local advocacy services and one person told us that they had an advocate. People were encouraged to personalise their bedrooms with their own possessions. There was information available about the Mental Capacity Act 2005 and senior staff were currently receiving training about the Act and its implications for people living in the home. One person told us “I have my own routines which I like and the staff are always ready to help me”. Two people who returned surveys said there were always enough staff available when they needed them, three said there usually were, and one said there sometimes were. We observed that there appeared to be enough staff available so that people did not have to wait for assistance, for example, to go to the toilet or to have their meal. Staff we spoke to were aware of people’s personal preferences and were clear about upholding personal choices. The six people who returned surveys, and all the people we spoke with told us they always liked the meals at the home. People said, “the choice is very good”, and, “I enjoy the roast dinners”. The dining rooms were clean and bright. The lunch served on the day of the inspection visit was well presented and looked appetising. We observed staff giving assistance to people in an unobtrusive way. The care records included an assessment of people’s nutritional needs and a care plan to address their needs. The assessments and care plans were updated monthly. The AQAA said, “maintaining individuality is paramount; as such we promote a person centred approach to care and endeavour to ensure service users are not constrained by routine”. “Service users are assumed to have full capacity unless proved otherwise. Staff promote independence in decision making where required” Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were satisfactory policies in place and good staff awareness so that people were protected and their concerns effectively dealt with. EVIDENCE: All the people living in the home and the relatives who returned surveys and who we spoke to told us they knew how to make a complaint. People told us they were satisfied with the outcome of any complaints made. One relative said that the home had responded appropriately when a complaint was made about clothes ‘going missing’ in the laundry. Staff who returned surveys and those spoken with all knew what to do if anyone wanted to make a complaint about the home. People said they knew who to speak to if they were unhappy. One person said, “Any member of staff would help me”. The complaints procedure was available in every bedroom in the home. We looked at records of complaints made directly to the home. The records included the action taken and the outcome of the complaint. One record did not include the outcome and some entries were not signed by the person making them. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 18 People were encouraged to complete regular surveys about their satisfaction with the service provided. The results of the surveys were published in the monthly newsletter with details of action taken to address any issues raised. There were satisfactory policies and procedures in place about safeguarding vulnerable adults. All staff at the home had received training about safeguarding issues and procedures. Staff spoken with were clear about reporting any allegations or suspicions of abuse. We had not received any complaints or concerns about the home, or any information about safeguarding vulnerable adults issues at the home. The home had sent us notifications of events as required by Regulation 37 of the Care Standards Act 2000. The AQAA said that the home was looking into the provision of advocacy services for people who may lack capacity. They were considering the impact of the effects of the Mental Capacity Act 2005. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was very clean and well maintained to ensure a safe, pleasant and comfortable environment that met the needs of people living there. EVIDENCE: People told us “a warm, clean, well decorated home”, “ its always nice and clean”, “my bedroom is great because I enjoy spending time in there”, and “the physical surroundings are excellent. It is very well maintained”. A member of staff told us, “we have good and advanced equipment for client and staff safety. Our management is more than happy to purchase equipment which is good for clients”. One person said, “I would like to see more changes Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 20 in pictures and ornaments in the lounge area – not just the same year on year”. The AQAA said that there was a planned programme of maintenance at the home. A full time maintenance man was employed to carry out this programme, and to ensure any other maintenance was carried out promptly when needed. All areas of the home appeared well maintained. The new garden room added to The Beeches had recently been put into use, although there were some finishing touches still to complete. External CCTV cameras had been installed to improve security. The home appeared well equipped. Profiling beds were provided for all people living there, suitable hoists for manual handling, hand rails in the corridors and grab handles in the toilets. Five of the six people who returned surveys to us said the home was always fresh and clean, one person said it usually was. People spoken with during the inspection visit said the home was always clean. We observed that the home was clean and free from offensive odours in every area seen on the day of the inspection visit. The AQAA said “The risk of infection is managed by: having three small homes as opposed to one large one, the layout of our homes, staff training, adequate staffing, choice of cleaning products used, emphasis put on prevention and a meticulous approach to cleaning – all managed by the nurse in charge”. Nearly all the staff had received training about infection control. We observed staff using disposable gloves and aprons appropriately. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good recruitment practices, a comprehensive staff training programme and satisfactory staffing levels so that people were protected and well supported. EVIDENCE: Two of the people who returned surveys to us said there were always staff available when needed, three said there usually were, and one said there sometimes were. People we spoke with during the inspection visit all said that there were enough staff available when needed. One person said, “The home seems to have a lot of staff in all the departments”. Another person said, “The staff to residents ratio is excellent”. The three staff who returned surveys to us, and those we spoke to all said that there were always enough staff to meet the needs of people in the home. Staff told us that extra staff were provided when necessary, for example, if someone needed additional care because of a change in their health. We observed that there appeared to be enough staff available, particularly at busy times, such as lunch time. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 22 The manager and providers said they focussed on recruiting the right people, rather than simply filling vacancies. They were proactive in their approach to planning for staffing and training to ensure people’s changing needs could be met. The AQAA showed that there was little turnover of staff in the home. We received many positive comments about staff, including: “staff are always nice” “Staff are lovely and helpful always” “The staff are very attentive, cheerful and welcoming” “very happy with the staff at Morton Grange and their caring attitude” The AQAA said that the home has an Edexcel accredited training centre so that all care National Vocational Qualifications (NVQ) could be conducted in house. The AQAA said that 70 of staff had achieved NVQ Level 2 or above. Also, that the nurses in charge were undertaking NVQ Level 4 in management, and that domestic staff had also undertaken relevant NVQ Level 2. We looked at the records for six members of staff, including staff recently recruited and registered nurses. The records included all the required information and documents, such as a Criminal Records Bureau (CRB) disclosure, two written references, and a full employment history. At the previous inspection in 2006, a requirement was made that the home must ensure that all the qualified nursing staff have a current registration with the Nursing and Midwifery Council. The home had put a system in place to ensure the registration of nurses employed was checked and verified. The induction of new staff and the training programme at the home met Skills For Care standards. The three staff that returned surveys to us said the induction covered everything they needed to know very well. They all said that they were being given training that was relevant to their role and that helped them to meet the individual needs of people in the home. Three of the relatives who returned out surveys said staff always had the right skills and experience to look after people properly, five said staff usually did. People we spoke with told us staff were competent and were aware of their needs and preferences. At the previous inspection in 2006, a requirement was made that all staff must have training in manual handling and fire safety. We saw records at this Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 23 inspection to show that all staff were up to date with this training. Staff we spoke with confirmed that they had received this training Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There was effective and proactive management of the home so that people received a well managed, consistent service that was run in their best interests. EVIDENCE: The manager, a registered nurse, had been in post for seven years. She had achieved the NVQ Level 4 Registered Managers Award (RMA). She was supported by a deputy manager who had also achieved the RMA. The manager and the deputy manager provided seven days supernumerary management cover between them. People we spoke to told us the manager Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 25 was approachable. One person said the manager was “caring and professional”. People said they had confidence that the manager would take appropriate action on any concerns raised. The AQAA was completed by the manager and was returned by the agreed date. The AQAA contained clear, relevant information supported by a range of evidence. The AQAA told us of changes made in the service, where improvements were to be made and how they were going do this. The data section was fully completed. The providers were part of the management team and worked from an office in the home. There was a weekly management meeting for the providers, the manager and the deputy manager. Several people told us the home was “well organised”. One person said, “this is an exceptional home”. Staff were pleased that the management team encouraged and listened to their opinions. One member of staff said, “staff are respected and treated well”. We observed that the management team were easily available to people living in the home, visitors and staff. From the AQAA, discussion with the manager and providers, discussion with other people, and observation, it was clear that there was strong leadership and a proactive approach to the management of the home. Examples of this included: the use of research to ensure the home provided care based on current best practise; high level of satisfaction with the service as shown through a comprehensive quality assurance system; people spoke highly and warmly of the manager and providers; good retention of staff with low staff turnover. The home used the Blue Cross Mark of Excellence quality assurance system. Surveys were used for people living in the home, relatives and staff. The results of the surveys were published in the monthly newsletter with details of action taken to address any issues. There were monthly meetings for people living in the and their relatives or representatives. There were regular staff meetings. We looked at the records of personal money held for people living in the home. The money was kept securely and the records were up to date. All transactions had the signatures of two members of staff. The money was checked every week by two members of staff, and periodically by the manager or providers. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 26 The AQAA gave details of the maintenance of equipment and systems in the home and this was all up to date. We looked at records of maintenance and checking of the fire safety equipment and systems in the home and found these were all up to date. Staff had received appropriate training in health and safety, such as manual handling, food hygiene and infection control. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 OP7 OP16 Good Practice Recommendations There should be more detail in the care plans of how people’s privacy and dignity are to be maintained and promoted. Records of complaints should always include the outcome and all entries should be signed by the person making them. This will help to ensure a more robust complaints procedure so that people can see their concerns are taken seriously and effective action is taken. Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton Grange DS0000002066.V370095.R01.S.doc Version 5.2 Page 30 - 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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