Inspection on 20/09/06 for Milbanke HFE

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Milbanke HFE 21/04/09

Milbanke HFE 14/01/09

Milbanke HFE 15/12/08

Milbanke HFE 20/10/08

Milbanke HFE 24/09/08

Milbanke HFE 23/06/08

Milbanke HFE 28/08/07

Milbanke HFE 05/09/05

Milbanke HFE 26/04/05

Milbanke HFE 20/12/04

Milbanke HFE 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Milbanke HFE Station Road Kirkham Lancashire PR4 2HA Lead Inspector Denise Upton Unannounced Inspection 09:00 20 & 21 September 2006 th st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milbanke HFE Address Station Road Kirkham Lancashire PR4 2HA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 684836 Lancashire County Care Services Ms Fiona Rigby Care Home 44 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (21), Physical disability (7) Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate service users in the following categories: Up to 21 service users in the category OP (Old Age not falling into any other category) Up to 7 service users in the category PD (Physical Disability) Up to 15 service users in the category DE (Dementia) 1 service user in the category MD (Mental Disorder) Service users in the physical disability category may only be accommodated in the 7 bedded rehabilitation unit, which must not accommodate any service user under the age of 55 years. 5th September 2005 2. Date of last inspection Brief Description of the Service: Milbanke Care Home has recently been redeveloped, completely refurbished and extended to provide high quality accommodation for a range of people with different needs and requirements. The home is separated into four different self contained units two of which provide accommodation for older people, one unit is for people assessed as requiring specialist dementia care and the fourth unit is a designated seven bed intermediate care unit. This facility, that can accommodate residents over the age of 55 years, provides time limited accommodation and support to people with a view to enabling them to return to their home environment. In addition, the building houses a designated, separately run day care centre and office accommodation. Milbanke Care Home is located in a convenient location close to the main shopping centre of the town and local amenities. The accommodation is purpose built, arranged over two floors and offers individual bedroom accommodation to all residents some of which are provided with an en-suite facility. Each individual unit also has a large lounge/dining room that is bright, airy and comfortable and a smaller quiet lounge. A designated smoking lounge is in the process of being provided. Newly refurbished bathroom/shower and toilet facilities are conveniently located and provided with appropriate aids to promote independence. A passenger lift is provided for ease of access throughout the home. The present rate for residential care charges at Milbanke Care Home ranges from £320 00 – £364 00 per week. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place during the morning, afternoon and early evening period of one day and a morning and lunchtime period of the following day. In total the visit spanned a period of fourteen and a half hours. Twentythree of the thirty-eight standards identified in the National Minimum Standards – Care Homes for Older People were assessed. The inspector spoke with the home’s registered manager, a residential care officer, the cook, a member of the domestic care team and individual discussion also took place with five care staff. In addition, six residents ‘at home’ during the course of the visit were spoken with individually along with three relatives and a District Nurse who were all visiting. Twelve residents also completed a Commission For Social Care Inspection comment card. A number of documents and records were also examined and a tour of the building took place that included communal areas of the home, some bedroom accommodation and kitchen and laundry facilities. What the service does well: Milbanke Care Home has good systems in place for assessing the needs and requirements of prospective residents before they take up residency at the home. This is to make sure that the home can provide the level of care and support required. The staff team are encouraged to undertake nationally recognised training for care staff and a substantial number of staff have achieved this award at various levels. There are also good links and good working relationships with local health care workers. All residents spoken with felt that their health care needs were well met. One resident said that there are “extremely good and kind staff and they take an interest in you. Carers will go out of their way and do little things they don’t need to do”. During the course of the site visit, residents were observed during the course of a midday meal. The meal was well cooked and presented and residents spoken with said that they had enjoyed the meal “very much”. The staff were seen to be sensitive when assisting residents with their meal to make sure that residents dignity were maintained. Residents have recently been consulted about planning new menus and the suggestions made have now all been incorporated in to new menus that offer a wide variety of foods. The home also has good arrangements to protect residents including a simple complaints procedure. Residents spoken with were aware of the complaint procedure and felt confident that any complaint would be taken seriously and fully investigated. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 in part, 3 & 6 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home’s Statement of Purpose and Service User Guide are good in providing service users and prospective service users and their family with details of the services the home provides enabling an informed decision about admission to the home. However it is essential that all newly admitted service users are routinely provided with Service User Guide at the point of admission. The assessment undertaken before a prospective service user is admitted to the home is thorough to ensure individual needs and requirements can be met. EVIDENCE: Milbanke Care home’s Statement of Purpose and Service User Guide are detailed and comprehensive. However from discussion with a number of newly admitted service users, it is clear that the Service User Guide, that tell service users about the home and services and facilities provided, had not been made available. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 9 It is essential that all newly admitted service users are provided with an individual, up to date copy of the recently revised Service User Guide, that includes the most recent Commission for Social Care Inspection report. Prospective service users are only admitted to Milbanke Care Home following a comprehensive assessment of current strengths and needs undertaken by an independent Social Services Care Manager. The outcome of this assessment is provided to the home prior to admission. In addition, the home’s manager visits the prospective service user in their current environment to conduct a further assessment to make sure that Milbank Care Home can provided the level of care needed and also to provide further information about the home and facilities available. Discussion with a number of recently admitted service users and a relative confirmed that assessments had been undertaken before admission to the home that included a visit by the home’s manager and that sufficient information had been provided to make an informed choice. Prior to admission, the prospective service user and their family/friends are also encouraged to visit the home to assess the facilities for themselves and meet other service users and staff on duty. One service user said that their admission to the home had ‘gone very well’, they were very pleased with the welcome received, and that ‘everyone is very kind and helpful and will go out of their way for you’. With regard to the intermediate care unit, in addition to the Care Manager assessment, designated professional staff that includes an occupational therapist, physiotherapist and district nurses from the local district nursing team, also undertake assessments soon after admission. The professional staff then devises a suitable care plan for the individual. Following these professional assessments, it is the responsibility of the care staff to ensure the requirements of the care plan are carried out as directed. However it was noted that although a generic risk assessment had been undertaken in respect of one service user that indicated ‘risk of falling when walking” there was no specific risk assessment with regard to this particular risk. In another instance, an incident had been recorded regarding an obvious risk with regard to a service user smoking. Staff had taken appropriate action but a formal risk assessment was not available to indicate why the action taken by staff was necessary. It is recommended that whenever a significant risk is identified, a formal written risk assessment be undertaken to protect the service user and clarify the reason for actions taken. One of the service user’s spoken with in the intermediate care unit was very pleased with the service stating she was now much better and looking forward to going home. This same service user confirmed that regular reviews of her needs had been carried out including a home visit and that she was satisfied with the domiciliary care package planned for her return home. “I appreciate Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 10 the cup of tea in the morning and enjoy the food. It is very nice here and kindness is shown all the time”. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. Although in the main there is a clear care planning system in place, the information provided is on occasions inadequate and does not provide staff with the information they need to ensure a consistent service. The health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good however staff do not always follow the home’s procedures for recording the administration of medication that could potentially place service users at risk. Privacy and dignity is addressed well at this home that ensures service users are treated with respect. EVIDENCE: Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 12 Although there is a good system in place to assess the current strengths and needs of service users, the individual written care plan that tells staff what the person can do for themselves, and what help is required should be more detailed. Whilst the current care plans have a section to indicate individual strengths, needs and goals, the information, particularly in the ‘goals’ section are more often comments rather than advising staff of the specific action required to achieve the ‘goal’ in order to ensure a consistent and relevant service. For example, in the social activities section of one care plan the ‘goal’ stated ‘to ensure he knows his whereabouts’. On another, the ‘goal’ was ‘to encourage him at all times’. (To do what?) It is questionable if these statements are located in the correct section of the care plan and clearly do not advise staff how these aims are to be achieved. Whilst there is no suggestion that this has compromised the actual individual care provided, it is recommended that all staff with responsibility for devising or implementing care plans should receive updated care plan training. This would ensure that staff are provided with the skills required to develop a detailed individual care plan covering all aspects of health, personal and health care needs. It was also noted that not all care plans or individual risk assessments had been routinely reviewed on at least a monthly basis. Whilst it is acknowledged that the home has recently had to rely quite heavily on agency/casual staff to supplement the core staff group, the routine review of all service users care plans should be re-established as a matter of priority. It is also important that an initial care plan be developed from the pre admission information available that is amended as required during the first few days. In one instance in respect of a service user ‘case tracked’, no initial care plan was available 5/6 days after admission even though there was sufficient assessment information available. At minimum, staff in the unit should have started to develop a care plan from the pre admission assessment information and their own observations of this person’s needs and requirements. From discussion with a number of service users and observation of documentation, it was clear that service users were aware of their care plan, had contributed to the content and signed the document accordingly. Staff had a good overall understanding of the needs of people who lived at the home and were seen to be patient, kind and respectful when interacting with service users. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 13 Through direct observation at the time of inspection, discussion with staff and observation of documentation, there was clear evidence of good multi disciplinary working taking place on a very regular basis with health care professionals. Service user’s spoken with felt that their health care needs had been fully met whilst they had been living at the home and that staff were ‘very good at getting the doctor for you’. Milbanke Care Home are required to implement the corporate policy and procedures with regard to the administration and recording of medication and all staff with responsibility for this task have received specialist training. As recommended at the last inspection, a controlled drug register has now been obtained and is in use. The administration and recording of controlled drugs is clearly recorded and audited. It is however recommended that the small freestanding metal locked box used for the storage of controlled drugs within the main locked drug cabinet should be bolted to the cabinet. This would help to ensure the safety of these medicines especially during the administration of medicines when the medication cabinet is open. The recording of medication administered was found to be variable with numerous dose omissions without explanation observed in some units. This would indicate that staff are not checking the medication properly prior to administration or signing the medication administration record immediately after administration. In order to protect service users it is essential that the correct procedures for the administration and recording of medication be consistently followed. It is recommended that the drug administration procedures be kept in the medication cabinet for ease of access, staff with responsibility for drug administration are reminded of the correct procedures to be followed and a designated member of the management team undertakes a weekly audit of medication within the home. This should include the record of all medicines received, administered and leaving the home or disposed and checks to ensure that all medicines are used within the expiry date. It is also recommended that in order to evidence this practice, the weekly check of medication be recorded and signed by the person undertaking the task and any comments or actions noted. Service user’s spoken with felt their privacy and dignity was respected and that staff were sensitive when they needed help with personal care. Staff were seen to be respectful and mindful of service users feelings with one service user saying, “I cannot thank them all enough, I could not have got better treatment anywhere”. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Service users experience the lifestyle that does not always satisfy their social or recreational interests and needs. Dietary needs of service users are well catered for with a balanced and varied selection of food available that in the main meets service users taste and choice. EVIDENCE: Routines of daily living are kept flexible and varied to suit service users expectations. A number of service users spoken with confirmed that they are able to make decisions about their chosen routines. As evidenced during the course of the site visit, social relationships are encouraged either through family/friends visiting at a time of the service users choice or visits out in the community. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 15 Although service users spoken with were consistent in their comments regarding the high standards of health and personal care provided at the Milbanke, comments about social activities made available were more mixed. Evidence of social activities taking place on a regular planned basis within the home was very limited and the majority of service users who completed the Commission for Social Care Inspection comment cards clearly indicated that activities are only sometimes arranged rather than always or usually arranged. However during the course of the inspection, it was observed that a member of staff was taking a service user shopping in the local community and there was evidence of some activities materials being available. A number of service users also choose to arrange independent social activity in the community and a number of other service users access the day centre facility situated on site. The home’s manager is aware that this is an area that should be developed. This would ensure that all service users are given opportunity for stimulation through leisure and recreational activities both inside and outside the home that suits their individual needs, preferences and capacities. This is particularly important in respect of people with dementia or other cognitive or physical disabilities who may not be able to enjoy some general activities made available. In these situations it is important that activities arranged take into account their specific needs, requirement and wants that is clearly identified on their individual care plan. Service users are encouraged to main control of the own financial affairs for as long as they wish to and have capacity to do so. Information in respect of advocacy services are also available that can be accessed independently. Through discussion with service users and observation of some bedroom accommodation it was confirmed that service users are encouraged to take personal possessions with them into the home to make their private bedroom accommodation more homely and comfortable. Meals and mealtimes at Milbanke Care Home are given high priority with a varied and balanced menu provided that is designed round the known likes and dislikes of service users living at the home. Discussion with the cook on duty established that new menus had recently been designed and were about to be introduced following a questionnaire for service users. The outcome of the questionnaires, particularly the suggestions for alternative meals, have now all been incorporated in the revised rotating menu. The majority of service users spoken with rated the meals served as very good with a wide choice made available. During the course of the inspection a mid day meal and breakfast meal were observed in two separate units. The foods served were well presented, plentiful and enjoyed by service users. It was also Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 16 noted that staff discretely and sensitively offered assistance as required to ensure the dignity of service users was maintained. Specialist diets in respect of medical needs are provided and diets in respect of religious or cultural requirements can also be accommodated. Currently the cooks are informed of the particular likes and dislikes or dietary requirements of newly admitted service users from a member of the care staff team and in consequence, have little direct contact or discussion with service users. It is understood that consideration is now being given to one of the cooks personally speaking with each newly admitted service user to get to know their dietary preferences, wants and needs and also to attend resident meetings. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that complaints are thoroughly investigated and service users feel that their views are listened to and acted upon. Staff have a good knowledge and understanding of adult protection issues, which protects service users from abuse. EVIDENCE: Since the last inspection, Milbanke Care Home has received two complaints. Both complaints were thoroughly investigated and a record of the method of investigation and outcome is maintained. The complaint procedure at Milbanke Care Home is compliant with requirements and identified in the Statement of Purpose and Service User Guide. Service users spoken with were positive about living at the home and confirmed that they were aware that the home had a complaints procedure and stated they felt confident that any concern would be taken seriously. Milbanke Care Home also has available a variety of corporate policies and procedures for the protection of service users. These include an Adult Protection Policy based on the `No Secrets` documents and a whistle blowing policy to help protect service users from abuse or discrimination. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 18 The majority of staff have undertaken specific adult abuse training that also helps to protect service users and further training in respect of this topic is to be arranged for the remaining staff. Discussion with a member of the care staff team confirmed her understanding of the Home’s adult abuse procedures and individual responsibility in reporting any incident of alleged adult abuse. Service users are informed with regard to personal insurance and also that staff are not permitted to accept gifts or witness any legal documents. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Recent investment and completion of the new building programme has significantly updated and improved the standard of the environment within this home that is now excellent in providing service users with a comfortable, attractive, safe and homely place to live. EVIDENCE: Over the last two years a significant refurbishment programme to existing accommodation and a new build programme to provide additional accommodation has recently been completed. The home is now divided into four separate units each with communal areas, bedroom accommodation and bathing and toilet facilities. There will also a designated smoking lounge that is to be available for all service users. This purpose build accommodation has been designed to accommodate service users with a variety of needs and requirements. Two of the units provide Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 20 accommodation for older people, one unit is a designated dementia care unit and the remaining unit provides short term, time limited intermediate care with the aim of enabling the individual to return to their home environment. The refurbishment of the existing building, has provided more spacious bedroom accommodation and new enlarged bath/shower and toilet facilities that are situated close to bedrooms and communal areas. In the new build accommodation, all bedrooms are provided with an en-suite facility. Aids including grab rails, hoists and assisted baths are available to meet the needs of service users accommodated. All bedroom accommodation is for single occupancy. The accommodation is attractively decorated, bright and welcoming. The main lounge/dining room in each unit is provided with facilities for making drinks and snacks. Each bedroom is spacious and comfortable and provided with a lockable facility for the safe storage of items of a personal nature and all individual bedroom doors are fitted with a lock with the occupant retaining the key. All service users spoken with were very satisfied with both their private bedroom accommodation and the communal areas of the home. Currently each unit is provided with a keypad system for entry. Whilst this is clearly appropriate in some areas, it was noted that a service user who was dependent on a wheelchair in one of the older people units was isolated within the unit. Unfortunately the individual could not independently use the keypad lock and required staff assistance in order to get out of the unit or return to the unit. It is suggested that consideration be given to determining whether a keypad system is actually necessary in all areas of the home particularly if this prevents independent ease of access around the home or garden areas. The home is clean, hygienic and very well maintained with a variety of policies and procedures to advise staff in the control of infection. New laundry facilities are sited away from food preparation areas and do not intrude on service users. The laundry has been provided with new equipment and the wall and floors are readily cleanable. Discussion with a member of the domestic staff team confirmed that there are always adequate cleaning materials and cleaning equipment is well maintained. It is understood that designated meetings are to be arranged to discuss alternative working arrangements for domestic staff that could give specific responsibilities for various areas of the building. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. After a period of considerable instability in staffing by having to rely on agency/casual staff to supplement core staff members, arrangements are in place to employ only permanent members of staff to enable consistency of care within home. There is a good match of well-qualified permanent members of staff who demonstrate a clear understanding of their roles. The standard of vetting and recruitment practices are good with appropriate checks being carried out to protect service users. The arrangements for the induction of newly appointed staff is limited with no evidence that recently appointed staff have undertaken a full induction training programme. EVIDENCE: Milbanke Care Home staffing levels and skills mix are determined in accordance with the assessed needs of service users accommodated. During the daytime and evening period, designated care staff is employed in each unit to provide consistency of care. Additional staff are on duty at peak times of activity and all night staff have ‘waking watch’ responsibility during the night Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 22 time period with a member of the management team ‘sleeping-in’. There is sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. Over the past few months the service has had to regularly rely on agency/casual staff to supplement permanent members of staff. This is because the number of service users accommodated has significantly increased and it has taken time to employ sufficient new permanent members of staff who have to fulfil the full recruitment requirements including references and clearances. The majority of service users and staff spoken with all considered that this had had a negative impact on service users who have not always received consistency of care from people with whom they were familiar with. One service user commented on the Commission for Social Care Inspection comment card that “There are to many casual and agency staff who haven’t got a clue what to do”. Another service user commented that “sometimes we only have one staff, I think we should have more and staff get tired”. However one service user was more positive when stating “ I cannot find fault with any of the staff they are always on hand” From discussion with the home’s manager, it is understood that the final round of recruiting new staff is in progress and it is anticipated that a full staff complement of permanent members of staff with be in place in the near future. Although there is a clear commitment to the training and development of all staff, it could not be confirmed that all newly appointed staff had received structured induction training. Recently appointed staff were unclear about what induction training they had actually received although one member of the care staff team did confirm that she has commenced NVQ Level 2 since taking up employment at the home. It is strongly recommended that all newly appointed care staff are provided with the ‘Skills for Care’ nationally recognised induction training programme within six weeks of appointment to their posts. Currently eighteen members of the permanent care staff team have achieved an NVQ Level 2 or Level 3 certificate in care, with other members of staff currently undertaking these qualifications. In addition, two further members of staff have achieved an NVQ Level 4 qualification. A staff-training matrix was available that highlighted the additional range of courses that staff had undertaken in order to provide a high quality service. This included recent training in respect of dementia awareness, medication handling, infection control, customer care, supervisory management and intermediate care. There is also a planned programme of further training arranged. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 23 Milbanke Care Home operates a structured corporate recruitment process in order to protect service users. From observation of three recently appointed staff member’s personnel file, it was evident that the policy and procedures in respect of staff recruitment had been followed, including an application form, health questionnaire, formal interview and references. All staff is required to have a full Criminal Records Bureau clearance before taking up employment at the home. Service users spoken with were very positive in their comments regarding the permanent staff group. The interaction observed between staff and service users is friendly and comfortable. One service user commented “They care (the staff) I have been very satisfied, everybody has been kind” Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 in part & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is well supported by senior staff in providing clear leadership throughout the home and has a good understanding of the areas in which the home needs to improve. The systems for service user consultation are good with some evidence that service users views are sought and acted upon. Systems are in place to ensure as far as possible the health and safety of service users, staff and visitors. EVIDENCE: Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 25 The registered manager of Milbanke Care Home is well qualified and experienced and has achieved a NVQ Level 4 in care, Registered Managers Award, Higher National Certificate in Social Care, Certificate in Management Studies, and an A1 Assessors Award. To further increase her skills and knowledge, the registered manager has also periodically undertaken a variety of other training courses. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of service users, staff and relatives. However, although there was clear evidence of a recent service user questionnaire regarding a specific issue, it was unclear from discussion with service users and staff if the internal consultation process had been as frequent as previously. Whilst it is acknowledged that because of the staffing issues and the change in accommodation some quality assurance systems may have temporary lapsed or become less frequent, it is understood that the full consultation processes will be implemented. At the time of inspection not all staff spoken with could confirm that formal staff supervision continues to takes place at least six times a year. However there was some evidence that formal supervision had taking place in respect of some staff. Through discussion with the registered manager, it was established all existing care staff and newly appointed care staff will receive formal documented supervision in the future on a regular basis. Daily informal supervision is a routine feature at the home to ensure staff are competent to undertake their role. Financial procedures in respect of service users monies and the safekeeping of valuables is robust to protect the interests of service users accommodated. In accordance with the home’s policy with regard to service users monies, all service users are encouraged to maintain control of their own financial affairs. However, appropriate systems are in place for the safe keeping of service users monies and accurate and up to date records of financial transactions are maintained. Policies and procedures and staff training are in place to ensure as far as possible the health and safety of service users, staff and visitors. The majority of staff have received moving and handling training and first aid training however it is essential that all new and any existing staff that have not received this training do so as a matter of priority. Currently two members of the management team have achieved the more advanced ‘First Aid At Work’ qualification. It is however recommended that a qualified first aider is on duty at all times and consideration should be given to addressing this issue. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 26 All staff that have not done so should also undertake health and safety training at minimum, in respect of fire safety, food hygiene, and infection control. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 X 3 Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The management team must ensure that medication records are signed immediately after medication is administered with particular reference to dose omissions without explanation. (Time scale of 30/09/05 not met) Timescale for action 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3. Refer to Standard OP1 OP3 OP7 Good Practice Recommendations All newly admitted service users should be given an individual copy of the Service User Guide that includes the most recent Commission for Social Care Inspection report. Specific risk assessments should be routinely undertaken when a risk has been identified with significant outcomes incorporated into the care plan. Care plans should be further developed to provide clear guidance regarding how aims are to be achieved. All newly admitted service users should have an initial care plan based on the pre admission assessments available. All DS0000032617.V310097.R01.S.doc Version 5.2 Page 29 Milbanke HFE 4. OP9 5 6 7. 8 OP12 OP19 OP27 OP30 9 10 11. OP33 OP36 OP38 individual care plans and risk assessments should be formally reviewed on at least a monthly basis and amended as required. It is recommended that care staff receive updated training with regard to the development of a care plan and care planning objectives. It is recommended that the freestanding metal box for the storage of controlled drugs be bolted to the medication cabinet. It is also recommended that the drug administration procedures be kept in the medication cabinets for ease of use. A member of the management team should undertake a weekly medication audit and a signed and dated documented record be maintained to this effect. A structured ‘in-house’ activities programme that is tailored to individual needs and requirements should be developed and introduced. Consideration should be given to establishing if keypad locks are actually required in respect of certain areas of the building. A full complement of permanent members of staff should be in place as soon as possible. All newly appointed staff should receive structured induction training and all newly appointed care staff should be provided with the ‘Skills For Care’ induction training standards within the first six weeks of their employment. The systems for service user/staff/stakeholder consultation should be fully implemented as soon as practical. All care staff should receive formal documented supervision at least six times a year. All care staff that have not done so should undertake health and safety training as identified in Standard 38.2 and a qualified first aider should be on duty at all times. Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milbanke HFE DS0000032617.V310097.R01.S.doc Version 5.2 Page 31 - 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!