This is the latest available inspection report for this service, carried out on 22nd June 2010.
CQC found this care home to be providing an Excellent 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.
Random inspection report
Care homes for older people
Name: Address: Millview Nursing Home Bridgeman Street Bolton Lancashire BL3 6SA three star excellent service 09/05/2007 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: Elaine Stoddart Date: 2 2 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Millview Nursing Home Bridgeman Street Bolton Lancashire BL3 6SA 01204391211 01204363246 bebbingn@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Helen Elizabeth Askins Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFHCare) Ltd care home 180 Number of places (if applicable): Under 65 Over 65 0 180 0 dementia old age, not falling within any other category physical disability Conditions of registration: 180 0 180 The maximum number of service users who can be accommodated is: 180. 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 - Code OP, Dementia - Code DE, Physical disability Code PD. Date of last inspection 1 7 1 2 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Millview is a Care Home providing nursing and personal care for mainly older people. It is situated in Great Lever about half a mile from Bolton town centre. It is close to main bus routes, the local railway station and the motorway network. The home is purposebuilt, single storey and comprises of six separate houses, each with 30 single bedrooms. There is plenty of car parking to the front of the home and there are garden areas around each unit for residents to sit out in. All the houses allow level access for wheelchair users and people who have problems climbing steps. Each house has a large lounge, a designated smoking area and a dining room. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. The home is registered to provide care for up to 180 residents with a variety of nursing and residential needs. These include general nursing and physical disabilities, palliative care and dementia care. The fees at the time of this inspection ranged from 373.38 to 719.04 pounds per week. For further details please contact Helen Atkins the home manager. Care Homes for Older People Page 3 of 11 What we found:
The Random inspection for Millview was conducted on 22nd June 2010 by two inspectors. A compliance inspector and a pharmacy inspector. A site visit took place with the homes manager and it lasted approximately six hours. The purpose of the inspection was to follow up on a number of requirements from the last Random inspections, which were conducted on the 17th December 2009 and the 11th January 2010. The inspection focused on two outcome areas. These were Health and Personal Care and Complaints and Protection. We found that all the requirements from the last Random inspection had been met. The new manager Helen Atkins (who has applied to the Commission to be registered) started at the home in January 2010. The manager confirmed she had made major improvements to address the requirements made at the last Random inspections. No further medication incidents have been reported since the last Random inspection. During the visit the compliance inspector case tracked four residents care files (their files were examined to help ensure staff were providing the care and support they needed). Three residents placed on the Rutland nursing care unit and one other resident on Albion residential unit. There were 142 people accommodated and the home was well staffed on the day of the site visit. People accommodated at the home like to be called residents and this term is used in this report as a mark of respect to them. Time was spent meeting with staff, residents and relatives to enable us to gain their opinions of the overall service. The last Key inspection was excellent. The AQAA from the previous inspection was used and up to date information was obtained from the manager during the visit.The AQAA is a quality assurance assessment, which was sent to us by the service and is completed once a year by the provider. The AQAA provides us with statistical information about the service and trends and patterns in social care. Outcome Area - Health and Personal Care. We spent some time on Rutland unit as the last inspection showed concerns regarding the lack risk assessments to keep residents safe. We found that this requirement had now been met, as clear and detailed risk assessments had been completed. This included how risks are managed, how the staff record the care they have given and the input residents receive from GPs and other health care professionals. Risk assessments had been completed where a risk had been identified in respect of a care need or task. These were seen to be reviewed monthly/or before to reflect changing needs. Residents who are at risk of falls are closely monitored and records seen showed this. A falls diary is kept of all residents falls and action taken by staff to minimise further occurrences where possible. We found sufficient staff were on duty to meet the needs of the residents. Staff were caring and attentive in their approach. The Rutland unit was found to have an unpleasant odour at the time of the visit and this
Care Homes for Older People Page 4 of 11 was discussed with the manager who agreed to take action to improve the environment for the people who live there. The unit was found to be very busy, as it was early morning and medication was being given, residents were assisted in getting up and other residents were having breakfast and receiving personal care. Relatives too were also visiting at this time. They were seen to be made welcome and were able to sit and chat with their relatives. Positive comments were received from relatives spoken with. These include: Mum has settled well and the care is good. No concerns. My husband has settled well. He never asks to go home. The home manage him very well. I am confident that he is being cared for. If I had any concerns I know they will be dealt with. Staff always keep me up to date. The handovers with staff are good as they are always aware of what has gone on at the last shift. They ring me day or night if they have any concerns and I like that. The staff are very approachable. I am very satisfied. Care plans viewed were found to cover all areas of need and actions to be taken by staff to meet those needs. These are reviewed monthly/or before to reflect changing needs. Care plans showed residents social background and their likes and dislikes. Thus enabling the staff to provide the care and support to meet their wishes. Staff spoken with were knowledgeable regarding the care and support required. We looked at daily care records and these showed that all care needs are completed by staff to show the care and support given to meet the residents needs. The changing needs of the residents are discussed with the staff at the handover at each shift change and at other times during the day. A key worker system is in place. A key worker is a named member of staff who works closely with the resident to ensure their needs are met. We found that records to show that residents have the capacity to make their own decisions was not clear. This was discussed with the manager who confirmed that this was to be reviewed on the assessment document. This will provide a clear assessment of their needs. The compliance inspector visited Albion unit as this has recently changed to provide dementia/residential. This was found to be a pleasant unit and staff were attentive to needs of residents during lunch and seen to treat them with dignity and respect. Meals were not hurried and assistance was provided when needed. The care manager was spoken with and confirmed that admissions are monitored to ensure they get to know the residents prior to admitting more people into the unit. One residents care file was viewed who had recently moved into the unit from another unit. A full re assessment of her care needs had been made to ensure her needs could be met. All areas of care needs were recorded in the plan of care and actions for staff to take to meet those needs. Regular reviews are undertaken to assess changing needs. All visits by health care professionals were recorded. Risk assessments of all areas of risk were clearly identified and kept up to date. Care Homes for Older People Page 5 of 11 The home promotes the dignity and respect of the people who live there. Staff were seen to knock on doors prior to entering residents rooms and spoke with respect to residents during visit. The laundry system was found to be organised to avoid losses to residents clothing. As part of this visit the pharmacist inspector looked at medicines handling to see how weaknesses identified at our previous visit had been addressed. We spoke with the manager, nurses and senior staff about the arrangements made for peoples medicines. We looked at a sample of care documentation within the home and the medication systems that were in place. We found that action had been taken to improve medicine handling. Senior staff completed regular medicines audits (checks) across all the bungalows in the service helping to ensure that should any weaknesses arise, they can be promptly addressed. And, the manager had met with the supplying pharmacy and main surgery to look at how medicines ordering, labeling and dose changes could be best managed. We found that staff had completed training in the homes new procedures for handling external preparations (e.g. creams) and that records better supported and evidenced their correct use. We looked at medicines administration. People who wish to, and are able, are supported to self-administer their medication. We saw that written risk assessments were completed and kept under review, but there could be more information about any support people may need to manage their medicines safely. Other medicines are administered by qualified nurses or, to people resident for personal care only, by staff who have completed certificated medication training. We saw that records were referred to and completed at the time of administration and that arrangements were generally in place to ensure that any special label instructions such as before food were followed. There was generally supporting information in place about the use of when required medicines to help ensure consistency in their use, when needed. But, as previously seen, on occasion this was missing or quite general and could be usefully expanded and made more personal. The home had arrangements in place for the use of homely remedies to enable treatment for minor ailments to be given without needing a prescription. We looked at how information within peoples care plans supported the safe handling of their medication. Since our previous visit written guidance and protocols had been put in place for people who take their medicines through a PEG (feeding) tube. This helps ensure consistency in the way this is carried out. We looked at the documents in place for two people living at the home who could have their medicines covertly (e.g. in food). We saw that family and health care professional advice was sought and that this decision was kept under review. However, one persons file had little information about how this was supported in practice. This should be recorded and kept under review to help ensure people are best supported when taking their medicines. We found that medicines record keeping had improved to better support and evidence the safe administration of medication. We compared a sample of medicines stocks and records and with the exception of a rare discrepancy; we were able to account for (track) medicines handling in the home. Stock control had improved and there were generally sufficient quantities of medication in stock to enable continuity of treatment, without overstocking. However, we saw one example where someone had missed doses of one
Care Homes for Older People Page 6 of 11 medication for several days. This had been followed-up by staff but could possibly have been addressed more quickly. Procedures for ordering medicines outside the main monthly delivery should be looked at to see if this risk can be reduced. We saw that generally clear records of advice and medicines changes from health care professionals were made and that arrangements were in place to help ensure new courses of medication were started without delay. Outcome Area - Complaints and Protection. We looked at how residents finances are managed and found that financial policies and procedures are in place to protect the residents. All transactions made are recorded and receipts obtained. Regular audits are conducted by the manager and the organisation to ensure residents monies are handled correctly. Policies and procedures are in place for complaints. Information on how to make a complaint is contained within the homes statement of purpose and leaflets are displayed on each unit for access by visitors. We looked at the complaints log, which showed how complaints had been dealt with by the home and the outcomes of the complaints. Relatives spoken with confirmed that if they did raise a complaint they were confident it would be dealt with. Staff spoken with showed their awareness of how to deal with abuse. Training records seen confirmed that staff have been trained in this area to protect the people they care for. Policies and procedures for abuse are displayed in the home for visitors to view. Copies of the local safeguarding agreements are available should any concerns be raised. One safeguarding referral is in progress and the home is dealing with this in cooperation with the correct services. All records to show this was made available during the visit. What the care home does well:
The home provided a welcoming approach to visitors who were seen to call in at all times during the inspection. Staff spoken with provided positive comments on the home and the management. These include: I love working here. I have a great relationship with both the residents and relatives. Training lots of it. I know what to do if witness any abuse. The new manager is like a breath of fresh air. We are kept up to date by daily meetings and the whole department monthly. The home has an activity organiser six days a week and the activities programme is displayed on the notice board. Activities include: Wimbledon, glamorous Grannie competition, prayer meetings, themes weeks such as, virtual cruises with ports of call and special meals provided. Each unit is to be decorated with the flags of areas visited.
Care Homes for Older People Page 7 of 11 The homes newsletter shows that the manager is available for relatives to pop to see her and times are made available for this. Regular medication audits are completed to help ensure that the homes policies are consistently followed and that should any shortfalls arise, they can be promptly addressed. 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 8 of 11 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 9 of 11 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 2 Records to show that a resident lacks the capacity to make their own decisions was not clear. The assessment document should be reviewed to provide a clear assessment of their needs. Training in the Mental Capacity Act and Deprivation of Liberty Safegards should be made available to staff to ensure they have a clear understanding of those residents who lack the capacity to make their own decisions. 2 18 Care Homes for Older People Page 10 of 11 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
