Care Home: Morton House

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What the care home does well Service users are given the key information on the home. Some aspects of equality and diversity are identified in care plans and staff receive training in equality and diversity. Service users are supported and enabled to make choices on how they want their care to be given. Service users are supported to maintain contact with family and friends. Service users have access to a choice of balanced and nutritious meals. Service users health and personal care needs are well met, promoting health and well being and ensuring that they receive medication in a safe and consistent manner. Systems are in place to deal with complaints and to ensure the protection of service users from abuse. The home is clean, nicely decorated and well maintained, promoting a homely and comfortable environment for service users. Staff are inducted, trained and supported in their roles to enable them to have the skills and competences to meet service user needs. Staff appeared confident in their roles and committed to the development of the service. Safe recruitment practices are in place. The home is effectively managed and monitored to ensure a high standard of care for service users. The atmosphere within the home was found to be calm, welcoming and enabling. Service users and relatives are generally happy with the quality of care and comments were received which include "my relative has been at the National Society for Epilepsy for years and it has been a wonderful home. I cannot speak highly enough of the care and treatment there". "The National Society for Epilepsy do a wonderful job for which we would like to express our sincere thanks" "My son is very happy and speaks well about the home and his care worker". One relative commented that they think their relative live a reclusive life and the idea of a move should be on going. However in discussion with the manager and staff this individual service user do not want to move and staff feel they have to support this decision. What has improved since the last inspection? The statement of purpose and service users guide has been reviewed and updated and the service user guide has been made available to service users. Person centred plans have been developed and put in place for all service users. Opportunities for activities have improved but this continues to need to be developed further to allow service users more opportunities to access the community. Staff have become involved in the planning and preparation of the evening meal at the home and aim to develop this further to enable service users to become more involved and develop their life skills. The complaints procedure has been made available to service users and a record has been put in place to record complaints received and the outcome of the investigation into complaints. Areas of the home have been decorated with new furniture purchased and attempts made to make it more homely. New care staff have been appointed and staff are working well together as a team to improve the quality of care in this service. All aspects of running and managing the home have improved with evidence available to support practice. CARE HOME ADULTS 18-65 Morton House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ Lead Inspector Maureen Richards Unannounced Inspection 14 & 15th May 2008 09:50 th Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494 601433 01494 871927 www.epilepsynse.org.uk The National Society for Epilepsy Care Home 17 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 17 residents, some of whom may have a physical disability, learning disability. 30th May 2007 Date of last inspection Brief Description of the Service: Morton House is one of a number of homes situated on the Chalfont Centre for Epilepsy. The home is registered to provide residential care to for up to seventeen adults with a learning and physical disability. People of both sexes are accommodated including a married couple. The home provides care and support to individuals with a range of personal care needs. The home currently has fourteen single bedrooms and one double bedroom and is accessible for people who use wheelchairs. The Centre provides banking facilities, an internet café, a shop, a restaurant and various social and life skill opportunities. There is access to public transport and the centre is accessible to Chalfont St Peter Village, which allows for access to the towns of Amersham, High Wycombe, Uxbridge and Slough. Fees range from £924.28 to £2469.07 per week. Extra charges apply for such services as hairdressing, chiropody, toiletries, magazines/papers and leisure activities such as football, outings and holidays. Morton House DS0000023000.V363708.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of two days and covered all of the key National Minimum Standards for younger adults. Prior to the inspection, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. These were also distributed to relatives by the staff. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager, staff and service users, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the inspection was safeguarding. Feedback on the inspection findings and areas needing improvement was given to the manager during the inspection. The manager, staff and people who use the service are thanked for their cooperation and hospitality during this unannounced visit. Requirements made at the previous inspection have been complied and this inspection has resulted in one requirement. What the service does well: Service users are given the key information on the home. Some aspects of equality and diversity are identified in care plans and staff receive training in equality and diversity. Service users are supported and enabled to make choices on how they want their care to be given. Service users are supported to maintain contact with family and friends. Service users have access to a choice of balanced and nutritious meals. Service users health and personal care needs are well met, promoting health and well being and ensuring that they receive medication in a safe and consistent manner. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 6 Systems are in place to deal with complaints and to ensure the protection of service users from abuse. The home is clean, nicely decorated and well maintained, promoting a homely and comfortable environment for service users. Staff are inducted, trained and supported in their roles to enable them to have the skills and competences to meet service user needs. Staff appeared confident in their roles and committed to the development of the service. Safe recruitment practices are in place. The home is effectively managed and monitored to ensure a high standard of care for service users. The atmosphere within the home was found to be calm, welcoming and enabling. Service users and relatives are generally happy with the quality of care and comments were received which include “my relative has been at the National Society for Epilepsy for years and it has been a wonderful home. I cannot speak highly enough of the care and treatment there”. “The National Society for Epilepsy do a wonderful job for which we would like to express our sincere thanks” “My son is very happy and speaks well about the home and his care worker”. One relative commented that they think their relative live a reclusive life and the idea of a move should be on going. However in discussion with the manager and staff this individual service user do not want to move and staff feel they have to support this decision. What has improved since the last inspection? The statement of purpose and service users guide has been reviewed and updated and the service user guide has been made available to service users. Person centred plans have been developed and put in place for all service users. Opportunities for activities have improved but this continues to need to be developed further to allow service users more opportunities to access the community. Staff have become involved in the planning and preparation of the evening meal at the home and aim to develop this further to enable service users to become more involved and develop their life skills. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 7 The complaints procedure has been made available to service users and a record has been put in place to record complaints received and the outcome of the investigation into complaints. Areas of the home have been decorated with new furniture purchased and attempts made to make it more homely. New care staff have been appointed and staff are working well together as a team to improve the quality of care in this service. All aspects of running and managing the home have improved with evidence available to support practice. 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 House DS0000023000.V363708.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is adequate. Service users are given the key information on the home and prospective service users are admitted for assessment, however an assessment needs to take place prior to admission for the full assessment to ensure the home is aware of needs and potential risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the previous inspection it was noted that the Statement of Purpose and Service Users Guide were out of date and there was no evidence that those documents had been distributed to service users. Both of those documents have now being updated and a copy of the Service Users Guide is included in service users plan. The Statement of Purpose should be further developed to include a clear outline of the assessment process. The home has had no new admissions since the last inspection but have had three prospective service users who spent time at the home being assessed as to whether the home can meet their needs and to allow those individuals to make a choice on whether they wanted to move to the home. Those individuals currently live on site at other services. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 10 The assessment documentation for one individual was seen which was completed over the assessment period whilst the individual was living at the home as opposed to prior to admission to the home for assessment. The assessment document outlines the individual’s personal details and contacts, it identifies the service users perspective of the problem, the service users expectations and motivation, the service users understanding of taking risks and risk management. It outlined the clinical background with a record of medical history, history of falls, medication use and ability to self medicate. This completed part of the assessment document outlined in detail medical issues but the documentation did not allow for information relating to medication to be recorded. The assessment document outlined the support required with personal care, oral hygiene, foot care, tissue viability, mobility issues, communication, mental health, epilepsy, cultural and faith needs. The assessment document should be developed in a simple format taking into account all of the areas to be assessed as outlined under standard 2.3. The manager confirmed that prospective service users from the community would be assessed in their own environment prior to admission for assessment but this practice should be put in place for all service users admitted for assessment to ensure that potential risks and compatibility issues are addressed prior to a prospective service users spending time at the home. A requirement was made at the previous inspection to ensure a full assessment of each service user’s needs is undertaken and a process put in place to ensure that these are regularly reviewed. The evidence seen indicates that assessments are taking place but this needs to be further developed to evidence that prospective service users are assessed prior to admission for the full assessment. The manager confirmed that other service users living at the home are made aware of forthcoming admissions for assessment. Six service users who completed surveys indicated that they were not asked if wanted to move into the home and were not given information. During discussion with three service users they advised that they had lived there for a long time and could not recall if they were asked if they wanted to move into the home or what information they were given. Service user plans seen included copies of the service user guide for their reference. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. Service users plans are in place, which indicates service users involvement in decision-making and ensures that service users needs are met in a safe and consistent way. Risk assessments must be further developed to further promote service users safety and well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four service users plans were viewed at this inspection. The service users plans have been developed as a person centred plan. The plans include a photograph of the individual and photographs and information of key people in their lives. It outlines a brief summary of the person and includes their past, interests and hobbies, their religion, their relationships with others, things they like to do, likes and dislikes, social life with a weekly outline of activities that the individual is involved in. It outlines communication needs, memory impairment, medical needs, general health needs, support with eating and Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 12 drinking, personal care needs, emotional needs, support required with domestic needs and participation in the community. These were generally found to be specific and informative. One service user plan seen did not specifically outline behaviours presented by this individual and did not indicate how staff support this individual with the behaviour which impacted on other service users. This should be addressed. The person centred plans made some reference to guidelines from other professionals but did not include all of the information included in the guidelines and these were filed in a different section of the plan. This should be addressed. The person centred plans showed evidence of them being discussed and agreed with service users and where this was not possible family members were involved in their development. The plans are reviewed monthly and some showed evidence of being updated following a review. However one of the plans viewed indicated deterioration in that individual’s health but the care plan was not updated to reflect this change to prevent further deterioration. A requirement was made at the previous inspection to ensure a service user plan is in place for all service users. This requirement has been complied with. The staff at the home have worked hard in developing person centred plans, which are working documents and aim to continue to develop those to include the above changes to benefit service users. Some service users plans viewed contained abbreviations with no explanations as to what those abbreviations meant. This practice should be stopped to ensure that care plans are clear and understood by all people involved in individuals care. Staff have attended report writing training to support them in their role of link/co link working. Service user plans make reference to individuals right and freedom of choice and outlines their right to choose or if support required in choosing clothes, meals, holidays, voting and going to church. Service users meetings are held and minutes seen indicate discussion on items to be purchased for the home, holidays and any issues which affect their well being at the home. One service user from the home is a representative on the residents committee, which is meeting that is held centrally with representatives from all of the homes on site. This forum also allows for service user issues from homes to be discussed and addressed. The home currently does not have any advocacy involvement but is aware how to access advocates if required and in the Annual Quality Assurance Assessment document, it indicates that they are going to actively seek an advocate to assist service users to run their own meetings. Feedback was received from ten service users. Five service users indicated that they make decisions about what they do each day. Five indicated that they do not make decisions about what they do each day. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 13 Feedback from one relative commented that areas of improvement is “for staff to have a greater knowledge of individuals likes and dislikes and maintaining person’s individuality rather than being seen as a group”. No further information was given to enable the manager to follow this up. The person centred plans included some generic risk assessments in relation to fire and living upstairs with some plans including risk assessments on bathing and epilepsy. Those were found to be reviewed annually. All of the plans included a moving and handling and waterlow assessment, some which were overdue for review. One of the care plans seen would indicate a change in the waterlow assessment for that individual but this was not reviewed and updated to indicate the change. The person centred plans included bathing and showering guidelines and risk assessment incorporated into one and this was not clear of the risks identified and how they should be managed. These should be kept separate. One plan included a risk assessment on falls but generally the care plans lacked individual and specific risk assessments and management plans. A requirement was made at the previous inspection to make proper provision for the health and welfare of service users and included a recommendation to introduce full risk assessments and management procedures as part of the service user plans. In the Annual Quality Assurance Assessment document and during discussion with the manager she acknowledges that what they could do better is to increase risk assessments for service users. A requirement will be made to address this. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. Opportunities for leisure activities are being developed with service users being supported with a lifestyle, which reflects their interests, provides them with nourishing meals and allows them to have contact with family, friends and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: None of the current service user group are involved in community work placements. Some service users access resources on site and service user plans outline a weekly programme of planned activities. Staff at the home confirm that they are attempting to access more community resources with evidence available of leisure activities and trips that have taken place and forthcoming trips that are planned. The staff have introduced in Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 15 house activities, which include games and music and are looking at ways of developing this. Service users are supported to make a choice of activity in one to one discussions with their key worker or as a group in service user meetings. Service user plans outlines service users’ interests and hobbies and staff are aware of this when planning an activity. Feedback from some service users, relatives and staff indicate that there is a need for more activities and outings. The manager is aware that, this an area that they need to develop and hope that this will be achieved when they have a full staff team. In the Annual Quality Assurance Assessment document it outlines that the home has increased activities and outings, but recognise that they still have a long way to go. One service user is supported by staff to go food shopping every other week. This service user indicated to the inspector that he would like to go food shopping weekly. Staff at the home are aware of this and plan to address it at his next review with a request for increased funding to allow for this. At the time of the inspection two service users were on holiday and other holidays are planned which includes a holiday to France and Spain. Service users spoken with confirmed how they were involved in choosing their holiday. The home uses Katalan which is a company that specialises in organising holidays for disabled people and provide an escort where required. Records of holidays that have taken place are maintained and records pertaining to forthcoming holidays were well maintained. Service users are supported to maintain family links and friendships and service user plans evidence this. Visitors are encouraged at the home and during the inspection a visitor confirmed this. She confirmed she is able to visit the home at any time, she is always made to feel welcome and kept informed of important issues relating to her relative. Staff also support individuals to visit their families if they want to and the family is in agreement for this to happen. Service user plans outline the support required with personal care needs. Feedback from service users confirm that staff are respectful towards them and promote their privacy and dignity. Service users confirmed that staff knock on their bedroom doors prior to entering and this was evident during the inspection. Individual signed consent forms are in place in relation to locking the front door at night, smoking and entering service users bedrooms at night for observational purposes. Staff were observed and heard interacting with service users in a respectful way and showed a good understanding of their individual communication needs. Service user plans outline use of communal space and whether any restrictions apply and why. Service users were observed to have access to all communal areas of the home. Service user plans outline support required with housekeeping tasks and the Annual Quality Assurance Assessment outlines Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 16 that an area for improvement is to develop service users social skills in the home and in the community. Feedback from professionals include “that more one to one funding was required”. “Could be better resourced for example transport in order to increase the level of choice offered”. “Need to actively engage service users in activities as a group or individually”. “Staff are very attentive to residents wishes and privacy. They have a gentle approach with residents, they offer flexible routines and they are very encouraging. However would like to see a few hours of dedicated occupational therapy each week so that residents have the opportunity to raise their skill level”. Some staff commented “they would like more opportunities for activities particularly at weekends”. Service users have access to three meals a day. Breakfast is usually a choice of cereals, toast and marmalade and fruit juices. The midday meal comes from the central kitchen and service users make their choice of this meal weekly in advance. The evening meal is at present being prepared at the home with service users having a choice of soup, baked potatoes with a choice of fillings, salad, sandwich or a hot snack. Hot and cold drinks and snacks are accessible and available throughout the day. The evening menu is developed in conjuction with the main meal menu and service users are assisted to make meal choices with the use of pictorial cards if requried. At present one staff member is responsible for the menu planning, preparing a shopping list and ensuring that the food shopping is done. Service users are being encouraged to become involved with the food shopping and this continues to be developed on with all staff taking an active role in meal planning and preparation. The AQAA indicates that the aim is to create a good menu that suits all and over time move towards being totally self-catering. Service user plans outline specific support required with meals and in particular swallowing guidelines. Staff were observed assisting individual service users with their meals in a discreet and sensitive way and the atmosphere at mealtimes was relaxed and calm. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. The health and personal care needs of people living at the home are well met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user plans outline the support required with personal care needs. This was specific and detailed as to how individuals like their personal care needs met. Service user plans included moving and handling risk assessments but as outlined under standard 9 these need to be kept updated and reviewed. Times for getting up and going to bed are flexible and this was evident during the inspection with some service users choosing to get to get up late. Service user plans outline how individuals make a choice on what to wear and service users sign a consent form to indicate whether they want male or female staff to support them with their personal care. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 18 Service users have technical aids and equipment provided as required and as assessed as being necessary. Service users have access to a wide range of professionals on site with evidence of involvement from Speech and Language therapist and Occupational Therapy. Staff at the home have 24 hour access to a first line nurse with all service users reviewed on a regular basis by the General Practitioner and Psychiatrist. Service users have a named key worker with less experienced staff taking on the role of co keyworker. Two of the three service users spoken to were aware who their keyworker was. Service user plans outline individuals’ likes and dislikes and their communication needs. Some families are actively involved in individuals care and advocates are accessed for individuals as required. All of the service users have access to a General Practitioner who holds a clinic on site and have regular input and review from the Psychiatrist. The home has separate medical records where the General Practitioner, Psychiatrist and other medical professionals record the outcome of review of individuals. Individuals have a clinical management plan, which is reviewed and updated annually. The person centred plans include a quick reference information sheet for hospital admissions and a separate record is maintained of hospital admissions. Some of the service users plans viewed outlined the level of support required by individuals in meeting their health care needs whilst others lacked this specific detail. This should be addressed. Service user plans included detailed descriptions of seizures with a record maintained of the frequency and type of seizures. Service users plans evidence that service users are weight regularly and changes in weight are monitored. Service user care plans indicate that service users have access to a wide range of professionals and that health issues are responded to in a timely fashion. As outlined in standard six one of the plans viewed indicated deterioration in that individual’s health but the care plan was not updated to reflect this change to prevent further deterioration. The home has a medication procedure in place, dated March 2005, which is permanently displayed on the front of the medication cupboard. Service users have two medication administration records, one which is for medication prescribed by the General Practitioner and one for medication prescribed by the Psychiatrist. The medication administration records are written by the manager and signed off by the Doctor. Some service users are on level 1 of self administration of their medication, which means they fill their dosette box and take their medication without prompts but under staff supervision. The service user plan outlines individuals’ daily medication and support required and includes a consent form for staff to administer medication. The medication administration records seen were in good order with no gaps in administration. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 19 Service user plans made reference to the protocols in place on the administration of as required medication including rectal Diazepam with detailed signed protocols included in medical notes and in the medication administration file to support this. As required rectal Diazepam is prescribed on the medication administration records but is stored by the first line nurse. The home does not use any homely medication and all medication administered is prescribed. The home has a system in place to record all medication received and disposed. The medication cupboard is well organised with external medication stored separately. The home has a list of staff who are assessed and deemed competent to administer medication. All staff must complete a medication management course prior to being involved in medication administration. They then undertake nine supervised medication rounds under the supervision of Registered Nurses from other homes and are then signed off to administer medication. All staff have a medication training update every two years and training records seen evidence this. Two staff at the home have being trained to administer rectal diazepam and after the formal training they are observed by the first line nurse to confirm their competency. They receive updates in this training annually. If none of the two named staff are on duty the staff at the home can access the first line nurse at any time to administer rectal Diazepam. Feedback from one professional made reference to staff working with a very complex care group. Sometimes individual situations could be handled better but no examples were given to feedback to the manager. It indicated that some low level personality clashes but residents’ welfare is the top priority. Feedback from relatives include comments that “ the home provide a good standard of care”. “Need to educate residents better regarding their appearance”. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Systems are in place to ensure service users views are listened to and acted on and to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Organisation has a complaints procedure in place, which was reviewed in May 2005 and is overdue for review. As part of the review the policy needs to be updated with the Commissions change of contact details. The home has a pictorial complaints procedure on the notice board, which has been updated with the Commissions contact details. The Annual Quality Assurance Assessment document outlines that the home has not received any complaints in the last twelve months. A log has been set up to record complaints and their outcomes. A requirement was made at the previous inspection to ensure a Complaints Procedure is made available to all service users and a record of complaints and their outcomes maintained. This has been complied with. Six out of ten service user surveys indicated that they did not know how to make a complaint but they knew who to speak to if they were unhappy. Service users spoken with during the inspection confirmed that they knew how to make a complaint. In the Annual Quality Assurance Assessment it outlines that plans for improvement are that staff want to assist service users to increase their knowledge on how to raise concerns and make complaints. The progress with this will be followed up at the next key inspection. No complaints have been made direct to the Commission in the last twelve months. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 21 The Organisation has a vulnerable adults and whistle blowing policy in place. The whistle blowing policy has recently being reviewed and updated. The home also has a flow chart on display in the office, which indicates steps to be taken in the event of a safe guarding incident and includes relevant contact details of key people. The manager was clear of the reporting procedure. All of the staff have up to date safeguarding of vulnerable adults training. Staff on duty confirmed that they are aware of what is considered a safe guarding incident and were aware of their responsibilities to report bad practice. The three service users spoken with were not aware if they were given any information about what you can do if you don’t feel safe. Two of the service users spoken with were aware who to talk to if they felt unsafe or frightened. The Annual Quality Assurance Assessment document indicates that there has been no safeguarding of vulnerable adults referrals in the past 12 months. Appropriate checks have been carried out on staff working with people using the service – see staffing section. Records are kept of incidents and accidents involving service users and staff. There is separate record to record specific accidents for example falls. Copies of all incidents, accidents and safeguarding of vulnerable adults referrals are sent to the Organisations Health and Safety department and the number of incidences are analysed centrally. This is reported back to the Health and Safety Committee and any necessary action agreed to prevent reoccurrence. Training records showed that all staff except one who is still on induction have attended courses on challenging behaviour. The manager has accessed a Professional to come and discuss particular issues, problems and challenging behaviours encountered by the team and explore ways of managing those problems. Service user plans made reference to support required with finances. Service users accounts are held centrally and there is a letter on file that confirms that they receive competitive rates of interest on their account. The manager confirmed that work has commenced in accessing community based bank accounts for individuals. Service users can withdraw up to £100 a day with the option to withdraw more when required. The home keeps a record of service users money in and out with receipts obtained for expenditure. Staff signs to confirm any transactions with service users having the option to sign or not. A note should be made on file to confirm that the service user choose not to sign, where this is the case. All balances are checked and signed off by seniors on a weekly basis and each completed financial record is signed off by the manager. The manager confirmed that a financial audit is carried out by external auditors on an annual basis. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. The home is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Morton house is a detached property situated in the centre of the site. Bedrooms are located on the ground and first floor with a small communal lounge with kitchenette on the first floor and a separate large sitting room, separate dining and a good sized kitchen on the ground floor. The home has one double bedroom which accomates a married couple and they have their own separate sitting/ kitchen area. There are two toilets and one bathroom on the first floor with three showers with toilets and a bathroom with a malibu bath on the ground floor. On the day of the inspection the home was found to be clean, bright ,airy, homely and welcoming. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 23 The Annual Quality Assurance document outlines a range of improvements to the environment and these were evident during the inspection. Morton house has had a complete face lift over the past twelve months. It has been decorated throughout in bright airy colours. The lighting has been improved in both the lounge and dining area, with a more domestic style lighting in place. Two shower rooms and one bathroom have been upgraded. Service users have been assisted to personalise their bedrooms. They have chosen new carpets and flooring and some have chosen new curtains and some new beds have been purchased. Six bedrooms were viewed during the inspection and found to be clean, personalised and comfortable. The home has an open garden to the front and a small grassed and patio area to the rear. The Annual Quality assurance document indicates that the home plan to improve the outside of Morton House and create a patio area which is more accessible and can be used by the service users if they wish. The home also intend to purchase some garden furniture and plants and would like to redecorate the outside of the house. Feedback received from a Professional states that they “Could make better use of upstairs living room. Staff could make it more appealing so downstairs do not get so crushed”. At the time of the inspection the manager confirmed that service users choose not to use this room but they were looking at ways of trying to promote it use. The home now have a full time domestic assistant and have created a parttime housekeepers post which they are in the process of trying to recruit to. Daily, weekly and monthly cleaning schedules are in place which were found to be completed by one staff member only. As a result there was gaps in the recording when this staff member was not on duty. The manager was aware that all staff are not taking an active role in taking responsibility for the cleaning and plan to address and reinforce this at one to one’s and the next staff meeting. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34,35,36.Quality in this outcome area is good. Staff are appropriately recruited, trained and supported to meet service users needs in a safe and consistent way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be accessible to, approachable by and comfortable with service users. The showed a good understanding of service users individual communication needs. The manager confirmed that staff are reliable and honest and the staff spoken with were found to be very motivated and committed to the development of the service to benefit service users. Some staff have training in learning disabilities, with one staff member recently attending training on swallowing and the manager plans for this to be made available to more staff. The majority of staff have training in epilepsy, challenging behaviours and equality and diversity. The staff at the home have established professional relationships with other Professionals. Feedback was received from 11 professionals and included comments such as “Staff friendly and responsive to requests and Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 25 recommendations. Staff able to think outside of the box”. Other comments included “excellent service”. The home has no staff under 18 and at the time of the inspection had only 6.6 of staff with a National Vocational Qualification. This is due to the high turnover of staff within the service in last 12 months. New staff have been recruited and they will be enrolled on the National Vocational Qualification training once they have completed their induction and probation. A recommendation was made at the previous inspection that the home increase the proportion of National Vocational qualified care staff to at least 50 . In the Annual Quality Assurance Assessment document it outlines that the aim is to increase the number of staff within the team with a National Vocational Qualification. It is hoped this will be achieved over the next year. The home has had a high turnover of staff in the last year with 11 staff having left employment. As a result the home has recruited a whole new care staff team and at the time of the inspection still had four full time care staff vacancies and one 25 hour domestic assistant vacancy. A third team leader and one full time care staff member had been appointed and start dates and induction was being planned for those individuals. The vacancies are being covered by regular bank staff and by permanent staff doing extra hours. Staff confirmed that there are generally six staff on the morning shift and five staff on the afternoon shift. There is always a deputy or senior on duty. There are two waking night staff with back up on call if required plus access to the first line nurse. The manager is not included on shift but covers shifts when required. The Annual Quality Assurance Assessment document outlines that the plan is to recruit an Administration Assistant to undertake some of the administration work within the home and ease the pressure on the care team to allow them to increase service users community focus prgramme and maintain records. Staff meetings take place with staff encouraged to contribute to the agenda. Team meeting minutes were seen which indicate that a meeting took place in February and a further meeting has taken place since then but the minutes were not yet available. Senior staff meetings have just commenced with the aim to develop on these. The home has a high number of staff where English is not their first language and those individuals are expected by the Organisation to attend English classes. Staff on duty during the inspection were observed to be able to communicate effectively with service users and peers. New staff confirmed that they had to have a Criminal Records Bureau check and two references prior to commencing work at the home. The manager has a recruitment checklist for all staff which is ticked and signed off to confirm that the required pre employment checks have taken place and have been seen by her. The recruitment documentation pertaining to individuals is kept at the Human Resources dept on site. Five staff files were viewed in the Human Resources department, which included two files for bank staff used at the home. The files were found to be Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 26 organised and contained an application form, copies of birth certificates, passports, visas and work permits where required, a recent photograph, two references and confirmation of a POVA first and Criminal Records Bureau check. The home has a training matrix on the wall in the staff office. This matrix was up to date and indicated that staff have the required mandatory training with updates already booked where this was required. Staff have their own individual training folder and one folder viewed confirmed the training that has taken place as outlined in the training matrix. All new staff receive mandatory training during their two week induction period and all new staff are expected to complete the induction standards module. All new staff have a further two weeks induction where they work alongside experienced staff and complete an in house induction. Specialist training is accessed as required and as made available. Staff on duty confirmed that they feel supported in their roles and that they receive regular formal supervision. There is a list of supervisor/ supervisee on the notice board in the office and a record on when supervision took place. This indicated some gaps in the supervision of the team leaders and this should be addressed to ensure that team leaders are being supported in their roles. The manager was aware of those gaps and in the Annual Quality Assurance Assessment document it outlines that the plan is to improve the support to and supervision of all staff. Six staff surveys were received and they confirmed that staff feel they are adequately trained, supported and supervised. Some comments include that “Sometimes the home is short staff and staff are stretched in the tasks they are asked to do”. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39,41.42 Quality in this outcome area is good. The home is effectively managed with monitoring systems and the required records in place to promote service users health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post since January 2007, initially in an acting role. She has recently applied for registration with the Commission and this process is currently underway. The manager has obtained the Registered Managers National Vocational Qualifaction level 4 award. She has worked in the nursing and care field for forty one years and has demonstrated excellent management skills in the management of this service since being in post. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 28 She has addressed issues of poor practice and have brought the home up to a good standard to benefit service users. She is supported in her role by an experienced deputy manager and two team leaders. Requirments made at the previous inspection have been complied with and this inspection has resulted in one requirment. Staff confirmed that they feel the home is well run and that the manager and senior staff team are approachable.The manager and senior staff team are developing a chohesive staff team who appear to work well together to benefit service users and to maintain a high standard of care. A completed Annual Quality Assurance Assessment document was completed by the manager prior to the inspection. All of the staff team were given the opportunity to read the completed document prior to it being sent to the Commission and to contribute to it. The completed Annual Quality Assurance Assessment document was found to be detailed with information supported by evidence and showed an accurate reflection of the progress made with a good insight into the areas that still need to improve. At this time no formal annual quality assurance audit tool is in use by the Organisation.However there is a system in place to audit aspects of care including accidents, incidents, seizures, safe guarding referrals, and complaints for the whole organsiation. The home carry out a quality audit of care plans with weekly financial checks of service users money and medication stocks. Alongside this the pharmacy do an annual medication audit and external auditors audit the finances for the whole service. At the time of the inspection the home was in the process of sending out surveys to service users, families and other stakeholders but it was not clear how the feedback would be collated. The Annual Quality assurance document indicates that the results will be published. The progress with this will be established at the next inspection. A requirement was made at the last inspection to devise a procedure to ensure that the quality of service provided is reviewed and improved as necessary. Some progress has been made in this with further improvements necessary. The home has monthly Regulation 26 visits and records seen evidence this. The records required by regulation were found to be organised, well maintained and accessible. Service users have access to their service user plans and are encouraged to be involved in their development and review. Confidential information pertaining to service users and staff was kept secure. Staff have up to date mandatory training with updates and refreshers booked where required. All staff have not got food hygiene training but are not involved in food preparation until this training has been completed. A sample of health and safety records were viewed. One of the team leaders is responsible for health and safety and the records pertaining to this were accessible and in good order. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 29 Staff at the home carry out daily and weekly fire checks with records maintained to evidence this. Records indicate that the fire equipment is serviced. The home carry out fire drills with the last one taking place in March 2008. Fire drills were recorded with the fire point checks and it was advised for those to be recorded separately and to outline the date, time, staff on duty, service users in the home and how long it took to evacuate. This would enable staff at the home to vary the times of fire drills and ensure that all staff get the opportunity to be involved in a fire drill. The team leader had devised a suitable form to record this information on by the end of the inspection. The home has a fire risk assessment which is due for review on the 30/05/08 but the manager was aware of this and had planned to get it done by the review date. Staff at the home carry out visual checks of electrical equipment and faulty items are removed until repaired. The home had an up to date fixed lighting certificate and stickers on electrical equipment to confirm that portable appliances had been checked. The home had confirmation of up to date servicing of gas appliances, hoists and legionnaires check. Staff at the home carry out weekly water temperature checks. There was some gaps in recording where the team leader was not on duty. The manager was aware of this and will address with staff to ensure all staff take responsibility for carrying out the required health and safety checks on each shift. As outlined under standard 9 service users risk assessment and management of risks must be improved and developed to further promote service user health and safety. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 1 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x 3 3 x Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement Service user risk assessments must be put in place, which outlines all known risks and management of those risks. All risk assessments including moving and handling and waterlow risk assessment must be kept up to date and reviewed. Timescale for action 31/07/08 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. 3. 4 Refer to Standard YA1 YA2 YA2 YA6 Good Practice Recommendations The Statement of Purpose should be further developed to include a clear outline of the assessment process. The assessment document should be developed in a simple format taking into account all of the areas to be assessed as outlined under standard 2.3. The manager should ensure that all prospective service users are assessed prior to admission for the full assessment. The practice of using abbreviations in care plans should be discontinued and discouraged. DS0000023000.V363708.R01.S.doc Version 5.2 Page 32 Morton House 5 YA23 A note should be made on individuals financial records to confirm that the service user choose not to sign for their money in or out, where this is the case. Morton House DS0000023000.V363708.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 House DS0000023000.V363708.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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