Inspection on 24/09/08 for Milbanke HFE

This inspection was carried out on 24th September 2008.

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

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 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 30/01/2009.

Inspecting for better lives Random 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: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Upton Date: 2 4 0 9 2 0 0 8 Information about the care home Name of care home: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA 01772 684836 Telephone number: Fax number: Email address: Provider web address: christinapelmore@careservices.lancscc.gov.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Lancashire County Care Services Elizabeth Pelmore care home 44 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 15 1 0 7 Over 65 0 0 21 0 Conditions of registration: 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 Brief description of the care home Care Homes for Older People Page 2 of 10 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. Care Homes for Older People Page 3 of 10 What we found: The primary reason for the site visit was to establish current staffing levels and whether the individual needs and requirements of each resident were being adequately met. From discussion with the area manager it was established that additional staff are now on duty throughout the waking day. This is partly the result of the intermediate care unit being not operational at present and the care staff from this unit being deployed to the remaining three units. At present on Clifton Unit there are three members of staff on duty throughout the waking day. Staff spoken with in this unit said the addition staff hours had made a positive difference although sometimes because of the unpredictable behaviour of some residents, an additional member of staff would be useful on occasions. In Elswick Unit that accommodates up to eight residents, there are now two members of staff on duty at all times of the waking day. Staff in this unit also commented that the additional staff hours were enabling a better quality of care to be provided especially as a number of residents had high dependency needs, including hoisting that required the assistance of two carers. On Newton Unit that accommodates up to fourteen residents, staff spoken with reported that the addition staffing hours provided has had little impact as there were predominately still only two members of staff on duty throughout the waking day. It was acknowledged however an additional member of staff is allocated to Newton Unit for one hour each morning during the medication round. It is understood that the additional person is supernumerary to the staff complement and is not taken from one of the other units to provide cover. The staff in this unit also explained that the laundry post had now been disestablished so care staff stated that they were again spending excessive time out of the unit to attend to residents laundry. This clearly impacts of the time available to provide for the holistic care needs of the residents accommodation in this unit. From discussion with the area manager it was established that the Direct Service Organisation is currently asking management staff to complete a survey detailing the amount of time care staff spend on none care duties. It is hoped that following the outcome of the survey completed in respect of Milbanke, that serious consideration will be given to re-establishing the laundry assistant at Milbanke or alternatively providing additional care hours to cover the amount of time carers have to spend in the laundry. It is also understood that care staffing arrangements in this unit are going to be reviewed in the near future. With regard to management staff, it was established that currently there are three 37 hour officer posts including the homes manager, one 26 hour post and a further temporary 37 hour officer on duty who is supporting the home at this present time. In addition, the area manager is working approximately half of her working week at the home. Care Homes for Older People Page 4 of 10 It was stated that during the night-time period there are three care waking watch staff on duty and a sleeping-in person. Although the member of staff may change throughout the night time period there is always a member of staff on duty in the dementia care unit. Whilst it would appear that except for the Newton Unit, the additional staffing levels have made a difference to the quality of life that residents can enjoy, this must be kept under review and staffing levels determined by the assessed needs and requirements of the residents accommodated in each unit. On the day of the site visit, the facts were also established regarding the recent medication error identified through a Regulation 37 Notice. It is understood that a relief Residential Care Officer (RCO) was administrating medication. The correct night time medication was selected but the RCO then asked residents which was the person named as requiring the medication and one resident said she was. The medication was then secondary administered by a care assistant to this person. Unfortunately there were two residents with the same christian name on the unit and the medication, Perinopril Erbumine 4mg was administered to the wrong person. The primary care trust were contacted for advise resulting in neither resident receiving their prescribed medication that night. It is understood that both residents suffered no ill effects by not receiving their night medication although the Perinopril Erbumine could have lowered blood pressure. There are a number of issues arising from this incident. It was evidenced that there is a picture of each resident with the medication administration records. It is clearly evident that the RCO did not look at the photographs to check the identity of the person the medication was to be administered to. It was also poor practise the medication was secondary dispensed when given to a care assistant to administer to a resident. It is understood that the RCO has been advised about her poor practise and further safety measures have been put into place following this incident. Additional medication trolleys have been provided to ensure that each unit has a dedicated medication trolley. There is now also the manager or an RCO that has received appropriate medication training to administer medication in each of the three units at the same time. This has helped ensure that residents are receiving their prescribed medication at the time intended. It is also understood that weekly medication audits are now taking place that is currently highlighting some mistakes/omissions mainly regarding the recording of medication administered. It is essential that the medication administration records are completed with care and accurately to ensure that a clear audit trail is available. It is understood that medication refresher training is to be made available and that additional members of staff will receive initial medication training. This is especially important as at present, some members of staff appear now to be lacking confidence in administrating medication and need continued support to overcome this. What the care home does well: Random inspection, not all standards assessed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 1 4(1)(2) The Statement of Purpose 30/09/2008 must be revised and updated and made available to all interested parties. 2 7 15 All residents must have an accurate, holistic and up to date plan of care that is regularly reviewed and amended as required. (Not assessed at this visit previous timescale 31/08/08). 09/09/2008 3 9 24(1) There should be an effective system in place to audit medicines and staff competence to make sure medicines are always handled safely. 12/10/2008 4 9 13(2) A legally compliant controlled 12/12/2008 drug (medicines that can be misused) cupboard must be available in the home to store controlled drugs to help keep them safe. 5 9 13(2) When necessary, information 12/10/2008 on how medicines should be used should form part of an Page 7 of 10 Care Homes for Older People individuals care plan to make sure they are given to people correctly. 6 9 13(2) Medicines must be given to 12/10/2008 people correctly because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 7 9 13(2) Records of medicines 12/10/2008 received into the home, given to people and disposed of must be accurate so that all medicines can be fully accounted. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 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 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. 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