Inspection on 08/09/09 for Millfield House Care Home

This is the latest available inspection report for this service, carried out on 8th September 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Millfield House Care Home Millfield House Care Home 8 Millfield Road Whickham Newcastle Tyne and Wear NE16 4QA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne McKean     Date: 1 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Millfield House Care Home Millfield House Care Home 8 Millfield Road Whickham Newcastle Tyne and Wear NE16 4QA 01914887351 01914887351 info@whickhamvilla.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Whickham Villa LLP Name of registered manager (if applicable) Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 39 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 category(ies): Old age, not falling within any other category - Code OP, maximum number of places: 39 Date of last inspection Brief description of the care home 0 Over 65 39 Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Before the visit, we looked at, information we have received since the last key inspection visit on 13 October 2008, and random inspection visit on 29th January 2009. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other Care Homes for Older People Page 5 of 30 professionals. The Visit, an unannounced visit was made on 8th September 2009 and a second, arranged visit was made on 18th September 2009. The total time taken in both visits was eleven hours. During the visit we, talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at other records, which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager, and the senior managers, what we found. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? This is the first inspection since the home has been registered as a new service. The home has been previously registered as one service with the home on the same site, which provides care for younger adults. As a result any requirements or recommendations made prior to the change are not formally reviewed as part of this inspection. However the management and owners have worked hard to make sure that the service has continued to improve. This includes looking at previous requirements as part of its quality assurance strategy. Improvements include, improving soft and pureed diets making them more appealing, providing more hot and cold drinks and snacks through the day and better records kept of this. There are now better arrangements individual special diet plans and improvements are being made to further improve the menus by developing set fortified and soft menus. Agency staff now have a detailed induction to the home and are given clear information about peoples health care needs with records kept. And improvements have been Care Homes for Older People Page 7 of 30 made to the administration of medicines procedures to make sure that the residents receive their medicines safely in line with good practice guidelines. Care plans have been improved to make sure that they are detailed, person centered and reflect up to date practice. They are also now reviewed at least monthly and show any changes in the residents care needs. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given detailed information about the service and receive full and comprehensive assessments of need to help them and the service make the right decision about the placement. Evidence: The home sets out the aims and objectives of the service in a Statement of Purpose, which is readily available. There is also a Service Users Guide that sets out the values of the home. There are plans to improve this further and make it available in different formats, for example large print and in audio form. This will make it more accessible. Before anyone is admitted, there is a process to make sure that a full needs assessment is carried out by a Care Manager, Home Manager and where necessary the nurse assessor. There is good information in the preadmission information that relatives have helped Care Homes for Older People Page 10 of 30 Evidence: to produce an initial care plan based their knowledge of the person. Examples of this are how someones nutritional needs must be met and how staff must make sure that everything is explained before anything happens. The assessments are very detailed and encourage staff to explore issues relating to equality and diversity as it refers to gender, ethnic origin, religion, social history and preferred likes and dislikes. The home continues to use assessment tool in line with good practice guidance. Before coming to live at Millfield House people can come and visit and spend some time getting to know the home. The home confirms in writing to each individual that they can meet their needs and everyone has a contract that sets out the terms and conditions while living in the home. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good care planning and reviews processes make sure that staff are clear how to care for residents and the people living in the home can be confident about the way they are looked after. Evidence: All people living in the home have an individual care plan that is started with the preadmission assessments and are developed through out the residents stay. The care plans are kept in the residents own bedroom and all of those spoken to were aware of the content of their care plan. The assessments are detailed and encourage staff to explore issues relating to equality and diversity as they refer to gender, ethnic origin, religion, social history and preferred likes and dislikes. Risk assessments include continence, skin condition, moving and handling, fall risk and nutritional risks. They also contain up to date contact with specialists including speech and language therapists, tissue viability (for pressure ulcers and wounds) Care Homes for Older People Page 12 of 30 Evidence: specialists, falls specialist, dietitians, occupational and physiotherapists. Information is available to make sure all staff follow the requirements from the Speech and Language Therapists regarding enteral nutrition (PEG). This means that nourishment is monitored, weights remain stable and there is no risk of aspiration. Care plans are available for medication, pain relief and side effects of medication such as Warfarin. Details of ongoing assessment of the condition of wounds are good and the use of wound mapping and photographs are used as evidence of whether they are improving or otherwise. There is clear evidence that the tissue viability nurse is contacted should staff have any concerns and her recommendations are then followed. The care plans also record the type of air mattress and chair cushion used the reason for any changes. Reviews are completed and a monthly analysis completed. Should there be any deterioration the staff contact the GP, tissue viability nurse or the staff at the leg ulcer clinic and their recommendations are followed. The home has bought different types of pressure ulcer mattresses including Nimbus, Halo Tetra, Quattro Acute, and Cavalier Air Flow. Those residents who have been assessed as needing profiling beds are provided with them and a number of others are also being nursed on them. The home can access other high specification equipment at short notice if necessary. Also the majority of people are nursed on appropriate profiling beds. Care plans are person centred. This means that details about their likes and dislikes and current preferences are recorded. For example, one person likes watching television soaps and staff make sure the right channel is on. Another liked to spend time music and enjoys regular visits from a relative who brings the pet dog. Someone else who does not practice their faith, does not join in activities but likes staff to pop in for a chat. Where people have been assessed as needing help with mobility the care plans specify the moving and handling techniques and the specialist equipment needed. Care plans show what management arrangements are in place to show what staff need to do when someone presents with any behaviour that would challenge. Information about peoples previous lifestyles and preferences are recorded, and the plans show that a person centred approach to care is being developed in areas of clinical care and social activities. Care Homes for Older People Page 13 of 30 Evidence: For example, staff record if anyone has preferences about having help with personal care by male or female carers, one person liked having dogs and cats as pets, enjoys visits from friends and family and likes staff to pop in for a chat. They also show how staff support people to follow their individual religious preferences. Everyone has access to all NHS facilities to ensure their healthcare needs can be met. There are regular visits from GPs and other health professionals including, Huntington and Parkinsons disease specialists, dentists, opticians and chiropody services. Storage and medicine security is good, the treatment room that is used for medication was tidy although it is small so it full and provides little space for staff to work. Dates of opening are recorded for medicines with a short shelf life once opened and handwritten entries on MAR charts were signed and countersigned. Photo identification for all people in Millfield House was complete. There are medication policies and procedures in place and regular audits are carried out. Qualified nurses are responsible for the management of medication within the home. They have now had up to date training and they follow the required requirements from the Nursing and Midwifery Council. Many of the staff have worked in the home for some time and know the people they care for well. All of the staff worked very hard to make sure everyone was treated with respect and their rights to privacy and dignity maintained. The manager is developing the end of life strategy for the home. The care plans contain a fears for the future section where the resident and their family are encouraged to discuss their preferred place of care at the stage when they are at the end of their life. Meetings are held and the outcomes are recorded in their plans. This process is not yet complete for everyone. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are good so people are given the opportunity to lead full and active lives Evidence: The home provides care and support for people within a wide range of need and leisure pursuits and interests vary considerably. There is an enthusiastic activities person who organises events on an individual and group basis. Forthcoming events are displayed on the notice board and there are photographs on display, which act as a reminder of previous outings and events. And the home has its own mini bus so that people from the home can go out on a regular basis. Millfield House residents can access the cafe in the younger persons home on the same site. During the visits it was being used by both units with some people sitting enjoying the atmosphere while others had coffee with their visitors. Everyone also has access to the hydrotherapy pool, beauty therapies and various events such as slide shows and art displays. Recent examples of places that the residents have visited included the Sea Life Care Homes for Older People Page 15 of 30 Evidence: Centre, and there are frequent visits to local public houses and the local shops. There is a monthly newsletter, which describes forthcoming and recent events that have happened in the home. Visitors are welcome at any time and are able to use the lounges or their relatives bedrooms for visits. It was confirmed that there are no restrictions regarding visiting times. Information about advocacy is available in the home. Many people have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. The home has one central kitchen, which supplies all of the meals to both units via a hot lock. This can limit peoples ability to maintain daily living skills when putting milk jugs, tureens or teapots on the table would help to enable this. People can also have their meals in the cafe. This serves continental breakfast and a range of light meals that are made to order. At reviews they now have nurses going through dietary needs and choices to make sure that they have more information about people living in the home. There was an example of a resident who likes particularly spicy food and this was being made in larger quantities and frozen so that he could have it as an alternative when he did not like what was on the menu. Feedback form the surveys about the food was generally good with comments from people including, choice of meals is available they do try to accommodate all tastes and the food is good and I get what I want if there is nothing on the menu I fancy. However there was also a negative comment, Improve the meals however no more information was given so it is difficult to know exactly what this referred to. There are plans to give the cook sixteen supernumerary hours when he will not be the only cook on duty. This is to give him time to develop the service to make it more responsive to needs of the service. Although the food being served was of good quality and there was a choice being given the dining areas were not well organised and were not as pleasant as they could be. During the meal times, on the ground floor, a number of residents were either Care Homes for Older People Page 16 of 30 Evidence: sitting in the lounge area or in the space between the areas in their wheelchairs (specialist). The communal area next to the conservatory is also being used for meal times and was pleasant but felt temporary and could have been provided in a way that promoted more independence to the people using it. The manager and senior manager agreed to look at the dining areas as part of their service development plans. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and protection procedures are in place and being followed. People are now sure that their views are always listened to and that they are protected from harm. Evidence: The are effective policies and procedures in place to show how the complaint will be dealt with within exact timescales for acknowledgment of the complaint and action to be taken and a revision of all letters sent out to complainants. In the reception area of both units is a comment book and suggestion box where people can write both concerns and compliments. There have been four complaints received by the home since the beginning of 2009, they have now all been resolved and the records are in place to show how this was achieved Residents and relatives were positive about the way that the staff listened to them and said they could bring up anything with Bev (the Manager) and she will sort it out. Staff receive safeguarding training through their induction and probationary period. Formal training with the Local Authority has now been provided so that staff can Care Homes for Older People Page 18 of 30 Evidence: recognise signs of abuse and feel confident about identifying when to raise an alert and therefore, safeguard people most likely at risk. There have been no safeguarding alerts in 2009 however the home continues to work with all external agencies including the Commission to make sure that any safeguarding issues are dealt with appropriately. At the time of the site visit there were no complaints or safeguarding alerts. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and a pleasant, clean and comfortable place for people to live. Evidence: Millfield House is a very impressive large house in extensive grounds in a very pleasant residential area of Whickham. It has been converted to provide accommodation for thirty nine residents. The home shares the site with a service for younger people, which was until recently part of the same registration. The Younger Persons Unit has had an extension including a cafe, beauty and hydrotherapy. There is also a gymnasium health club and a flotation tank all of which are available for the residents of Millfield House to use. The garden areas are well kept and include a fishpond which has a ramped area that enables wheelchair users to get close to see the fish and the garden area is also accessible. The home has been refurbished and redecorated. At the entrance to the home is a large conservatory, which overlooks the landscaped gardens. Several of the people living in the home choose to spend most of their day there. Care Homes for Older People Page 20 of 30 Evidence: The front lounge has been refurbished and everyone who lives in the home has access to IT equipment and an interactive entertainment centre. The other lounge dining rooms are well decorated and have benefited from an ongoing refurbishment programme. The furniture was in keeping with the home and was in good condition. The bathrooms and toilets were well decorated to make them pleasant places for the residents, they are modern, have appropriate equipment and are easy to clean. Equipment is provided for those who have specific nursing care needs including, pressure mattress and specialised beds. People have been given choices about decor and floor coverings from a range of options. Generally they dont decide on wall colour, as the theme is neutral colours throughout. One resident has recently had her room re-decorated as the family thought it would cheer her up and she has had new bedding and towels to match the new decor. People moving into and living in the home have also been encouraged to bring small items with them and most bedrooms are highly personalised and reflect previous and present lifestyles. The housekeeping and cleanliness is good and cleaning schedules and regular housekeeping audits are undertaken to make sure the home is kept clean, tidy and free from offensive odours. Liquid soap and paper towels are available throughout the home. This is greatly helps with the prevention and control of infection. The laundry has been re sited and there is now provision for a soiled and clean room. This reduces the risk of cross infection and provides more space and a more pleasing place for staff to work. The sluices were locked and disinfectors have been provided on all units. Liquid soap and paper towels were available in these to enable staff wash their hands and prevent spread of infection. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and systems around recruitment, selection and training of staff are good and meet the range of needs of the people using the service and protect them from harm. Evidence: The home has in the past had problems recruiting suitability trained and experienced staff. There has also been some turnover of qualified staff, which has resulted in agency usage. This has improved recently and the current staff team are settled. During the visits there were the following staff on duty:- Two registered nurses, one of which was the Manager, seven care staff (four upstairs and three downstairs), one team leader, activities co-ordinator, the site manager, two administrators, two handymen (covering the whole site). The number of care staff on duty is two more than the minimum staffing level expected for this client group. This number is provided as the manager considers the dependency of the residents as well as the numbers. Generally the residents were satisfied with the numbers of staff however one survey said The staff work very hard and do their very best but there are occasions when additional staff on duty would be an advantage. The majority of residents need 2 people to handle them with only three staff on duty other residents can be faced with a waiting period. This obviously relates to the number of staff on a particular floor and may be a subject that could be discussed at the residents meeting Care Homes for Older People Page 22 of 30 Evidence: so that they are more informed about staffing issues. Residents were very positive about the nursing and care staff an example of this being one who said that the things that the home does best is Looking after all of the clients, keeping them clean and tidy another said that there was friendly and helpful staff. Senior nurses have some supernumerary time to let them complete management duties and direct and supervise the staff team. And there is now a team nursing system in place. There are two teams of carers, these are on a two week rolling rota. This means staff have alternate weekends off. The nurses have a less structured rota so that it can meet the needs of the service. As agency staff are used the manager has introduced an induction checklist, which informs them of peoples needs, health and safety including fire procedures, and contact numbers of key staff should there be any problems during their shift. There is also a communication book which records general daily events and activities for that day. This will make sure they deliver the right care, as they will not know people well. In addition to the nursing and care staff the home employs occupational therapists, physiotherapists and sufficient support staff. There is now a detailed training plan for all staff for each year which shows that the induction for new staff follows the Skills for Care workbooks. Four staff have completed the moving and assisting trainers programmes so that moving and handling training can be provided in house to a high standard. Other training includes safeguarding adults, dementia and dealing with behaviours which may challenge. The programme show that staff have completed all mandatory training. Qualified nurses have completed training in prevention of pressure ulcers, leg ulcer management, enteral nutrition, catheter, end of life care, care of an artificial airway and continence care. New staff receive induction and have some supernumerary time working alongside experienced staff. They then have a probationary period to make sure they are able to carry out their role. Staff files showed that a suitable application form had been used. Two references are Care Homes for Older People Page 23 of 30 Evidence: obtained and Criminal Records checks and Adult Protection checks were done. There was also evidence that staffs identity had been checked and qualified nurses Personal Identification Numbers (PIN) checked to make sure they are registered and able to practice. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a competent manager who makes sure that good quality assurance and safety systems are in place. This makes sure that people receive a good quality of care. Evidence: Millfield House is a home for older people which shares the same site as a home for adults. Both services are owned by the same provider and they have the same management structures in place. The manager is a registered nurse and has extensive experience working with older people. She has been employed in the home as both a nurse and as the deputy manager. This has resulted in her having a very good knowledge of the residents and their families or representatives. She continues to maintain her professional registration by undertaking the necessary updating of her skills. She is also currently completing the Leadership and Management Award (formally known as the Registered Managers Award). The company has a management structure to support the manager Care Homes for Older People Page 25 of 30 Evidence: in her role. There is a senior managers group which is comprised of, the Registered Managers of both of the homes on the site, the General Manager and the Chief Executive. There is also now a Medical Consultant who is part of this group and who provides clinical/medical advice on both a clinical and developmental basis for the whole site. Other advisors join this group depending upon the issues being discussed/reviewed. Regular staff meetings are held with minutes kept. These show that all staff discuss current best practice, home issues and detail their requests for extra resources. Relatives, visitors and people living in the home are asked to complete questionnaires about the quality of the care and service so that the manager can have a clear understanding of how they view the home. These are carried out monthly on a random basis. Leaflets are available in the reception areas for comments compliments, suggestions and complaints. There are monthly Multi Disciplinary Team meetings for the staff when each resident is discussed, and then there is an any other business for general issues to be discussed. This gives the staff opportunities to keep up to date with the care of the residents and have the opportunity to contribute to the planning of the care by providing information about their current needs. The people living in the home have their own forum were they talk about issues that affect them. These include breakfasts, food including diabetic puddings and the laundry service. The home uses the surveys and the meeting to plan changes required including special offers in the health club and theme nights and events. There have also been changes in offering continental breakfasts and changes to the menu requests. People living in the home are encouraged to raise issues and are confident that their comments and requests about the running of the home are listened to and addressed. The AQQA was completed and the information gave a reasonable picture of what was happening in the home and information about how it plans to develop over the next year. The homes policies and procedural guidance had been revised and updated in September 2007 with good, appropriate information compiled by the Registered Nursing Homes Association. These have been cross-referenced to with the local Care Homes for Older People Page 26 of 30 Evidence: policies used within the service. Records show that the staff receive regular supervision and this is managed audited to make sure that this is kept up to date. A random check of personal financial records showed that clear and detailed records are kept. Accounts are held individually, receipts are kept for all expenditure and two signatures are recorded for all transactions. Accidents and incidents are recorded and the manager has now developed an audit tool where she can track the frequency of issues such as pressure ulcers, infections and accidents. This follows best practice and prevents as far as possible the same incidents and events from happening again. In house maintenance checks are carried out weekly. Water temperatures are recorded to ensure temperatures of 44 C is not exceeded. Safety certificates were available for gas systems, water chlorination and electrical appliances and, fire safety records are up to date. A quality assurance system is in place that monitors all areas of practice, health and safety and infection control. This is the The Blue Cross mark of Excellence. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 It is recommended that the information available to potential residents is made available in different formats to make it more accessible. It is recommended that the way residents are supported to have their meals and the use of dining rooms be reviewed. This should include the use of individual teapots, milk jugs and vegetable tureens to enable some self-service and to promote peoples independence and dignity. 2 15 Care Homes for Older People Page 29 of 30 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. 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