Inspection on 23/06/08 for Milbanke HFE

This inspection was carried out on 23rd June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Milbanke HFE Station Road Kirkham Lancashire PR4 2HA Lead Inspector Denise Upton Unannounced Inspection 23rd June 2008 09:05 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.V363552.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.V363552.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 christinapelmore@careservices.lancscc.gov.uk Lancashire County Care Services Vacant Post 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.V363552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 44 service users to Include:: 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) Up to 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. 28th August 2007 2. Date of last inspection Brief Description of the Service: Milbanke Care Home provides 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. 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. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience an adequate quality outcome. This unannounced site visit took place during the course of an extended midweek day and in total spanned a period of approximately ten and quarter hours. Twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a partial re-assessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the home’s temporary manager, the organisation’s area manager, four care assistants and a District Nurse who was visiting the home. In addition, individual discussion took place with three people living at the home and two relatives. Several other residents were also briefly spoken with in various communal areas of the home. A second inspector also spent a period of time observing the care needs being given to a small group of people living at the home. The time spent observing residents daily life and care staff practices found that significant improvement had been made to the time staff had to spend with residents to ensure they were kept safe. Care staff also had time to engage with residents in social activities either individually or in small group activity. A number of records were examined and a partial tour of the building took place that included communal areas of the home and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the home’s temporary manager. On this occasion no Commission for Social Care Inspection surveys for residents and relatives were completed. The temporary manager explained that no surveys had been received to give out to residents and relatives to complete. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Currently the fees at Milbanke Care Home range from £390:00 to £407:500 per week for residents who permanently live at the home. Different rates apply for people who are admitted for a period of respite care. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been significant improvement in the time available to support residents individually and collectively. Extra staff have been made available and this has enabled residents to enjoy more social activities in the home and wider community. The majority of care plans that guide and direct staff have been considerably improved. However not all care plans have been updated and therefore in a small number of instances, staff have still not received sufficient written information to ensure a holistic and consistent service is provided. Better risk assessments are also in place. This helps to protect residents. Staff have received some recent training that includes, adult protection training and dementia care training. Although care staff have previously received manual handling and first aid training, the manager explained that for some people this training needs to be updated. Since the last inspection the home’s Service User Guide has been revised and amended to contain more up to date information. This tells residents and prospective resident about the services and facilities provided at Milbanke Care Home. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 8 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.V363552.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. The Service User Guide is now revised and updated and provided to newly admitted residents. In the main this provides accurate information about the services and facilities provided at the home. However the existing Statement of Purpose has not, as yet, been updated and therefore does not provide up to date information as required. The pre admission assessment enables an informal decision to be taken to make sure that the prospective resident’s current strengths and needs could be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 10 Since the last inspection the home’s Service User Guide, that gives information about the services and facilities available including details about the staff group, has been revised and updated to good effect. This information, that is provided to newly admitted residents, is clear and detailed and made available in larger print so that people can read it more easily. However some of the information provided is already out of date including details of the registered manager, the area manager and the current cost of accommodation at Milbanke Care Home. The Service User Guide should be amended to reflect these changes. At the last inspection it was established that the home’s Statement of Purpose was also in need of review and update as it contained inaccurate and out of date information. This has not been done. There is a requirement that the Statement of Purpose must set out the aims, objectives, philosophy of care, up to date services and facilities and terms and conditions of the home. The Statement of Purpose must be revised, updated and made available to residents, relatives and any other interested parties as soon as possible. People are only admitted to Milbanke Care Home if their needs and requirements could be met. A member of the management team completes an assessment of all prospective residents, prior to admission to the home to make sure that the staff team can provide the level of care and support required. This includes visiting the prospective resident in their current environment in order to undertake an initial assessment of current needs and requirements and to provide further information about the home. Prospective residents and/or their family are also invited to visit to the home as frequently as they wish to assess the accommodation for themselves and meet staff and existing residents so that they can make informed choice about living there. It was also evident that in some instances, other health and social care assessments had been obtained to supplement the pre admission assessment undertaken by a member of the management team. This combined information helped to make a decision as to whether the needs and requirements of the individual could be met and formed the basis of individual care plans. Milbanke Care Home also provides a designated seven-bed intermediate care unit. This unit provides specific, time limited accommodation to people who require further assessment, rehabilitation and support with the intention that the individual will return to live in their own home. However it is understood that more recently, the majority of people who have been admitted to this unit have been subsequently assessed as requiring long-term residential care. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 11 Prior to admission to the intermediate care unit, a care manager assessment is provided and an occupational therapist, physiotherapist and district nurses from the local district nursing team also undertake assessments soon after admission. Following these professional assessments, a task sheet is then devised and it is the responsibility of the support staff to ensure the requirements of the task sheet are carried out as directed. Support staff record, sign and date an entry when a task is completed. Risk assessments are undertaken and risk assessments are on occasions, also provided by the person’s care manager. Task sheets are updated as required. Although there is a formal review system in place that includes the professional staff involved and support staff working in the intermediate care unit, when a resident has been accommodated in the intermediate care unit for an extended period of time, formal reviews are not necessarily taking place on a monthly basis. It is recommended that in these circumstances support staff carry out a review especially in relation to social, emotional and psychological care needs to ensure that these areas of care are not neglected. It was also noted that the occupational physiotherapist and/or occupational therapist updated the task sheet as required, but the new instruction is not always signed or dated. It is recommended that all entries to documents be signed and dated by the person making the entry to confirm accuracy and to take ownership of the recording. When discharge is planned, a home visit is arranged for the individual with the occupational therapist, a support worker and usually the person’s relatives to ensure the home environment is appropriate. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. There is now, in the main, a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. However, not all care plans have been revised and updated. This means that in a minority of instances, care staff are still not provided with sufficient, relevant written information to ensure that a consistent service is provided. The medication in this home is generally well managed however there were some inconsistencies that could potentially be detrimental to resident’s health and welfare. It was observed that personal support was provided in such a way as to promote and protect the privacy and dignity of residents. This judgement has been made using available evidence including a visit to this service. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 13 EVIDENCE: A number of care plans were evidenced in various units within the home. In the majority of cases the care plans had been reviewed and updated to good effect using the Saturn system of care planning and risk assessments. These were informative and gave staff clear detail and direction to provide a good quality and consistent level of care. The home had a number of risk assessments in place, including nutritional assessments that were reviewed. These also enabled staff to monitor the resident’s progress and provide additional support where necessary There was some evidence of very recent monthly reviews on some of the updated care files. Care staff spoken with confirmed that monthly reviews do take place but that the actual review notes are not kept on the units. Later this was discussed with the manager who also confirmed that written monthly reviews do take place but these could not be located at the time of the site visit. A few days later the missing monthly review records were found. A system is in place whereby care staff write the monthly review, this is then sent to the office where one of the residential care officers or the home’ administrator inputs the information onto the computer and the updated care plan is then sent to the individual unit. On one unit however, a number of care plans had not been updated and still contained insufficient information to guide staff. As at previous inspections, in these instances the care plans evidenced were poor with little direction provided to staff on how a strength or need was to be addressed. Again in some cases it was again difficult to see how some of the comments written in sections of the care plan related to the individual’s specific strengths and needs. This is particularly disappointing as an additional period of time had been requested by the organisation in order to undertake the task of reviewing and updating all care plans. Following the last inspection, agreement had been reached between the Commission for Social Care Inspection (CSCI) and the organisation’s area manager that all care plans would be reviewed and updated by the middle of January 2008. This clearly has not been the case. It is essential that the remaining care plans that still require reviewing and updating to provided a comprehensive and detailed account of the individual residents assessed needs and requirements, be completed as a matter of urgency. It is understood that some staff have now been provided care plan training. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 14 At least one of the ‘older’ style of care plan/personal information communication record, had what appeared to be the original date(s) tippexed out and the document not signed or dated. It is unclear why an existing document should be amended in this way. All records should be as originally written. Any amendments should be clearly highlighted detailing any further instruction/direction and signed and dated. No information previously recorded in a written document should be tippexed out. The majority of care plans are now situated in the main communal area in each unit rather than locked cupboard on a corridor. This has helped to ensure that staff are more familiar with the content of individual care plans and that these become a working tool rather than an unused written document. It was noted that a gentleman had been admitted into permanent care at Milbanke Care Home from the intermediate care unit. There was no evidence that a formal, detailed pre admission assessment had been undertaken by the management team prior to this person being admitted for long term, permanent care at the home. Any person that is admitted to the home for a period of intermediate care should not be admitted for long-term care unless a detailed pre admission assessment is undertaken to ensure current needs and requirements could be met. At the time of admission, a rudimentary written care plan, that can be expanded upon, should be in place to direct and guide staff based on the outcome of the home’s pre admission assessment, risk assessments undertaken and any current assessments of other professional staff involved in their care. Although this person had been transferred from the intermediate care unit a week previously, no care plan could be evidenced. It is understood that this was in the process of being developed. Therefore staff in the unit where this person was accommodated were having to rely on verbal information sharing or any written information in the daily dairy. Never the less, residents in the main were receiving an adequate service that met their needs and requirements. A small number of residents briefly spoken with in various areas of the home during the course of the day were satisfied with the level of care provided and spoke highly of the staff group that were seen to be kind and caring towards residents accommodated. Staff spoken with appeared to be familiar with the preferences and wishes of each resident accommodated in that unit. There was evidence that the health care needs of residents were well met. There is a good relationship with health and social care professionals in order to maintain health and social well-being. A number of health and social care professionals are routinely involved in the home. These included GP’s, district nurses, occupational therapists, physiotherapist, and continence advisors. A District Nurse who visited the home during the course of the site visit said that communication between carers had improved since the last inspection and that Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 15 information was been passed on at change of shift. The District Nurse also said that staffing in the dementia care unit had improved and that “regular staff in the home were always very helpful and the management side was also very helpful”. This same person felt that there was “definitely an improved service”. The District Nurse again stated she felt that there was good input from the home when requesting medical assistance. The home has good systems in place for the administration and recording of medication. Staff that have responsibility for the administration of medication have all received appropriate medication training. A record is kept of all drugs received into the home or disposed of. All residents who wish to are enabled to self-administer their own prescribed medication following the outcome of a specific risk assessment to ensure that the individual is competent to do so. A locked facility is provided in individual bedroom accommodation for the safe storage of medication. However it was again noted that there were occasional dose omissions on the drug administration records without explanation. In one instance one medication was recorded as being administered ten days ago but the medication was still in the blister pack. In another instance a gentleman in the intermediate care unit is prescribed digoxin, the drug administration record was not fully completed on a particular day. It is unknown if the medication had been administered and the drug administration record not completed accurately of if the drug had not been given. This medication was provided in bottles and therefore more difficult to check if the medication had been administered. If this drug had not been given as prescribed, this could potentially have been dangerous and caused harm to the resident. This sort of evidence suggests that some staff are not completing the drug administration record immediately after the drug has been administered. It is essential that the administration record be completed in line with the corporate policy and procedures regarding the administration and recording of medication to ensure that an accurate record is kept. It was also evident that hand written drug administration records are not being signed or countersigned by a second person to confirm that the hand written entry is an exact replica of the dispensing label supplied from the pharmacy. It was evidenced that one hand written entry on the drug administration record in relation to Clifton Unit was not the exact replica of the pharmacy label. This could have serious consequences if medication was administered not as prescribed. In the intermediate care unit a collective bound book is used to inform staff of any changes to the prescribed medication of residents. This is not good practice. In order to ensure confidentially, each resident should have a separate sheet to record confidential information that staff should then access as required. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 16 It is recommended that a regular internal medication audit system be re established to assist in highlighting any medication recording errors that may occur. The evidence obtained could then be used to identify areas of concern and assist in advising staff of the correct procedures to be followed. Staff were observed to speak appropriately to residents and treat them with respect. Residents spoken with said that staff were good, they will do anything they can to help. Maintaining privacy and dignity on the extra care unit has improved since the last inspection. Staff were observed to use equipment safely including hoists and wheelchairs, told residents at all times what they were going to do and ensured their dignity was not compromised by adjusting clothing discretely and ensuring residents remained clean and tidy if they spilt some food. This is in part, because additional staff are now employed in the unit and have more time to supervise residents. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Residents are now more able to experience a lifestyle that satisfies their social or recreational interests and needs. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that meets individual taste and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 18 The atmosphere in the home was relaxed and staff morale has improved since the last inspection. This helps to create an environment where residents feel comfortable. Visitors are welcome to visit the home at any reasonable time and could visit residents in the privacy of their own individual bedroom. One visitor spoken to on the day of the site visit said she visited her relative very frequently, felt comfortable visiting the home and that staff were approachable. A resident spoken with confirmed that people are able to exercise choice in their chosen daily life style and choose to do what they want to do. This resident was about to visit the local shops on his motorised wheelchair, an almost daily occurrence weather permitting. The range of “in-house” activities has improved. Different activities are provided on each unit to suit the needs of people living there. Care plans evidenced identified social care needs and requirements. This was particularly pleasing in the dementia care unit. Dancing, sing a longs, nail painting, puzzles and ‘quizzes’ now regularly take place. One resident attends communion on Sunday that was recorded in his care plan. Events such as national and international football competitions and wins are celebrated and it is understood that an event was organised for St Georges Day. Garden games have been purchased along with a large ‘connect 4’ for residents to enjoy. Local schools occasionally visit to give a concert and the temporary manager is hoping to rekindle opportunities for young people from a local high school, undertaking a health and social care course to visit the home on a weekly basis as part of their course work. One carer spoken with stated that in the main planned activities are recorded but impromptu activities that take place on an ad-hoc basis are generally not recorded. It is suggested that all social activity that takes place be recorded to provide a detailed record of what has been enjoyed or what has been less successful. The inspector who conducted the SOFI observation found that as residents and staff normally accommodated in the extra care unit had access to outdoor garden areas through the patio doors, staff were able to gently persuade all residents outside into the sunshine and residents had a sing a long and a game of soft ball. Staff said it was nice to have the outdoor space even if it was only for a short while. Staff also ensured all residents signed a birthday card and helped two residents to wrap a present. Staff interaction was continuous and good. A number of residents who live at Milbanke Care Home also attend a day care facility, situated on the same site, for varying period of time and enjoy the company of other people who do not live at the home. A different range of activities is offered in the day centre that resident’s who attend, enjoy. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 19 Recently a summer fare was organised attended by relatives and people that live in the local community. A sum of money was raised that has been used to hire a bus to enable residents to visit places of interest and for lunches out over the coming weeks in the summer. People living at the home are encouraged to maintain control of their own financial affairs for as long as they wished to be or assisted in this task by their family or advocate. Information regarding the local advocacy service is made available to enable residents and/or relatives to access independently if they so wish. From observation of some individual bedroom accommodation, it was clearly evident that people are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel more homely and comfortable. At previous inspections people living at the home said that they enjoyed the meals at Milbanke Care Home and confirmed that a choice of menu was always available that suited their taste and choice. Residents are offered a varied, wholesome and nutritious diet and specialist diets in respect of religious, cultural or medical need can be accommodated. Fresh fruit and vegetables are provided and residents can select an alternative from the menu choices. As observed, hot and cold drinks and snacks are also made available throughout the day to supplement main meals. There is still a wipe board in the kitchen to advise catering staff of individual requirements especially in relation to specialist diets. To strengthen this process and ensure that up to date information is always provided, a computer generated record identical to the information written in the care plan is to be developed to advise catering staff of the exact requirements of each individual. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has developed a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. All members of staff have now been provided with formal adult abuse training that helps to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive, corporate complaints policy in place, which included all of the required detail and outlined the steps that could be taken if a resident was unhappy with the service provided. The policy was made available to residents and their relatives. Since the last inspection six complaints were received by the home and one complaint was received by CSCI. All of the complaints were resolved within 28 days none of the complaints were upheld. The complaint received by CSCI was Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 21 investigated externally from the organisation, however the home fully cooperated in the investigation. As observed the relationship between staff and residents is relaxed and friendly and residents and relatives spoken with in the past all stated they would have no hesitation in raising any concern or complaint directly with a member of the management team. Milbanke Care Home continues to have in place a variety of corporate policies and procedures for the protection of residents. These include an Adult Protection Policy based on the `No Secrets In Lancashire’ document and a whistle blowing policy to help protect people living at the home from abuse or discrimination. Further corporate policies and procedures for the protection of residents are also in place that includes aggression, restraint and financial procedures. It is understood that all staff have now received updated adult protection training. This helps to protect both residents and staff. Staff spoken with in the past understood what they must do if an allegation of suspected abuse was made to them. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. The standard of the environment within this home is excellent and provides residents with an attractive, homely and well-maintained place to live This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milbanke Care Home continues to provide excellent accommodation that is attractive, comfortable and a welcoming place to live. The building is divided into four separate units each comprising of a large communal lounge/dining Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 23 area, a smaller separate quiet lounge, bedroom accommodation and bathing and toilet facilities. The main lounge/dining room in each unit is provided with facilities for making drinks and snacks. The space saver kitchen units, located in three of the individual units are in the process of being replaced. The annual quality assurance assessment (AQAA) completed by the temporary manager, indicates that the patterned carpet in the extra care unit is also to be replaced. Currently, residents are spending the waking day in different areas of the home but sleeping in their own bedroom accommodation while the work is being completed. This purpose build accommodation has been designed to accommodate residents with a variety of needs and requirements. Two of the units provide accommodation for older people, one unit is a designated dementia extra 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. All bedroom accommodation is for single occupancy some of which is provided with an en-suite facility. Each bedroom is spacious and comfortable and provided with a lockable facility for the safe storage of items of a personal nature. All individual bedroom doors are fitted with a lock with the occupant being offered the key within a risk assessment framework. Aids including grab rails, hoists and assisted baths are available to meet the needs of residents accommodated. Outdoor areas of the home are spacious, provided with seating, hanging baskets and tubs and a sensory garden. Further improvements are planned including improving the landscaping to parts of the grounds to enhance the appearance and to provide more privacy for residents. The 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 sited away from food preparation areas and do not intrude on residents. The laundry is well equipped and a designated laundry assistant has now been appointed. According to the Annual Quality Assurance Assessment (AQAA) completed by the temporary manager, all staff have received infection control training. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Improvements have been made in order to ensure a stable staff group, however currently there is still some reliance on casual/agency staff There is a good match of permanent members of staff who demonstrated an understanding of their roles The standard of vetting and recruitment practices are good with appropriate checks being carried out to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection staffing levels have improved. At the time of this inspection there were sufficient care staff on duty in each unit to ensure that the holistic needs of all residents were being met. In addition, a laundry/domestic post has been created. Care staff consistently said that this had made a big difference to the time available to spend with residents and Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 25 that there had been all round improvement to the care provided. It was also evident that staff morale had also improved significantly that helped to create a more relaxed environment for people to live. There continues to be some dependency on the use of agency staff. This is managed by the same agency workers visiting in order to provide some continuity of care for residents. It is understood that several vacant care posts have now been filled. The organisation is waiting for satisfactory references and clearances to be received before the applicants can begin working at the home. Once these people are in post, the reliance on agency/bank staff should be significantly reduced. At the time of this site visit, no new staff had been appointed since the last key inspection. However the organisation has a corporate recruitment policy and procedure that is followed. At previous site visits, the files of recent appointed staff were viewed and were found to contain all the documentation to confirm that the correct recruitment procedures had taken place to ensure that residents were protected. Previous discussions with recently appointed staff also confirmed that these people had undergone the formal recruitment process before they commenced employment at the home. Staff spoken with were able to demonstrate their commitment to provide the residents with a quality service that met their individual and group needs. Staff spoken with stated that they were clear about their role and generally worked well as a team to ensure the individual and collective needs of the residents were met. A relative spoken with said that she was “really happy with the care she (her mother) is getting, she is well cared for by nice and friendly staff”. Another relative said, “I am really happy with the care, lovely people”. During the course of the site visit, the up to date staff-training matrix could not be located. However from information provided in the Annual Quality Assurance Assessment completed by the temporary manager, 95 of care staff permanently employed at the home has achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. This is commendable and well exceeds the minimum standard expected. In addition, several members of staff have also achieved a Level 3 of this award. The residential care officers are working towards obtaining an NVQ Level 4 qualification to ensure that they have an understanding of the responsibilities of management and that residents are cared for at all times by a staff group who are capable to meet their needs. Discussions with staff and examination of some staff records confirmed that a range of training had been provided, including dementia care training, to ensure that staff had a clear understanding of the specific care needs of the residents accommodated. Staff are encouraged to update their knowledge and skills to ensure that residents receive the correct care to meet their needs. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 26 A member of staff spoken with said that she felt more supported by the management team and included in all aspects of the residents care. There was again evidence of ‘Skills for Care’ common induction standard training being available. However as no new staff had been appointed, it could not be evidenced that this nationally recognised induction training had been introduced. The temporary manager did however say that the newly appointed care staff waiting to take up post would definitely be provided with this training. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. The temporary manager is supported by senior officers in providing clear leadership throughout the home. The systems for resident consultation are good with some evidence that the views of people living at the home are sought and acted upon. Individual staff supervision has been allowed to lapse and until very recently, has not taken place on a regular basis since the last inspection. This does not support staff adequately. Policies and procedures are in place to ensure as far as possible the health and safety of residents, staff and visitors. Although there has been improvement to staff health and safety training, not all staff have received all aspects of this important training. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 28 This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the registered manager at Milbanke Care Home has terminated her employment. Currently a temporary manager who is qualified and experienced and knows the home well is undertaking day-to-day management responsibility. It is understood that a new manager has very recently been appointed. This person will need to demonstrate that they have the required qualifications, skill and knowledge to manage a care home for older people before they would be registered with the Commission for Social Care Inspection. The home has quality assurance systems in place to monitor the level of service being provided for its residents, which included gathering the views of residents and relatives and keeping them informed about events being organised by the home. Resident and relative questionnaires are provided bi annually and a resident meeting is held in each unit on a monthly basis. Each residential care officer has direct responsibility for arranging and chairing a resident meeting for the same unit each month. The Annual Quality Assurance Assessment completed by the temporary manager also highlighted that the home had received ‘positive and encouraging remarks of many residents families and professional visitors to the home. Financial procedures in respect of resident’s monies and the safekeeping of valuables are robust to protect the interests of people living at the home. In accordance with the home’s policy with regard to resident’s monies, all residents are encouraged to maintain control of their own financial affairs. However, appropriate systems are in place for the safe keeping of resident’s monies and accurate and up to date records of financial transactions are maintained. As at several previous inspections, it could not be evidenced that formal staff supervision takes place at least six times a year. From discussion with the temporary manager it was established that in the recent past, only nine members of staff have received formal one to one supervision. This however Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 29 could not be evidenced, as supervision notes had yet to be written. The temporary manager explained that it was intended that all staff would receive formal one to one formal supervision in the near future. After the initial supervision, the responsibility for staff supervision would in part, be devolved to the residential care officers. It is essential that all staff that supervises others have the knowledge, skills and abilities to undertake the task. All care staff should receive formal one to one documented supervision at least six times a year. This should cover at minimum all aspects of practice, philosophy of care and career development needs. All staff do receive daily informal supervision as part of the management role. Policies and procedures are in place to ensure as far as possible the health and safety of residents, staff and visitors. Inspection of maintenance records confirmed facilities and equipment were being maintained as required by health and safety legislation to provide a safe environment for residents and staff. At the time of inspection, the up to date staff-training matrix could not be evidenced. However the AQAA states in the section ‘what we can do better’ that, “we need to ensure that all staff have mandatory training and are implementing a comprehensive training plan”. The temporary manager stated that all staff had received manual handling and first aid training but in some cases this may need updating. All staff had received fire safety training. The AQAA states that 75 of catering staff and 55 of care staff have received safe food handling training and at the last inspection all staff had received infection control training. It is recommended that all staff that have not done so, receive updated health and safety training. Food hygiene training should also be provided for all staff that prepare, cook or serve meals or snacks or assist/support residents at mealtimes. Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 30 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 2 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 3 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 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 4(1)(2) Requirement The Statement of Purpose must be revised and updated and made available to all interested parties. All residents must have an accurate, holistic and up to date plan of care that is regularly reviewed and amended as required. Timescale for action 30/09/08 2 OP7 15 31/08/08 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. Refer to Standard OP1 Good Practice Recommendations The recently amended Service User Guide should contain current information regarding fees and the management structure. It is suggested that a formal review takes place on a regular basis when people are accommodated in the intermediate care unit for an extended period of time. 2 OP6 Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 32 3 4 5 OP6 OP7 OP7 All records in documents should be signed and dated. Written records in documents should not be tippexed out. All prospective residents should be subject to a formal pre admission assessment of current strengths and needs. This includes people accommodated in the intermediate care unit who are assessed as requiring permanent care. A rudimentary care plan based on the pre admission assessment(s) should be in place when a newly admitted person takes up residence. If a dose omission is noted on the drug administration record this should be immediately addressed. It is recommended that a regular internal medication audit is re-introduced. All staff must adhere to the corporate medication procedures at all times. All hand written drug administration records should be signed and countersigned by a second person to ensure accuracy. The hand written medication administration record must be the exact replica of the pharmacy label. Each resident should have a separate sheet to inform staff of changes to medication rather than a collective bound book as at present. Formal one to one care staff supervision should take place at least six times a year. All staff that have not done so should received updated manual handling and first aid training. All staff that have responsibility for preparing, cooking or serving food should be provided with food hygiene training. 6 OP7 7 8 9 10 OP9 OP9 OP9 OP9 11 12 13 OP9 OP36 OP38 Milbanke HFE DS0000032617.V363552.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V363552.R01.S.doc Version 5.2 Page 34 - 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. 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