Inspection on 01/09/10 for Mill House

This is the latest available inspection report for this service, carried out on 1st September 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mill House 11/08/08

Mill House 13/08/07

Mill House 31/08/06

Mill House 29/11/05

Mill House 21/04/05

Mill House 26/11/04

Mill House 07/07/04

Mill House 29/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Random inspection report Care homes for older people Name: Address: Mill House 51 Mount Pleasant Bilston Wolverhampton West Midlands WV14 7LS one star adequate service 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: Morag Ross Date: 0 1 0 9 2 0 1 0 Information about the care home Name of care home: Address: Mill House 51 Mount Pleasant Bilston Wolverhampton West Midlands WV14 7LS 01902493436 01902493436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ragavendrawo Ramdoo,Mrs Bernadette Ameranmerion Ramdoo Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 24 24 The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 24 Dementia ( DE) 24 Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home Mill House care home is providing personal care and accommodation for 24 older people who have some form of mental illness, but who are not in need of nursing care. The home is located on a main road with ease of access to the Bilston high street and all of its amenities.The home is a large detached two-storey building that was adapted as a residential care home in 2002. The accommodation consists of 24 single occupancy rooms with en suite and shower facilities with the exception of one bedroom without a shower facility. Communal facilities of sitting and dining areas are located on each floor. There is a quiet room for people who use the service and a meeting room for visitors on the first floor. There are adequate communal toilets and assisted bathrooms facilities on each floor. There are gardens and a patio area at the rear of the building. There is ample car parking space at the rear of the building. The Registered Providers Mr Ragavendrawo Ramdoo and Mrs Bernadette Ramdoo have been operating this service since March 2002. They make the services of Mill House known to people thinking about living at the home in The Statement of Purpose and Service Users Guide. The Inspection Report is mentioned in the Statement of Purpose and how a copy can be obtained. The care home rates are reviewed annually and service users are notified one month in advance. The only additional charges to service users are for hairdressing and chiropody. The reader is advised to contact the service to clarify their current rates. Care Homes for Older People Page 3 of 13 What we found: The pharmacist inspector visited the home on 1st September 2010 to check the management and control of medicines within the service. The purpose of this inspection was to check compliance with requirements relating to medicines. We looked at medication storage and medication administration record (MAR) charts. We spoke with the Acting Manager who had been in post for three weeks. We were told by the Acting Manager that in the three weeks since arriving, medicine arrangements had changed in order to improve and also to meet the requirements. We were told that there were weekly audits and checks made on medicines. We were shown the last audit dated 27/8/10, which recorded that there were no problems and all the checks were correct.The delivery of medicines had changed from every week to once every month. We were informed that staff were trained in the safe handling of medicines. Three senior staff had recently undertaken an update in medicines management. The Acting Manager was booked on a training course to obtain a certificate to teach medication training. A medicine policy was available which had been reviewed in March 2010. The Acting Manager was in the process of ensuring that all trained staff signed to say they had read and understood the policy. All stored medicines were locked away and the key held by the person in charge. We looked at the storage of medicines, which was neat and tidy. The medicine trolley stored all medicines, however we saw that external preparations such as creams and ointments were also stored next to peoples medicines for internal use such as tablets or liquids. The Acting Manager agreed that this was not correct and had already informed staff of correct storage arrangements. Medicines that required special storage arrangements were stored correctly and safely. For example, medicines that required refrigeration were stored in a locked refrigerator with daily temperature checks recorded. Any medicines that required special locked storage also met the Misuse of Drugs (Safe Custody) legal requirements. We found that there was overall good documentation and recording of medicine records. We looked at three MAR charts and found that they were documented with a signature for administration or a reason was recorded if medication was not given. For example, one person was prescribed seven different medicines. Six of the checks made were correct, which showed that they had been given six of their seven medicines as prescribed. We found that one of the prescribed creams had not been recorded accurately. The cream had recently been started and had been hand written onto the MAR chart. There was no signature or double check signature recorded. The directions did not state where the cream was to be applied. There was no signature on the MAR chart for the previous evening or for the morning of the inspection to show if the cream had been applied. We located two tubes in the medicine trolley labelled for the person and both tubes had been dated when opened with the same date as 1/9/10. The Acting Manager agreed that this was not satisfactory and would deal with it straight away to ensure the directions were clear and that only one tube should be opened and used at a time. Care Homes for Older People Page 4 of 13 Overall, we found that there had been improvements in the management of medicines to ensure that medicines are given to people safely and as prescribed. What the care home does well: What they could do better: 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 5 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14 When anyone thinking of moving into Mill House is being considered, a full physical and psychological assessment of needs must be carried out as part of the preadmission process, involving all significant parties and representatives of the individual to ensure the best interests of the person are fully accounted for. These actions will demonstrate the home will make sure they only admit people once all parties involved are satisfied the home can meet the mental health needs and physical needs of the person concerned. 11/08/2010 2 7 15 Measures must be taken to ensure care plans provide sufficient information. This should ensure staff know who to meet peoples needs properly. 22/03/2010 3 8 12 Action must be taken to ensure risk assessments provide sufficient information. 22/03/2010 Care Homes for Older People Page 6 of 13 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 This should ensure all staff know how to assist people safely. 4 8 12 Appropriate action must be 01/03/2010 taken to address peoples dietary needs, where records show they are underweight or have special nutritional needs to keep them healthy and well. This should promote peoples health. 5 10 12 Mill House management 11/08/2010 must review care practices of individuals to make sure they address their needs which maximises the unique individuality of people to ensure their needs and preferences are not challenged by compromises to their dignity privacy and wellbeing This will offer assurance to people that live at Mill House that they are supported to meet their needs in a way that promotes their esteem pride and self respect. 6 15 12 Action must be taken to ensure people are provided with the relevant support to eat and drink. This should promote their health. 7 18 12 The needs assessment 24/09/2010 Page 7 of 13 01/03/2010 Care Homes for Older People 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 process for people living at Mill House who have mental health challenges must be developed to account for peoples decision making abilities to ensure there is confirmation of their capacity to be involved in options about their daily lifestyle and well-being. This will confirm the service have taken the decision making needs of people into account in lines with Mental Capacity Act legislation as part of the service effort to promote the safety and wellbeing of individuals living in the home. 8 19 23 Fire safety arrangements at Mill House must make sure all fire exit routes and surrounding areas are kept clear of obstruction at all times. The home must raise staff awareness of this matter to ensure fire safety routes and exit areas are sterile of obstruction. This will offer assurance to people living visiting and working at the home that the management are promoting the safety of individuals at all times in order to deal with any emergency evacuation situation. 9 19 16 The home must devise an auditing and monitoring system to ensure the 16/09/2010 04/06/2010 Care Homes for Older People Page 8 of 13 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 environment is maintained to a satisfactory standard. This will offer assurance that the management systems make sure people have a safe place to live with all equipment necessary to promote their well being in good working order. 10 19 23 Within 5 days remedial 11/06/2010 action must be taken to confirm all hot water supplied to areas where people use the service is safe and maintained around 43 Degrees Centigrade. This action will ensure people using the service have access to a safe hot water supply. 11 19 23 Storage areas for fire 04/06/2010 extinguishers must be unlocked with appropriate signage to inform people not to lock them again. This will ensure people have access to emergency fire fighting equipment in the event of an emergency and promote the well being of individuals at Mill House. 12 26 16 Action must be taken to 01/03/2010 review the cleaning regime in the home. This should promote peoples health and comfort. Care Homes for Older People Page 9 of 13 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 13 26 13 The home must develop and 17/09/2010 put in place effective infection prevention and control processes based on evidence based research and relevant guidance. This is to ensure people are provided with an environment and equipment which is clean and free from odour. 14 29 19 Staff recruited by the home 27/08/2010 must have all required pre employment checks undertaken including appropriate reference clearance and authentication of documents used as proof of identity before they commence employment. This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 15 30 18 Management systems must 27/08/2010 be developed to ensure staff apply their learning outcomes from recent training into their day-to-day practice of working at Mill House to improve standards of care and support. This will offer assurance to the people that they are being cared and supported by people who are competent in their roles in line with up to date practice. Care Homes for Older People Page 10 of 13 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 16 38 13 Action must be taken to 01/03/2010 ensure all Control of Substance Hazardous to Health (COSHH) are securely stored. This should ensure people are not placed at risk of harm. 17 38 13 The service must provide 27/08/2010 evidence that a full up to date Legionella risk assessment has been carried out, and any remedial actions have been carried out promptly to resolve any issues identified. This will offer assurance to people living visiting and working at the home that the management team is taking all necessary precautions to provide safe premises. Care Homes for Older People Page 11 of 13 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 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 9 External preparations, such as creams and ointments, should be stored separately from medicines to be given by mouth. This is in order to prevent contamination and therefore reduce the potential for harm to people. Hand written instructions on the MAR charts should be checked and signed by two trained staff to ensure the accuracy of the information. This is to ensure that people are given the correct medicine at the correct time and correct dose as prescribed. 2 9 Care Homes for Older People Page 12 of 13 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. 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