Inspection on 21/04/09 for Milbanke HFE

This inspection was carried out on 21st April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 20/09/06

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 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA 01772684836 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lancashire County Care Services Name of registered manager (if applicable) Mr Aidan Finley Type of registration: Number of places registered: 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 physical disability Additional conditions: 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. The home is registered for a maximum of 44 service users to Include:-: upto 21 service users in the category OP (Old Age not falling into any other category) upto 7 service users in the category PD (Physical Disability) upto 15 service users in the category DE (Dementia) up to 1 service user in the category MD (Mental Disorder) Date of last inspection 2 4 0 9 2 0 0 8 15 1 0 7 Over 65 0 0 21 0 care home 44 Care Homes for Older People Page 4 of 37 Brief description of the care home Milbanke Care Home provides high quality accommodation for a range of people with different needs and requirements. The home is currently separated into three different self contained units two of which provide accommodation for older people and the other is for people assessed as requiring specialist dementia care. 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. Newly refurbished bathroom/shower and toilet facilities are conveniently located and provided with aids to promote independence. A passenger lift is provided for ease of access throughout the home. Care Homes for Older People Page 5 of 37 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: one star adequate 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: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The unannounced site visit took place during a mid week day and spanned a period of approximately eight hours. During this site visit, a second inspector completed part of the inspection and a Care Quality Commission pharmacist inspector was also present to look specifically at the medication standard and how this was being met. At the time of the site visit, 25 people were in residence. Twenty two of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the requirements and recommendation Care Homes for Older People Page 6 of 37 made at the last key inspection. We (The Care Quality Commission - CQC) spoke with the homes manager, the area manager and private, individual discussion took place with eight members of the care staff team. Several other members of staff were also spoken with throughout the course of the inspection. In addition, we spoke individually with two residents, and brief general discussion took place with several other residents throughout the course of the day in various communal areas of the home. CQC surveys that invited feedback about Milbanke care home were received from eight members of staff and eight residents, prior to the site visit taking place. This all helped to form an opinion as to whether Milbanke care home was meeting the needs and expectations of the people who live there. The majority of the comments made by residents were positive. Information was also gained from the annual quality assurance assessment (AQAA) completed by the homes manager prior to the site visit taking place. This is a self assessment that focuses on how well positive outcomes are being achieved for people using the service. A number of records were viewed and a tour of the building took place looking at communal areas of the home, bathrooms and some individual bedroom accommodation. Time was also spent observing the relationship between staff and residents as they went about the days activities. Details of current fees and what is included in the fees is available from the home. The last key inspection took place in June 2008. In September 2008, October 2008, December 2008 and January 2009 random inspections, undertaken by a pharmacist inspector took place looking specifically at how well medication was managed at the home. The reports relating to these random inspections are held at the CQC office and would be made available on request. What the care home does well: What has improved since the last inspection? What they could do better: Care plans, that tell staff what an individual residents needs and requirements are, are generally good and contain a lot of information to guide and direct staff. However on one unit the care plans in place were not always complete or up to date. A detailed and up to date care plan should always be available regarding each resident living on that unit. This would make sure that staff had current, clear information about the holistic needs of each person. Information provided on some of the CQC resident surveys that were returned, said that activities were not always available that they could take part in. This is an area that the homes manager is aware could be improved and steps have been taken to provide training for staff so that a more appropriate activities programme can be developed. Care Homes for Older People Page 8 of 37 Likewise some residents told us that the meals were not always to their liking and that there was sometimes a lot of repetition about the meals served. Residents are currently in the process of being asked about the meals served and mealtimes in general so that changes can be made to suit the wishes of the people living at the home. There is a requirement that all care staff working at the home must receive basic first aid training and manual handling training. This is to help protect residents. At present not all members of the care staff team have received this important training. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information, and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: Prospective residents are provided with the written information they need to make an informed choice about whether to live at the home. Since the last inspection, the homes Statement of Purpose and Service User Guide have been updated and amended to make sure that the information provided is accurate and up to date. It is understood that the newly revised Service User Guide is about to be provided to each resident and the updated Statement of Purpose, made available to all residents, prospective residents and any other interested individuals. No new residents have been admitted to Milbanke care home since the last key inspection in June 2008. However there remains good systems in place so that Care Homes for Older People Page 11 of 37 Evidence: individual needs and requirements are known prior to admission. People are only admitted to the home if their health, personal and social care needs could be met. In order to ensure this, the manager undertakes an assessment of the persons current strengths and needs in order to determine if the level of care and support required could be provided at the home. This information is recorded, which in some cases is supported by a Health and, or Social Services assessment of current requirements. In the main this collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. All this helps to make sure that as much information as possible is gained in order for the manager to make an informed judgement as to whether the home could provide the level of care and support required. Following the pre admission assessment, the prospective resident is informed in writing whether or not their current needs and requirements could be met by the staff team at Milbanke care home. Although comments from residents were mixed, a number of residents that completed a Care Quality Commission survey said that they had received enough information about the home so they could decide if it was the right place for them. One person told us, Stayed for a trial period of one month before deciding and another person said I did not receive any information, but I knew it was a good home. The intermediate care unit at Milbanke care home is not operational at present, therefore the standard relating to an intermediate care service was not assessed on this occasion. Care Homes for Older People Page 12 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Milbanke care home have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: The pre admission assessment covered a wide variety of needs including personal care, diet and weight, sight, hearing and communication, oral health, mobility, medication, mental state and cognition, personal safety and risk, social interests and hobbies, cultural and religious needs and carer and family involvement. Separate care plans are written for each area of need, such as personal care, mobility and health care. Care plans that were available were in the main, clear and detailed to guide and direct staff. This enabled staff to provide an individualised, person centred service that was delivered in a consistent way. This also helped to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. However there were some inconsistencies. In one of the older peoples units the care Care Homes for Older People Page 13 of 37 Evidence: plan information in respect of one resident was very limited and only covered a small number of individual needs, it is unknown if the care plan was initially more comprehensive or if some elements of the care plan had become detached. Discussion took place with a carer in the unit who explained that this persons individual needs had changed but an amended care plan had not been provided. This was of particular concern as other information indicated that this person displayed challenging behaviour but there was no care or support plan available to advise or direct staff on the unit about how to manage these behaviours. Risk assessments were available dated 2007 and 2008 with regard to the effects of the dementia, wandering and short term memory loss but there was no actual care plan in place about these matters. It is unknown if the risks assessments in place still remained current. There was some evidence of reviews taking place but not necessarily on a monthly basis. One monthly review evidenced was dated 2009 but as no month was recorded it was not possible to establish from the records any changes that may have recently taken place. In another instance, on the same unit, the care plan in respect of another resident had been last modified in August 2008. There was evidence of a review sheet dated 2009 but no actual date of when the review had taken place. It appeared that no reviews had taken place between these two periods. The carer spoken with stated that this persons needs and requirements, particularly with regard to personal care has significantly increased but the care plan had not been amended to reflect this. We were informed that any changes to the support and assistance required are logged on the individual daily diary sheet and staff relied on this in order to provided the level of care required. Whilst there is no suggestion that residents needs were not being met in practice, it is essential that staff working in the units are provided with comprehensive and detailed care plans that are consistently used to support the people living at the home. This would make sure that all staff receive the same information in order to provide a consistent service. It is also necessary to make sure that the formal review of the care plan is completed on at least a monthly basis or more frequently dependent on need. The outcome of the review should be clearly recorded showing which elements of the care plan have been amended and why. Staff that complete records must also be careful to sign and date the document in order to take ownership of the recording and to confirm that an accurate record has been maintained. On some of the documents seen, the date was too vague and had sometimes not been signed by the person making the record. Individual care plans seen on the other units were more comprehensive although on some occasions the information in the care plan could have been more detailed, for Care Homes for Older People Page 14 of 37 Evidence: example to identify how or what actual assistance was required and how staff were to provide the level of support required. A variety of risk assessments, specific to the individual, are also undertaken including when appropriate, a nutritional assessment and manual handling assessment. Any significant risk assessment outcome is incorporated in the care plan. Action is taken to minimise or eliminate any identified risks. Discussion took place with the residential care officer on duty about the review system in place and care planning arrangements. It was apparent that in respect of one resident, the care plan available on the unit was dated July 2008, and the care plan had been modified in October 2008. We were informed that the care needs of this person had increased since admission. There was no evidence of further monthly reviews taking place until April 2009. The April 2009 review information was held on computer along with a new care plan. The amended care plan not been provided in the unit to direct and advise staff. All care plans should be working tools that should be amended as soon as required and placed on the unit. Staff should not be relying on daily diary entries to find out about the changed care and support needs of people living in the units. Residents and or their relatives are given opportunity to be involved in the care planning process, so that they could have some say about the care provided. This helps to ensure that the individual wants and wishes of the person can be met in the way that they would like. Residents that completed a CSCI survey said that they always or usually got the care they needed at the time that they needed it. It was evident through discussion that residents health care needs are being fully met. This was also confirmed through comments in the resident CSCI surveys that had been returned. All stated that people living at the home always received the medical attention that they needed when they needed it. Each resident has a key worker that takes a special interest them, staff get to know people well and can spot any changes in health and well being. There is a good relationship with health and social care professionals in order to maintain residents health and social well-being. At present, medical input visits are recorded on the individual daily dairy sheet with a record of the visit date been kept in the office. This made it difficult to track medical visits and outcomes from the daily diary sheet as a lot of other information is also recorded on these sheets on a daily basis. In order to address this, it is recommended that a separate individual record is maintained of all health care professional visits for each resident. This could be held in the care file along with other relevant information. This should record the date of the visit, reason for the visit and outcome. The health care element of the individual care plan may need to be amended if significant outcomes become apparent. This would ensure that an easy access, good record is kept of health Care Homes for Older People Page 15 of 37 Evidence: care visits and the frequency of need. At the last key inspection in July 2008, it was clearly evident that medication was not being managed appropriately or safely. Since that time, there has been considerable involvement from a pharmacist inspector from the Care Quality Commissions. The pharmacist inspector has undertaken a number of random inspections over a period of months to look at the medication processes in the home, observe the way that staff were managing medication and to advise and guide staff on managing medication safely in order to protect the people living at the home. Improvements were slow to happen. There was particular concern about the number of medication mistakes that were occurring resulting in some people not getting their medication given to them as prescribed. Medication was not organised properly and there was also concern about how medication recording was managed that resulted in some residents not receiving their medication when they should have. As part of this key inspection site visit, the Care Quality Commission pharmacist inspector also again visited the home to check how medicines were being handled. On this occasion it was noted that improvement had been made. We found medicines stock to be well organised, records were clearly presented and spare stock was stored securely in clean and tidy rooms. Records of medicines received into the home, given to people and disposed of were usually signed and up to date. We saw regular recorded checks that were carried out weekly and monthly to make sure staff were giving and recording medicines correctly. When any mistakes were found action was taken immediately to help prevent them happening again. We saw an example of good practice when a person was allowed to lie in bed until later that morning, staff gave them some painkillers that they needed but then later returned to give them the rest of their medicines. This shows that staff are considering the feelings and individual needs of people who live in the home. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We saw some good information about how when required medicines were to be given but found some of these were not fully up to date, for example, one person was taking a medicine for anxiety every day but the care plan said they only needed it occasionally. Having clear written care plans helps make sure people get their medicines when they need them. We looked at how people were supported to look after their own medicines and we saw good procedures for this. People were encouraged and helped to do this and we saw Care Homes for Older People Page 16 of 37 Evidence: examples of people managing their medicines safely. We looked at how staff were trained to handle medicines. Some staff said they had attended medicines training in the last six months but not all certificates were available on the day of the visit. Some staff had been formally assessed for competency when handling medicines but this had not been completed for all, the manager said the remaining staff were to be formally assessed as soon as possible. Regular training and competency checks on staff help make sure they have the necessary skills to handle medicines safely. Whilst it is acknowledged that the way medication is managed has now been significantly improved, it is essential that this improvement can be evidenced, over a period of time, to be consistently maintained. The regular, on-going, internal medication audits that help to quickly spot any medication miss management should continue along with regularly ensuring that staff with responsibility for the administration of medication remain competent. This is essential to protect the people living at the home and to ensure safe medication practices. It was observed that the privacy and dignity of residents was well respected and that staff were sensitive and mindful of residents feelings. One resident told us on a survey form that, Over all, care very good. Another person said when asked if they would like to add anything else, Only that I am very happy and comfortable here, and all the staff who work on my floor are very kind. Staff receive training in respect of maintaining privacy and dignity during their induction training and National Vocational Qualification (NVQ) training, a qualification that the majority of staff working at the home has achieved. Care Homes for Older People Page 17 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and nourishing meals are provided however they do not necessarily meet the expectations of some people living at the home. Evidence: Daily routines are kept flexible to take into account individual preferences. Some activities are provided and in one unit it was evidenced that there is a formal weekly activities programme. However a carer explained that the activities programme is not always followed as residents daily preferences are taken into account and different activities may be provided other than those on the activity schedule. In this particular unit, although activities and interests are identified on the individual social care plans, the carer said that these were not necessarily taken into consideration when determining social activities. However on the day of the site visit, one of the units was preparing for a St Georges day party, a party had taken place on St Valentines day, and there are occasions when residents do have opportunity to go out in the shared mini bus for an outing. Religious festivals and birthdays are also celebrated. One carer told us that sometimes staff will take residents out to a local supermarket for tea. This same person said that activities Care Homes for Older People Page 18 of 37 Evidence: are very individual and dependent on staffing levels. On another unit, a member of staff said that sometimes residents enjoyed dominoes, reminiscence and dancing. It was also pointed out that some residents are difficult to engage in social activities. When talking about activities provided in the home, one resident told us, I get a little bored. From comments on some of the resident and staff surveys, this is an area that should be developed to provide more meaningful activities that meet peoples interests and needs. One resident told us, General lack of activities - days are long and lack stimulation. Staff need time to do the activities but time seems to be in short supply. External people could be brought in to do activities - trips out are also lacking. Another resident said, We use to do activities but over the last few months they have stopped even when there are three people on duty. I have heard comments like they are all older now and cant do the same. We use to make cards or have a go at craft making but not any more. Some staff also commented about lack of stimulating activities with one person saying, Have activity days (organised) by professional activity or occupational therapist coordinators. Work more with clients mobility, ie individual exercises and tasks to do each day. However another person told us I very rarely take part in activities out of choice but I do enjoy attending the parties and I enjoy the entertainers coming in. A member of staff, in answer to the question, What does the service do well commented It provides a lovely atmosphere most times. Clients are made to feel important and have activities to occupy them, outings and entertainment etc. On the same site as the care home, a day care facility is provided. A small number of residents do attend and enjoy activities that are provided for day centre service users. In order to address some of these issues, a member of the management team is currently undertaking an extended activity development training programme covering a range of interests. The person undertaking this training in also cascading the training to other members of the staff team so that more appropriate activities can be provided by members of staff in order to meet the expectations of people living at the home. The manager explained that because of the current low occupancy, staff have sufficient time to provided a good social activity programme that is suited to the needs and abilities of all people living at the home. However Milbanke care home is also hoping to recruit volunteers from the local community to assist in providing social stimulation and some interviews regarding the recruitment of volunteers is to take place in the near future. It was noted that in one of the units a hard backed book was being used to record the activities undertaken and which residents had participated in that particular activity. Care Homes for Older People Page 19 of 37 Evidence: Whilst this is good practice, in order to maintain confidentiality it is recommended that activities enjoyed by each resident be recorded on a separate sheet. This can be a continuing record of activities enjoyed by one person over a period of time. This does not prevent a collective record of all activities provided or arranged to be recorded. People living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Residents are involved in choosing the decoration for their own bedroom and encouraged to personalise this personal space with their own important things. Individuals are also supported to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member takes on this responsibility. Details of advocacy services are also made available for residents and their family to access if and when they choose. Visitors are made welcome at any time of the residents choice and there is a good relationship between relatives and staff. Visitors can be entertained in any communal area of the home or in the privacy of individual bedroom accommodation. People living at the home are provided with well balanced and nutritious meals with a choice of menu however this is not always to every bodys taste and choice. While some people told us that, The food is very good and Meals have improved over the last few months and the presentation has improved, but we get a lot of mince, other people thought there was room for improvement. Although most people that completed a survey said they usually like the meals served, comments were made about the repetition of some foods. For example one person said, Good on the whole at lunchtime but very samy at teatime, lots of sandwiches! Sometimes food isnt too hot. Another person said, Too much pastry. The manager at the home is aware that this is another area that could be improved. There is at present some discussion going on with residents about what they would like to see on the menu for each mealtime and also if they would like an occasional take away meal. Consideration is also being given to moving the main meal of the day from lunchtime to the evening. This would allow residents that enjoy a lie in the morning to enjoy the main meal of the day in the evening instead of having a late breakfast and then not wanting a main meal soon after. As observed, staff assist residents at mealtimes discretely to maintain the dignity of the person. Specialist diets in respect of medical, religious or cultural requirements can be provided if required. Menus are periodically changed to reflect the seasons and residents are encouraged to have their say about meals and mealtimes. Care Homes for Older People Page 20 of 37 Care Homes for Older People Page 21 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good safeguarding procedures help to ensure that people remain safe in this home. The complaint procedure is clear and accessible meaning that residents and their relatives feel listened to and taken seriously. Evidence: Milbanke Care Home has the corporate complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the site visit, a record of complaints is kept that includes details of any action or investigation undertaken. Written details of the complaint procedure is incorporated in the Service User Guide, a copy of which is provided to each resident. Since the last key inspection, one complaint had been received at the home. This was thoroughly investigated using the corporate complaint procedure. The complaint was upheld. This shows that complaints are taken seriously and acted upon to improve the service. From comments on the resident surveys that were returned, it is clear that residents living at the home are very clear about who they would talk with if they did have a concern or complaint. One person told us, I would tell the care staff, they would sort it out. Another person said, I would go to one of the care staff, but Im never not happy. Care Homes for Older People Page 22 of 37 Evidence: Milbanke Care Home continues to have a variety of policies and procedures in place for the protection of residents. This includes the corporate adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse, refresher training is provided annually. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Although currently infrequent, opportunity is also provided for this topic to be discussed during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Since the last inspection one safeguarding referral has been made. This was throughly investigated by a variety of agencies under the local safeguarding protocols. This matter is now concluded, however the organisation is now subsequently investigating the concerns by way of their internal policies and procedures. Care Homes for Older People Page 23 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is excellent and provides residents with an attractive, homely and well-maintained place to live. Evidence: Milbanke care home is purpose built, situated on a main thoroughfare and located in a residential area of the town. Accommodation is provided on the ground and first floor of the building and there is a passenger lift for ease of access to the upper floor. The home has lawns to the front, side and a rear garden area. There is also a car park. The home is well maintained and provides excellent accommodation. The building is divided into four separate units although one of the self contained units is currently not operational. Each unit comprises of a large communal lounge and dining area, a smaller separate quiet lounge, bedroom accommodation and bathing and toilet facilities. All bedroom accommodation is for single occupancy and some bedrooms are provided with an en-suite facility. The main lounge and dining room in each unit in use, are provided with space saver kitchen units providing facilities for making drinks and snacks. Communal areas of the home are bright, welcoming and airy. Pictures and ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. Milbanke care home is close to the centre of the town and all local amenities. Care Homes for Older People Page 24 of 37 Evidence: The purpose built accommodation has been designed to accommodated people with a variety of needs and requirements. Two of the units provide accommodation for older people and the third unit is an extra care unit specifically designed for people with a diagnosis of dementia. Each bedroom is spacious and comfortable. To ensure safety, radiators are guarded and there are thermostatic devices on all hot water outlets in resident accommodation to prevent the risk of accidental scalding. A lockable facility is provided for the safe storage of personal items and all bedroom doors are fitted with a lock to ensure privacy. Aids to independent living, including grab rails, hoists and assisted baths are provided to meet the needs of residents accommodated. As at previous inspections, Milbanke care home remains clean, hygienic and very well maintained with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are in a designated area of the home and situated away from resident accommodation and food preparation areas. The laundry is well equipped and a designated laundry assistant has been appointed. Information in the AQAA confirmed that 13 of the 30 members of the care staff team have received infection control training. This important training should be provided to all staff to ensure that people working at the home are aware of good infection control measures in order to protect residents. Care Homes for Older People Page 25 of 37 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. The people that live at the home are supported by a team of staff who know them well, but some staff have not, as yet, received up to date health and safety training. This could put some people at risk. Evidence: Currently occupancy is low. The homes manager confirmed that there were sufficient staff on duty at all times to ensure that the needs and requirements of all residents are met. As the intermediate care unit is not operational, staff from this unit are also working in the other three units and this has allowed for generous staffing levels in some units, especially in the extra care dementia unit. In addition to management and care staff, domestic staff, a laundry assistant and catering staff are also employed. Recently the night time staffing arrangements have been reduced. Now there are two waking watch members of staff and a member of the management team sleeping in. However the homes manager does have a flexible budget to bring in additional night staff should a resident be ill or for any other reason that an additional member of staff may be required. The manager confirmed that to date, there has been no incident when additional staff had been required and he had not been made aware of any occasion when the night time needs and requirements of residents had not been met. However we were told on a resident survey that, I need help during the night to go to Care Homes for Older People Page 26 of 37 Evidence: the toilet, this sometimes is not always forthcoming. It is important the residents are regularly asked if their night time needs and requirements are being met and staffing levels for the night time period should be kept under constant review. Residents spoken with, spoke highly of the staff team, some of whom have worked at the home for a considerable period of time. One member of staff told us, The staff are usually friendly and very approachable, good care workers. Another member of staff in answer to the question, what does the care home do well? said Provides a secure, clean and warm, homely environment and the majority of staff seem to be very caring and willing to learn. A resident wrote that she was ,Very happy at Milbanke and another person said, Over all, care very good. However a member of staff also told us that communication systems within the home could be strengthened particularly between the management team and care staff and another person said, Some staff need to be more person focused and less task orientated. Carers need to spend more time to do activities in the home. A third person said, We could do with more feedback on any concerns raised on residents. National Vocational Qualification (NVQ) training is promoted, with 19 of the 30 members of the management and care staff team having achieved at minimum a Level 2 of this award. An additional, three members of staff are currently undertaking the more advanced Level 3 of this award and a further member of the management team has achieved a Level 4 qualification and the Registered Managers Award. NVQ training is a nationally recognised qualification for care staff and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. From discussion with the homes manager it is understood that although the nationally recognised, Skills for Care induction training for care staff is available at the home, the two most recently appointed members of staff have not been provided with this training. It is important that any newly appointed member of staff that has not already done so, undertakes this training within the first few weeks of employment. This would make sure that newly appointed care staff had the basic skills and understanding to ensure that they were competent to provided an appropriate level of care and support. Additional training is also provided that is valued by staff. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is promoted by a well trained staff team. However a number of staff also made it clear that further additional training is still required particularly with regard to dementia care and some health and safety Care Homes for Older People Page 27 of 37 Evidence: training. A member of staff said, We have the necessary training in moving and handling and the safe handling of medication but we could do with more varied training in dementia care, challenging behaviour, time management, recording information, first aid, policy and procedures, health and safety at work etc. The same person, when asked if there was anything else she would like to tell us, went on to say, Just that the care home could be so much better and offer a better quality of care with some investment in staff training and employing activity leaders to come in and organise activities regularly on the units. In general, I feel the home is a comfortable place to be. With some changes it could be fantastic. We spoke individually and in private with eight members of the care staff team and one member of the domestic staff team. In addition, two further members of care staff were spoken with collectively in one of the units. Although some people did explain that they would benefit from further training, generally most people we spoke with did feel that they were well trained in order to provide a good service. The management team at Milbanke care home are well aware of these issues and an in-depth, Stirling University dementia care training package has already been arranged. Eighteen members of staff will commence this training in the near future. There will be a rolling programme of this specific training delivered in-house, until all members of the management team and carers at the home have undertaken this course of study. It was noted that the home does not keep a clear and concise staff training matrix. Therefore it was difficult to establish just what training staff had been provided with including mandatory health and safety training. It is recommended that a staff training matrix be developed in respect of all staff. This would provide evidence of all staff training that had been successfully completed, what training is still required and provide a trigger for when refresher training is due. The local authority carries out the required range of background checks on all staff including a Criminal Records Bureau (CRB) check. We looked at the recruitment process for the two most recent members of staff and found this to be robust, safe and promote equality and diversity. This helps to keep people living at the home safe and to make sure that only staff with the right personal qualities are employed to care for and support vulnerable people. Care Homes for Older People Page 28 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed with systems, policies and procedures in place to ensure that the health and safety of staff and people living there are promoted and protected. However some staff have not received all the recommended health and safety training and therefore residents may not be sufficiently protected. Evidence: Milbanke care home has been without a registered manager for a considerable period of time. This has been an unsettling period with a number of different people managing the home on a day to day basis. Staff have not been properly supported and the home has had little direction in order to make positive changes. However, recently a new manager has been appointed. An application to register this person with the Care Quality Commission has been received. It is understood that the application process is now almost completed. However in order for the manager to be registered with the Commission, this person with have to demonstrate that they have Care Homes for Older People Page 29 of 37 Evidence: the qualifications, experience and personal qualities to run the care home in the best interest of the people that live there. There are clear lines of accountability within the home and external management. An area manager from the organisation visits the home on at least a monthly basis to audit records and to speak with resident and staff. This helps the area manager to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. Quality assurance systems are in place to identify if the needs and expectations of people living at the home are, in the main, being met. However this could be strengthened to make sure that the system is robust. Because of recent management changes within the home, some of the established ways of receiving feedback from residents has unfortunately lapsed. Ad-hoc resident meetings are occasionally taking place but this needs to be a more planned process so that residents can feel confident that they have a formal platform to air their views. Most residents that are able, do however have informal one to one discussion with members of staff. This does provide some opportunity to make their views and opinions known. There was also evidence of a How Was Your Week questionnaire. This asks specific questions about the environment at the home, attitude of the staff, meals, if residents felt their views were listened to, whether staff respond to concerns, if individual needs were being met and a space for any other comments. It is planned that this questionnaire will be distributed to residents on a two monthly basis. This will help to keep track of internal quality monitoring. Corporate resident and relative questionnaires are also provided on a bi-annual basis that helps to inform the organisation if needs and expectations are being met at the home. Customer complaints, concerns and complements leaflets are freely available in the home and there is an open door policy for relatives. Staff meetings have also being taken place occasionally, although more frequently of late. In the recent past, two meetings have taken place for care staff, a night staff meeting has taken place, there has been a catering staff meeting and there have been two residential care officer meetings. Some of these meetings have taken place on more than one occasion to make sure that as many staff as possible are able to attend. This all helps to make sure that as much information as possible is shared between the staff team and also provided opportunity for all staff to have an equal say on matters of importance. Now a new manager has been appointed, it is planned that staff meetings will routinely take place on at least a three monthly basis.The home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Care Homes for Older People Page 30 of 37 Evidence: People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home do retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate records of any financial transactions undertaken, secure facilities to hold monies and regular financial audits by the local authority. Through discussion with the manager and members of staff it was clear that formal supervision has been infrequent although some very limited supervision is now taking place. Staff spoken with confirmed that supervision had not taken place for a very long time with comments such as Not had formal supervision over the last 12-18 months and, Supervision, never had one to one supervision, would love it, use to have it in former employment and Not had supervision for at least twelve months and, Last supervision was in August, I feel in limbo. It is clear that staff value one to one supervision and formal, regular, one to one staff supervision should be re introduced as soon as possible. This provides opportunity for the development of the staff member and the ultimate good care of residents. All staff do receive daily informal supervision as part of the management role. Generally there are good arrangements in place for maintaining the health and safety of those living at the home. Maintenance records were available to confirm that various routine health and safety checks are maintained on a regular basis including weekly fire alarm tests, the testing of small electrical appliances and servicing of equipment. It is also noted that the water temperature of hot water outlets in resident accommodation is routinely tested and recorded. This helps to prevent the risk of accidental scalding. Good, detailed environmental risk assessments are in place and a new fire risk assessment had been undertaken in January 2009. It is organisational policy that all management and care staff receive a variety of health and safety training that is regularly updated. This should include, manual handling training and first aid training that are mandatory for all care staff and must be provided, food hygiene training, infection control training and fire safety training are also strongly recommended. Infection control training would equip staff with the understanding and knowledge to help prevent the risk of cross infection and food hygiene training should be made available to all staff that prepare, cook or serve food to ensure safe food and hygiene practices. Refresher training should be provided as recommended to ensure that staff have up to date information regarding best practice. Protection of vulnerable adults training and medication training for those staff that have responsibility for the administration and recording of medication has recently been provided at the home. Care Homes for Older People Page 31 of 37 Evidence: The manager said that most but not all staff had received all the above health and safety training. This was confirmed by some care staff spoken with and some comments on the staff questionnaires. As there was no training matrix available, it was unclear just how many people had not received some or all elements of this training. However there is now a planned programme of the required health and safety training. Fire safety training and risk assessment training is to be delivered to staff within the next two weeks. It is understood that the remainder of the required health and safety training, some of which will be refresher training, is to be delivered to staff within the next few months. It is important that all staff are provided with comprehensive health and safety training for the protection of residents, protection of themselves and to ensure a safe environment. Care Homes for Older People Page 32 of 37 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 33 of 37 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 1 26 13 All staff that have not done so should receive infection control training. This would make sure that the staff group have a good understanding of infection control measures to protect the people living at the home. Care staff that have not done so must receive manual handling training and first aid training. This would help to equip staff with the skills and training to provide a safe working environment for the protection of residents. 01/08/2009 2 38 13 30/08/2009 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. Care Homes for Older People Page 34 of 37 No. Refer to Standard Good Practice Recommendations 1 2 7 7 All records should be signed and accurately dated by the person making the entry. Risk assessments should be automatically reviewed on a monthly basis along with care plans and amended as required. All care plans should be up to date, detailed and accurately reflect current strengths, needs and requirements. All individual care plans held on the units should be detailed and comprehensive to advise and direct staff. It is recommended that a seperate individual sheet for each resident is developed to record medical input visits and outcomes. It is essential that the improvement to the way medication at the home is managed, be consistently maintained. It is recommended that instead of the collective book that is currently used to record the names of people that have enjoyed an activity, a separate individual record sheet is devised for each resident. This would ensure that confidently is maintained. The planned cascade of social activity information should continue to enable all staff to become involved in each units activity programme. An appropriate activity programme should be develop for each unit taking into account peoples individual interests and abilities and including those identified on the individual care plans. The activities programme should be kept under consistant review so as to make sure that residents do not become bored with the same activities over an extended period of time. Following the current consultation process with residents, new menus should be devised that suit residents taste and choice. Internal quality assurance systems should be strengthened to make sure they are robust. Resident meetings and staff meetings should take place on a planned, regular basis. Formal, planned, one to one staff supervision should take place at least six times a year and should cover at minimum all aspects of practice, philosophy of care in the home and career development needs. Food hygiene training, infection control training and fire safety training should be routinely provided to all care staff. Arrangements should be made to provide this training as soon as possible for all members of the care staff team that Page 35 of 37 3 4 5 7 7 8 6 7 9 12 8 12 9 12 10 15 11 33 12 36 13 38 Care Homes for Older People have not received this important training. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - 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!