Care Home: Morton House Nursing & Rest Home

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What the care home does well The focus of the inspection was to investigate the complaints that had been shared with us. Therefore, we did not look at many aspects of the service and may not, therefore, have identified some positive things about the home. The next key inspection will provide us with the chance to look at the broader picture of the service at the home and what it is like for the people who live there. However, we did note the following:Staff who we spoke with appear to be dedicated and committed, who want to provide good care to people living at the home. We were told that the use of agency staff to cover shifts as decreased since we last visited the home. This means that people are being assisted by staff who know them. Each person living in the home now has a named member of staff. This way of working enables staff to form close relationships with individuals so that people who live at Morton House are able to feel comfortable in disclosing any concerns and or issues. Staff supervision is now taking place and appraisals are being completed so that staff are supported to increase their skills and knowledge to enable all staff to perform their roles and responsibilities appropriately. What the care home could do better: Each persons personal, physical, nutritional, emotional, psychological and health needs must be drawn up into care plans and risk assessments as appropriate. This will make sure that all staff are provided with care plans that are designed to instruct them in meeting each persons specific needs in a consistent and safe manner. These care plans and risk assessments should also be used as monitoring and reviewing tools. All care plans should be drawn up with the person, their relative and or representative so that individuals are able to say how they are assisted with their care, at times to suit them best and by whom. All moving and handling care plans and risk assessments must be drawn up in a timely manner to include the size of the hoist and sling so that staff are able to support people in a safe way. When staff are assisting people with their personal care tasks they must remember to record these so that we can be confident that people are receiving the support and assistance required to maintain their personal hygiene needs in the way they prefer. This should include assisted strip washes and or showers. The administration of medication in the morning must be reviewed as people should not be woken early for specifically receiving their medications unless this practice has been directed by their clinical physician. This will make certain that any staff practices are based upon the needs of the person and not the service. The planning and variety of activities and social stimulation must improve to meet each persons needs in these important areas of their lives. This should include displayingactivity planners and discussing activities at resident and relatives meetings. This will ensure that people are supported to lead lives that are purposeful and meaningful. The planning of meals should be done with people who live in the home, their relatives and or representatives so that meals offered meet the needs of people who live in the home. Menus should be displayed so that people are reminded of the choices of meals on any given day. All linen and towels must not be stored within communal bathroom areas as this does not protect people from risk of infections. All designated fire doors must not be wedged open as this does not protect people if a fire should start. Random inspection report Care homes for older people Name: Address: Morton House Nursing & Rest Home Grange Lane Fernhill Heath Worcestershire WR3 7UR two star good service 04/02/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 0 5 0 3 2 0 1 0 Information about the care home Name of care home: Address: Morton House Nursing & Rest Home Grange Lane Fernhill Heath Worcestershire WR3 7UR O1905754489 01905754489 asanghera@mortonhouseproperties.co.uk None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Narinder Sanghera Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 0 32 0 dementia old age, not falling within any other category physical disability Conditions of registration: 17 0 32 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 32 Dementia (DE) 17 Physical disability (PD) 32 Date of last inspection 0 2 1 1 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home Morton house is a Georgian property that has been converted for use as a nursing and residential care home. There are 23 single bedrooms of which 3 have ensuite facilities and 4 double rooms none of which have ensuite facilities. In addition there are 2 communal bathrooms, 1 shower room and toilets, which are fitted with special aids to assist the less mobile, two lounges and a conservatory and two dinning rooms. There is a shaft lift between floors and handrails are fitted to assist the residents. The detached property is surrounded by 2.5 acres of well-stocked mature level gardens, and is located on the main A38 between Droitwich and Worcester. It is close to open countryside and yet convenient to the M5 via Worcestershires Northern Link Road, making travel from the Midlands and surrounding areas easy. The manager is Mrs. Roberta Quarterman. Mrs Narinder Sanghera is the registered provider. The home is registered to provide care for a maximum of thirty-two older people of either sex who have personal and health care needs. A maximum of seventeen people may have needs relating to a dementia illness and a maximum of twenty-four people may have nursing needs. For details about the range of fees charged along with what is, and what is not included within the fee, please contact the home. Care Homes for Older People Page 3 of 14 What we found: The manager was away from work on the day we visited the home but we were assisted by the admin manager and other members of staff. We were told that there were currently twenty-nine people living in the home on the day we visited. The reason for this inspection was to investigate some complaints that had been shared with the Commission and the outcome is as follows: Health and Personal Care. We looked in-depth at the care records for two people who live at the home and partially looked at third persons. We saw that the manager assesses peoples care and health needs before they come to live at the home. This should ensure that staff are able to meet these needs. One area that should be reviewed is the completion of Physical and Social Assessments as we found that these are not being fully completed. These assessments provide information about meeting peoples needs in relation to eating and drinking, continence, personal care and mobility when they initially come to live at the home. If they are not to be used then consideration should be given to removing this paperwork to avoid any confusion arising. The care plans that we looked at lacked a person centred approach to meeting peoples individual needs. For example, choices around peoples times of rising and going to bed were not always documented together with individual preferences in relation to a female and or male member of staff to assist individuals. This means that we cannot be confident that peoples needs are always being met in the way that best suits them. It was positive to see some care plans had been completed in relation to a persons anxiety, where a person had a fall and staff were to encourage this person to walk with their frame, diabetes, personal care and for a urinary tract infection. However, overall we saw that there was a lack of care plans in the records we looked at. Therefore we cannot be confident that all of the needs people have are fully documented into appropriate care plans and risk assessments for staff to follow. This was shared with the admin manager at the time of our visit and after our visit with the manager. In one care record we saw that the person required full assistance of staff to complete their personal care tasks and to safely move from bed to chair. However, we could not find any care plans to cover this persons needs and or risk assessments. This means that staff have no manual handling instructions to follow in relation to safely moving the person, such as, size of hoist and slings which could potentially place people at risk. Also staff have no guidance in meeting this persons washing and dressing regime to ensure all of their preferences are met by staff who have the knowledge of the persons specific needs. In another persons care records we could not find a care plan in relation to this persons Care Homes for Older People Page 4 of 14 mental health needs. This is concerning as this person has recently come to live at the home and their care records told us that their recent hospital admission had been due to their mental health. Therefore staff have no care plan to follow with strategies in place to meet this persons mental health needs at any given time, such as, identifying likely triggers to the type of behaviour and or emotions people may potentially display. Also what staff should do to diffuse situations in relation to diversion activities. Care plans assist with monitoring and reviewing peoples specific areas of needs. We saw that a person was experiencing some weight loss and we would have expected a care plan to meet the persons dietary needs but we could not find one. However, we did see that this person was being weighed regularly but the recording on the 23.02.2010 was left blank. We acknowledge that some people are coming to live at the home on an urgent basis but significant care plans and risk assessments must be in place for staff to follow. This practice will ensure that all peoples needs are being met consistently in a safe manner. We shall be continuing to monitor peoples risk assessments and the review of care plans as part of our regulatory activity. We became aware that nurse who cover the night shifts had just started to administer some peoples medications to them early in the morning. We were told that some people have been woken up to have their medications. We discussed this with the admin manager and after the inspection with the manager. We were told this practice had only just begun and would be monitored but we were assured that people will not be woken up early to have their medications. We shall be continuing to monitor the administration of medications and review this practice as part of our regulatory activity. A complaint that had been shared with us was in relation to the bathroom on the first floor being changed into a bedroom as it was thought that there would not be sufficient capacity for all people who live in the home. The Care Quality Commission (CQC) have not received a variation notification to inform us that this alteration was being planned. We discussed this issue with the admin manager who said that they did contact the general number for CQC and there were no issues with changing the use of a bathroom into a bedroom at the time. We looked at the assisted bathroom on the ground floor and the shower room on the first floor. We were told that staff hardly ever used the bathroom on the first floor. We looked at the separate bathing records that are completed when people are assisted to take a bath. We saw that staff are noting when people have baths. One area that should be considered for improvement is to make sure all staff are recording in peoples daily records when a person is assisted with their personal care tasks, such as, strip washing or showering. We spoke with a member of staff and the admin manager about the importance of staff recording in this area and it was recognised that some staff are not always recording when people are being assisted with strip washes and or showers. From our observations no people living in the home looked unkempt and or unclean so could not clearly state there are poor outcomes in this area for people. We were shown the improvement plan by the admin manager and it was noted on there to continue to audit the care plans and to continue to carry out further development of Care Homes for Older People Page 5 of 14 the care plan system. We shall continue to monitor staff recordings and observations of how people are supported and assisted with their personal care tasks as part of our regulatory activity. Daily Life We were told that the home employs an activity co-ordinator who works on a part time basis from Monday to Wednesday, 10:30 until 16:30. We were shown activity files where each person has their own recordings of what activities they have participated in and enjoyed. It is also recorded where a person has declined to participate in any activities on offer. Activities noted were, bingo, nails painted, read newspapers, made fat balls for the birds, Holy Communion and exercise class. We were told that there are no activity planners for the week ahead so that people could choose how to spend their time and or meetings which would assist people who live in the home to have their say about activities that could be planned. Also the activity recordings showed us that activities and social interaction was not being planned on a daily basis and could be improved in relation to the variety of activities offered to people. We could not find any care plans and or in-depth life histories in the records we looked at which would support people with activity choices and or social stimulation both inside the home and in the community. Potentially this would result in staff having very little knowledge of individuals interests so that people could be supported to achieve their goals in relation to social activities and stimulation. The admin manager is aware of our findings. On the day we visited we did not observe any specific activities happening in the home apart from televisions being on. All staff interactions were around tasks that were being completed. On a notice board by the front door it stated exercise classes, Mondays, Wednesdays and Fridays. Also March, April and May 2010 was displayed in relation to the summer fete. The ground floor main lounge area had a variety of seating which could be enhanced by arranging some of the seats into small groupings to facilitate social interaction. There were two televisions which could cause some confusion to people living in the home if they were both on at the same time. One of the televisions is particularly old and we were told by the admin manager that this is rented and it was proving to be difficult to end the rental agreement. The manager and the admin manager are well aware of our findings in relation to the lack of activities which had already been identified on the improvement plan that we were shown. However, action must now take place in a timely manner so that people are able to choose and take part in a variety of activities that hold meaning to them which will enhance their quality of life. We shall continue to monitor how people are supported and assisted with their choices of activities as part of our regulatory activity. We could not find any menus on display in the home and we were told that there were none for people to look at as they choose or as a reminder. Care Homes for Older People Page 6 of 14 We spoke with one of the cooks who works four days per week and saw copies of the four weekly menus. It became unclear to us how menus were planned and how people living in the home, their relatives and or representatives were involved in this process. The cook told us that they have a note of peoples dietary requirements and was able to confirm their knowledge in relation to meals for people with diabetes and a person who needs gluten free meals. The cook told us that people are asked daily about their meal choices and if people do not want any of the meals of any given day there are always other options for people to choose. The cook also said that if people do not eat their meal they do investigate the reasons why. The admin manager told us that they are working with the cook to improve meals. Improvement plan tells us, to continue to provide high quality and choices of meals at Morton House. We shall continue to monitor how people are supported and assisted with their choices of meals as part of our regulatory activity. Environment As stated previously we were partially shown around the home. We observed that towels and some linen was being stored in the ground floor bathroom on an open shelving unit. This does not promote good infection control practices and this was confirmed with the nurse and admin manager at the time of our visit. The manager was also informed after out visit and we have been informed that this has been removed. On the first floor of the home we saw that a fire door had been wedged open with a container and this practice must stop so that people are fully protected by all staff practices. The admin manager was made aware of this at the time of our visit. We shall continue to monitor the homes infection control, and fire procedures including practices within the home as part of our regulatory activity. Management and Administration. From our findings we note that action has been taken in some areas since our last key inspection which shows that the manager and admin manager want to work with us in striving to make improvements. We were shown records that reflected that the admin manager has been completing Regulation 26 visits which highlight the improvements that have been made, what is planned and how people feel about services that are offered at the home. This should assist the manager in ensuring that the home is being run in the best interests of people living there. We were told that there are now two trained nurses completing morning shifts at weekends with care assistants. This is currently being done on a trial basis and will be reviewed. However, it is positive that the manager has taken this forward as we were concerned at the time of our last visit to the home that if there was a medical emergency the nurse would have to leave the administration of medications to attend to this. Care Homes for Older People Page 7 of 14 What the care home does well: What they could do better: Each persons personal, physical, nutritional, emotional, psychological and health needs must be drawn up into care plans and risk assessments as appropriate. This will make sure that all staff are provided with care plans that are designed to instruct them in meeting each persons specific needs in a consistent and safe manner. These care plans and risk assessments should also be used as monitoring and reviewing tools. All care plans should be drawn up with the person, their relative and or representative so that individuals are able to say how they are assisted with their care, at times to suit them best and by whom. All moving and handling care plans and risk assessments must be drawn up in a timely manner to include the size of the hoist and sling so that staff are able to support people in a safe way. When staff are assisting people with their personal care tasks they must remember to record these so that we can be confident that people are receiving the support and assistance required to maintain their personal hygiene needs in the way they prefer. This should include assisted strip washes and or showers. The administration of medication in the morning must be reviewed as people should not be woken early for specifically receiving their medications unless this practice has been directed by their clinical physician. This will make certain that any staff practices are based upon the needs of the person and not the service. The planning and variety of activities and social stimulation must improve to meet each persons needs in these important areas of their lives. This should include displaying Care Homes for Older People Page 8 of 14 activity planners and discussing activities at resident and relatives meetings. This will ensure that people are supported to lead lives that are purposeful and meaningful. The planning of meals should be done with people who live in the home, their relatives and or representatives so that meals offered meet the needs of people who live in the home. Menus should be displayed so that people are reminded of the choices of meals on any given day. All linen and towels must not be stored within communal bathroom areas as this does not protect people from risk of infections. All designated fire doors must not be wedged open as this does not protect people if a fire should start. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be in 26/03/2010 place for all identified areas of risks to a persons health and wellbeing which must inform staff practices. This will help to maintain peoples safety at all times. 2 7 12 Care plans must be in sufficient detail so that staff have the instructions and guidance to meet each persons needs. This will ensure to ensure risks to individuals health and wellbeing is minimised. 26/03/2010 3 8 12 The registered person must 26/03/2010 ensure that the moving and handling assessments and a falls assessments include how the residents mobility is supported including resources, manoeuvres and staffing. This will make certain all practices are in place to Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action prvide the right care that ensures the safety of each person. 4 12 16 The registered person must ensure that all residents have their daily life and social activity abilities and needs assessed and that either a care plan or programme of activity are individually implemented that are clear, concise and informative for staff. This wil make certain that people are being supported to lead purposesful and meaningful lives. 5 26 13 The registered person must 26/03/2010 ensure that the infection control issues identified in the main body of the report are completed and undertake its own regular audit of infection control practices and if needed make necessary improvement. This will ensure that people are fully protected by staff practices iin the area of promoting good infection control. 6 38 13 The registered person must 26/03/2010 ensure that all fire doors are not wedged open. This will make certain people are protected by practices in fire safety. 26/03/2010 Care Homes for Older People Page 12 of 14 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should provide details about personal preferences so that people receive care in a way that they prefer and that care plans are drawn up with the involvement of residents or where needed their representatives People should have opportunities to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. The registered person must ensure that food menus are always available to keep residents informed of what is available and which will help them to make a choice. People should be offered a choice of meals daily so that their personal and dietary preferences are met and this is done in a manner that individuals understand to enable full participation. 2 13 3 15 4 15 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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