Inspection on 25/02/10 for Milton Grange

This is the latest available inspection report for this service, carried out on 25th February 2010.

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.

Other inspections for this house

Milton Grange 11/01/07

Milton Grange 25/01/06

Milton Grange 03/08/05

Milton Grange 08/02/05

Milton Grange 10/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Milton Grange Milton Road Eastbourne East Sussex BN21 1SL     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: Alexis Reilly     Date: 2 5 0 2 2 0 1 0 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Milton Grange Milton Road Eastbourne East Sussex BN21 1SL 01323731695 01323532217 janice.knight@eastsussex.gov.uk www.eastsussex.gov.uk/socialcare East Sussex County Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Caroline Pulleyn Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary need on admission to the home are within the following category: Old age, not falling within any other category- (OP) Dementia (DE) Mental Health (MD) The maximum numbers of service users to be accommodated is 37 Date of last inspection Brief description of the care home Milton Grange is a large purpose built unit which provides a service for 37 people. The service is set up as four units and there is also a day care centre on the premises. The service provider is East Sussex County Council. Care Homes for Older People Page 4 of 25 Over 65 0 0 37 37 37 0 Brief description of the care home Unit 1 is a specialist mental health unit providing care for 10 service users with primary functional mental health care needs such as depression and anxiety. Units 2,3 & 4 provide care for up to 27 service users with primary organic mental health care needs such as dementia and Alzheimers. The service carries out a full financial assessment of individuals circumstances with regard to fees payable. The latest inspection report is available from the home. Care Homes for Older People Page 5 of 25 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: The site visit for this service began at 10am and finished at 2pm. A variety of documents were also taken from the site visit to look at following the inspection, these included the statement of purpose and service user guide. During the inspection the inspector looked at the care that four individuals received in the home. A variety of documents were viewed to help the inspector make a judgement about this care. The documents included the individual plans of care for the people and the associated documents such as risk assessments and activity plans. Other documents examined were copies of notifications, accidents and appointments, evidence of external reviews, the complaints procedure, copies of service users meetings, meetings for each unit, staff meetings and various meetings were work is allocated or referred. Staff recruitment files and induction training sheets and training records were also Care Homes for Older People Page 6 of 25 examined, as were the plan of staff supervision. A sample of the sheets which record the administration of medication were viewed, as was the duty rota. The inspector visited the ground floor unit and one of the upstairs units. The inspector walked through the kitchen and also the gardens. On the day of the inspection two of the upstairs units were closed due to a outbreak of illness. The inspector spent time with the Manager, Deputy Manager, senior carer and two service users in private. The inspector observed other staff interacting in a positive manner with service users during the inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 25 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 9 of 25 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 10 of 25 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. Service users benefit from receiving relevant and up to date information, which is made available to them prior to admission, this allows them to make an informed choice about home. The processes in place for ensuring that suitable Pre Admission Assessments are conducted is good, with services being offered to only those people whose needs can be met. Evidence: As part of the inspection the inspector case tracked four service users in the home and spent time with two of these people individually. Other service users were seen during the course of the inspection and staff were observed interacting in a positive manner with service users. The inspector had the opportunity to speak with the senior carer the Manager and the Deputy Manager. The inspector looked at the person centred documents in the home such as plans of care, risk assessments and activity plans for these individuals; also seen were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a Care Homes for Older People Page 11 of 25 Evidence: comprehensive care plan. The inspector also looked at the service user guide and service users information pack and can confirm that they are clear document which contain relevant information. The inspector found evidence to confirm that service users are involved in the admissions process and are given choice. The service had comprehensive assessment document in place which were used to assess someone referred to the service. Also available to view was collated information with regard to service users in the home, and their referring documents. This highlighted that the Manager obtains background information and up to date CPA and mental health assessments if applicable prior to offering a place in the service. Care Homes for Older People Page 12 of 25 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. Care plans and procedures in place are sufficient to ensure that a good provision of health care and personal support is provided to service users by the home. Care is administered in way that protects residents privacy and dignity. Medication procedures are in order. Evidence: During the inspection the inspector found that the care plans examined were clear and easy documents to follow. Evidence was supporting to confirm that service users are respected and personal care is delivered maintaining individuals privacy and dignity. The procedures in place to administer medication were in order and were ever possible service users are encouraged to deal with their own medication. The inspector evidence good procedures with regard to referring service users to occupational therapy and also the use of planned and staged home visits to enable integration back into the persons home following the stay at Milton Grange if this is appropriate. The inspector evidenced through out the care plans good practise examples in the way Care Homes for Older People Page 13 of 25 Evidence: service users were to be encouraged and their independence promoted and maintained. Staff spoken with confirmed this and detailed guidance was available on the plans of care. Care Homes for Older People Page 14 of 25 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. Evidence was supporting to confirm that a range of social, cultural and recreational activities are on offer with the wishes of the service users being central to the provision. The menu is varied and specialist diets are provided for service users, with service users choice and wishes being respected. Evidence: Evidence was supporting to confirm that relatives feel welcomed into the home. Menus are varied. Activities are on offer within the four units in the service and evidence was supporting to confirm that individuals wishes with regard to activities are taken into consideration, and that staff have a good understanding of individual service users likes and dislikes and indeed their history. This information is used to encourage service users to be involved in activities. Service users views are taken into consideration with regard to the activities and this was evident through minutes of the service users meetings. On the day of the inspection the inspector saw residents involved in a chair based net ball activity and one of the service users showed the inspector some of their completed art work. The service also has a visiting hairdresser and a cafe offering hot and cold meals and drinks. Care Homes for Older People Page 15 of 25 Evidence: Personal relationships and family relationships are encouraged Care Homes for Older People Page 16 of 25 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. Service users benefit from a robust and efficient complaints procedure, whilst the homes procedures and processes protect residents. Evidence: During the inspection the inspector examined copies of notifications, and accidents and appointments, evidence of external reviews, and the complaints procedure. Evidence was supporting to confirm that all staff have received training in Safeguarding of Vulnerable Adults, and the service has the required policies and procedures in place to protect service users. East Sussex County Council has a clear complaints procedure and guidelines in place. It was evidence that any incidents are dealt with effectively and that the service notifies the CQC of any relevant issues. The service has no current complaints. Care Homes for Older People Page 17 of 25 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 all areas of the home, including the garden, and all areas are accessible to service users. The size, location and layout of the home are suitable for its stated purpose. Evidence: At the site visit the inspector had the opportunity to walk around the building. All communal areas were viewed. The inspector did not visit two of the upstairs units due to an outbreak of illness in the service. Milton grange comprises of four separate units, each unit has a lounge, dining area and kitchen. All bedrooms are single and have an en suite shower, toilet and wash basin, The service also has assisted bathrooms. The centre has communal areas as well as a large dining area, and smaller rooms are available around the building for activities and groups. There is access to a decked anti slip area and a large area of garden. This incorporates raised flower beds. The service has the required policies in place with regard to infection control, and on the day of the inspection had followed the companys procedure with regard to isolating two of the units due to a outbreak of illness in the home. Care Homes for Older People Page 18 of 25 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. Staff recruitment procedures are effective and protect service users from potential harm or risk associated with poor recruitment practises. Staff are trained and supervised to enable them to carry out their role in the home. Evidence: As part of the inspection the inspector examined the recruitment files of two newly recruited staff to the service these were found to be in good order. The service uses the skills for care induction booklets, and a list of staff training was also seen as were copies of staff meetings and the list of staff supervisions carried out. Evidence was supporting to confirm that staff are well trained, supervised and attend regular staff meetings. Staff are also trained in areas relevant to the needs of service users. Members of staff were seen on the day of the inspection interacting positively with service users in an encouraging manner. Currently the way the units are staffed means that in the evening from 9.30pm until 7.30am there is one waking night staff on duty in each unit. Four staff in total Therefore if anyone needs help with personal care or requires medication to be administered in the downstairs unit a staff member will need to leave one unit upstairs to go downstairs. The upstairs units can be opened into one by a connecting door. Care Homes for Older People Page 19 of 25 Evidence: This was discussed in detail with the Manager on the day of the inspection and the inspector was assured that in the pre assessment stage of assessing someones suitability for the service; if it was identified that a person would require two staff to aid them during the night a member of additional staff would be put on the rota to work. This would also happen if someones needs changed during the stay at the home. The Manager also confirmed the organisation was giving thought to having senior care staff carry out the waking night duties as well as care staff. The Managed however confirmed that there is always a senior person on call during the night. The Manager should be mindful to keep this situation under review. Care Homes for Older People Page 20 of 25 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 Manger has ensured that service users live in a safe and well managed service which is run in their best interests. Evidence: Evidence through out the inspection was supporting to confirm that service users received a good level of service. Care plans and risk assessments were informative, activities are provided and service users dignity and independence is respected. Staff are well managed, supervised and trained. Service users are protected by the homes policy on recruitment and handling of finances and valuables. Evidence was supporting to confirm that resident views are sought through meetings and quality assurance documents. Regulation 26 visits are carried out by a representative of the provider and these reports were seen on the day of the inspection. The service has recently undergone major refurbishment and the ongoing Care Homes for Older People Page 21 of 25 Evidence: maintenance is contracted out to a company. Evidence was supporting that weekly meetings take place and any maintenance issues are addressed on a rolling weekly programme and dealt with effectively. The service is run by East Sussex County Council Adult Social Care department, and the Manager of the unit has NVQ level 4 in health and social care, NVQ level 4 in management D32/33 Assessor award, a Open University certificate in care and a ASET certificate in Dementia Care. The Manager has completed the registration and interview process with the CQC and is awaiting her certificate to show registration. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Care Homes for Older People Page 24 of 25 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 25 of 25 - 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!