Inspection on 26/04/05 for Milbanke HFE

This inspection was carried out on 26th April 2005.

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

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

Other inspections for this house

Milbanke HFE 21/04/09

Milbanke HFE 14/01/09

Milbanke HFE 15/12/08

Milbanke HFE 20/10/08

Milbanke HFE 24/09/08

Milbanke HFE 23/06/08

Milbanke HFE 28/08/07

Milbanke HFE 20/09/06

Milbanke HFE 05/09/05

Milbanke HFE 20/12/04

Milbanke HFE 21/04/04

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Milbanke Home For The Elderly Station Road Kirkham Lancashire PR4 2HA Lead Inspector Denise Upton Unannounced 26th April 2005 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 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 and Care Homes for Adults 18 – 65*. 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 Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Milbanke HFE Address Station Road Kirkham Lancashire PR4 2HA 01772 683246 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lancashire County Care Services Mrs Karen Mason CRH Care Home 28 Category(ies) of OP Old Age 22 registration, with number PD Physical Disability 6 of places Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Staffing must be provided in accordance with the Residential Forum Staffing Guidance by April 2004. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The external windows and paintwork of the home must be repaired and repainted by 31st March 2005. The cubicle toilets to the ground floor of the building must be redesigned to provide a totally enclosed environment for each toilet by 31st March 2005. Service users in the physical disability category may only be accommodated in the designated, 6 bed rehabilitation unit, which must not accommodate any service user under the age of 55 years. Date of last inspection 20/12/04 Brief Description of the Service: Milbanke Care Home is presently registered to provide residential accommodation for up to 22 older people who do not require nursing care. However, due to current building and redevelopment work that will provide extended residential accommodation, a new day care facility and office accommodation, the number of service users accommodated has been restricted. At present, the building is being used flexibly to enable the continued delivery of existing services. In addition to the main residential accommodation, a designated six bed self contained intermediate care unit is in operation at the home. This facility, that is registered to accommodate service users over the age of 55 years, is housed in a separate area of the building and provides time limited accommodation and support to service users with a view to enabling them to return to their home environment. Milbanke Care Home is located in a convenient location close to the main shopping centre of the town and local amenities. The existing accommodation is purpose built, arranged over two floors and offers individual bedroom accommodation to all service users. Communal areas are diverse offering a variety of lounges including a designated smoking lounge. Although individual bedroom accommodation does not provide an en-suite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with appropriate aids to promote independence. A passenger lift is provided for ease of access throughout the home. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a day and a half and in total spanned a period of 11 hours. In addition, a further short visit took place at a later date to provide some specific information to the registered manager. During the course of the inspection, the inspector spoke individually with 4 of the 13 residents in the main residential care unit, however one of these people could not verbally communicate very well and 2 of the 6 people who were accommodated in the intermediate care unit. In depth, individual discussion also took place with the registered manager, senior residential care officer, 3 members of the care staff team in the main residential care unit and the two support workers on duty in the intermediate care unit. In addition, brief general discussion took place throughout the course of the inspection with various other residents. A number of records and policies and procedures were also examined and a partial tour of the building took place. At this inspection, the Commission For Social Care Inspection pharmacist inspector also visited and assessed the medication standard. The findings of this are included in the summary report. What the service does well: The main residential care unit in the home has a group of staff that have helped and supported the residents living there for a considerable period of time and who are committed to providing a high quality of care. The relationship between staff and residents is good. Residents spoken with felt that the staff had built up a good relationship with them and did their best to help improve their quality of life. One resident said that she was quite happy with everything and that ‘all the staff are very good, nothing is too much trouble for them, including shopping’. Although staff work hard to make sure that people living at the home are well cared for, residents are also encouraged to make decisions about themselves and to have there say in the day to day running of the home. This is achieved by various means that includes service user meetings, resident questionnaires and informal daily discussion. Care is taken to make sure that service users rights are protected and privacy and dignity maintained. Family and friends are made welcome at any time of the resident’s choice that was seen at the time of the inspection. In addition, social activities either ‘at home’ or in the local community are encouraged and a social activity programme is arranged by staff. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: The recording of information in the intermediate care unit could be further developed. This would ensure that a permanent record would be maintained identifying the support and care that had been provided by support workers during the service users stay. This would be of particular important if information was required at a later date. The recording of medication received, administered and disposed of needs to be improved to ensure that the records held are accurate and up to date. Other medication issues identified by the pharmacist inspector also need to be addressed. Advice was given with regard to these matters both verbally at the time of the inspection and later by letter. The standards regarding homes for older people recommends that all newly appointed staff undertake nationally recognised induction training within the first six weeks of employment. This is to ensure that newly appointed staff have the basis skills to provide an appropriate level of care. Whilst it was evident that staff, in the main, had been provided with induction training, staff that had been in employment at the home for an extended period of time had Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 7 still not completed the training. In addition, foundation training has yet to be developed and introduced within the first six months of employment. There is a requirement that all staff must be provided with first aid training to help ensure the health of service users. Whilst some staff have already received this training other staff have not. This needs to be given some priority to ensure requirements are met. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 New residents are only admitted to Milbanke Care Home following a professional Care Management assessment of current strengths, needs and requirements. Although the written outcome of this assessment is received by the home prior to the new resident being admitted, in respect of the intermediate care unit, once a service user takes up residence, little information is recorded. In consequence, a permanent record of the input and support provided by the support staff in the unit is not maintained by the home. This could leave staff and service users at risk if information is requested at a later date that is not recorded and the detail is reliant on memory. EVIDENCE: Because of the current building work, no service user has been permanently admitted to the residential care unit at Milbanke Care Home for some considerable period of time. However frequent short-term admissions have Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 10 taken place to the designated intermediate care unit. Prospective residents are only admitted to the home following a comprehensive assessment undertaken by a Care Manager with the written outcome of this assessment provided prior to admission. In respect of the main residential care unit of the home this assessment forms the basis of the initial care plan. With regard to the intermediate care unit, in addition to the Care Management assessment, designated professional staff that include an occupational therapist, physiotherapist and district nurse also undertake an assessment soon after the admission of the individual to the unit. The professional staff then devise an appropriate care plan for the individual service user. However this only relates to care planning in respect of an occupational therapy programme or physiotherapy programme. Following these professional assessments it is the responsibility of the support workers to ensure the plan of care is carried out as directed. However it was noted that a permanent record of the tasks to be undertaken by support staff or their observations is not maintained by the home. Likewise, although there is a structured review system in operation that is attended by support staff, outcomes of the review are not available at the home and any further guidance or instruction resulting from the review meeting is not permanently recorded by support staff. It is required that a more structured, written approach be developed that incorporates the assistance provided by support workers in respect of social and personal care needs such as bathing, dressing and toileting. It is essential that the recording of important information be routinely maintained in order to protect staff and residents and to provide a permanent record of the work undertaken by staff in the intermediate care unit. Two service users spoken with in the intermediate care unit both described their admission to the intermediate care unit and felt that sufficient information had been provided prior to admission. In addition both service users were very aware that their time in the unit was limited and of the planning and review processes in operation to enable them to return home. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and10 There is a clear and consistent care planning and review process maintained in the main residential unit of the home. The systems adopted adequately provide staff with the information they need to satisfactorily meet service users needs. However, recording of information could be improved in the intermediate care unit. The health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The home has a structured process in respect of medication. However issues in respect of medication could be significantly improved that would provide greater protection for service users accommodated. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 12 EVIDENCE: Individual plans of care are available in the main residential unit that incorporate the outcome of relevant risk assessments to ensure that all aspects of health, personal and social care needs are identified and planned for. However in the intermediate care unit, although discussion with staff clearly identified that individual needs and requirements were being addressed, there was a lack of permanent written documentation in relation to the care and support provided. Although there is a wipe board giving some basis information, this approach is, in the main, dependent on staff memory and good verbal communication systems. Residents and staff could be at risk if these informal systems break down or if information is requested in relation to a person’s period of residency at the home once they are no longer resident. At this inspection, the Commission For Social Care Inspection Pharmacist Inspector assessed the medication standard (Standard 9). Milbanke Care Home uses a monitored dosage system for medication that is suitable for the needs of the home. However poor practice was evidenced in respect of medication administration recording. There was no system for recording drugs received into the home or for drugs destroyed or returned to the chemist for disposal, making it difficult for an accurate audit trail to be maintained. This in turn could place service users at risk. All staff with responsibility for medication administration should receive updated medication training to ensure correct administration are followed. The medication room door should be kept locked with the senior person on duty retaining the key on their person. Further advice was provided that included, the need for documented risk assessments for service users who elect to self medicate, signed prescriptions should be seen prior to dispensing, and patient information leaflets should be obtained and made available to staff for training and information. In addition, all hand written records should be double-checked to ensure accuracy and clarity. Service users spoken with confirmed that they felt their privacy and dignity was respected and that they had access to medical services as and when required. Comments made by service users during individual discussion confirmed their satisfaction with the level of care and support at times of illness and spoke positively of the way their needs were addressed. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 All residents are actively encouraged to maintain independence and live the lifestyle of their choice. Links with family and friends and the local community are good that support and enrich service users social opportunities and activity both within the home and wider community. Staff are pro active in enabling service users to make positive choices in respect of their daily lives to ensure that as far as possible, wants and wishes are realised to the satisfaction of the resident. EVIDENCE: From individual discussion with a number of residents, it was clear that routines of daily living within the home remain flexible and varied to address individual needs. One service user spoken with described how she preferred to stay in her bedroom for most of the time but was always told by staff of the activities and entertainment that had been arranged for that day. If anything interested her she ‘would go down and join in’. This same lady stated that the staff were ‘very good and caring’ and ‘help you all they can’. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 14 During the course of the inspection it was observed relatives and friends visited at the time of their choice. One relative stated he visits his father regularly at various times of the day or evening period and is always made very welcome. This same relative also commentated on the good relationship both he and his father has with the staff group and of the positive communication with the management team at the home. Through discussion and observation it was clearly evident that residents are able to take into the home at the time of admission, items of importance to them including personal possessions and in some cases small pieces of furniture. One service user spoken with said this helped to create a sense of ‘home to have my things around me’. Service users are encouraged to handle their own financial affaires for as long as they want and have capacity to do so. Advocacy service details are available. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the three standards were assessed at this inspection. EVIDENCE: None of the three standards were assessed at this inspection. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the eight standards were assessed at this inspection. EVIDENCE: None of the eight standards were assessed at this inspection. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 & 30 A pro-active approach is adopted with regard to staff training to ensure staff have the skills, knowledge and abilities to provide a high quality service. However first aid training has not been provided to all staff at this present time that could potentially leave service users at risk. EVIDENCE: Staff training at Milbanke Care Home is given high priority and the majority of staff have undertaken a varied programme of recent additional training that is still ongoing. Staff commented on the amount of training they are encouraged to attend and how this had improved their skills and knowledge especially the recent dementia awareness training. Through discussion with the registered manager, it was identified that one member of the care staff team has achieved NVQ Level 4 in care, four members of staff have achieved Level 2 of this award, and a further eight members of staff are currently undertaking Level 2 of this award. It is anticipated that a least 50 of the care staff team will have achieved at minimum, NVQ Level 2 accreditation in the near future. At present staff recruitment at the home is limited because of the current reduced number of service users. However over the last two years, staff have Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 18 been recruited to the intermediate care unit and provided with TOPPS induction training, however this training has yet to be completed. In addition, a further member of care staff was recently transferred to the home that had previously worked in a different area of care, however on this occasion there was no evidence available that this member of staff had been provided with induction training. It is recommended that all staff are provided with TOPSS induction training that is completed within the first six weeks of employment and that foundation training to TOPSS specification is developed and introduced and provided to all newly appointed care staff within the first six months of employment. Through discussion with the registered manager and observation of the training matrix, it was evident that all staff received mandatory moving and handling training on an annual basis. It was also evidenced that 12 members of staff have also completed first aid training however a further 14 members of staff still require this training. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 38 The registered manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating a clear awareness of their roles and responsibilities. Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their quality of life. The systems for service user consultation are good with a variety of evidence that indicates that service user views are both sought and acted upon. EVIDENCE: The registered manager is competent and experienced to run the home and meet its stated purpose, aims and objectives. In addition, the registered Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 20 manager has undertaken periodic recent additional training and has already achieved qualifications in care and is about to commence a further NVQ enhanced qualification in management and care. Staff and service users spoken with were very positive with regard to the support of the manager with one member of staff stating the manager was ‘very good, helps you develop, is approachable and encourages you to take responsibility’. General comments from service users and staff was that the home is a good place to work and live with a family like atmosphere and that if a disagreement did occur it is calmly sorted out. It was clearly evident from observation that there is a very good rapport between residents, staff and visitors that helps to create sense of belonging. The home regularly reviews aspects of its performance through a good programme of self-review and consultation, which includes seeking the views of service users, staff and informally the views of relatives. In addition the ‘Investor In People’ award has been achieved. Service users confirmed that they are regularly consulted and that their views and opinions are taken into account. To develop this process further, anonymous questionnaires could be developed for other stakeholders to support the informal system already in place. Milbanke care home ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and training issues. It was evidenced that both internal and external environmental risk assessments are undertaken that is of particular importance at this present time because of the on going building programme. It is understood that two members of the management team have completed the ‘First Aid At Work’ course and a further member of the management team is to undertake this course of study. Once this had been accomplished a qualified first aider will be on duty at all times. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 x 3 3 4 x 5 x 6 2 HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score x x x x x x x x Score Standard No 7 8 9 10 11 Score 3 3 1 3 x Standard No 27 28 29 30 x 2 x 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score x x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 3 34 x 35 x 36 x 37 x 38 3 Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 22 YES Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement The manager to ensure an accurate record is made of all medicines received into the home. The manager to ensure an accurate record is made of medicines leaving the home. The manager to ensure the records are signed immediately after medicines administered with particular reference to dose ommissions without explanation The manager to ensure all medication is securely stored with reference to access to the medication storage room and refrigerated items in the rehabilitation unit. The manager to ensure all medicines are used within the expiry date. The registered person must make suitable arrangements for the training of staff in first aid. Attention must be given to external window frames and paintwork of the existing building as part of the refurbishment programme. (Timescale of 31/03/05 as identified in F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Timescale for action 30/05/05 2. 3. 9 9 13 13 30/05/05 30/05/05 4. 9 13 30/05/05 5. 6. 7. 9 30 19 13 13 23 30/05/05 30/09/05 31/03/06 Milbanke Home For The Elderley Version 1.20 Page 23 8. 21 23 9. 7 15 previous inspection reports could not be met) The cubicle toilets to the ground floor of the building must be redesigned to provide a totally enclosed environment for each toilet. (Timescale of 31/03/05 as identified in previous inspection reports could not be met) Comprehensive written care plans must be developed and maintained in the intermediate care unit to identify the actions to be taken by support staff in respect of service users accommodated. Details of outcomes of the regular review meetings that suport staff attend must also be maintained. 31/03/06 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard 7 9 9 9 9 9 9 Good Practice Recommendations All individual care plans should be reviewed on a monthly basis. All prescriptions should be seen and checked prior to the pharmacist dispensing, documented evidence should be made of this. All handwritten medication administration records should be formally double-checked, preferably evidenced by two staff signatures. A declaration of wishes should be obtained for all residents and for those that are self-medicating, this should be regularly reviewed as part of the risk assessment process. The manager is advised to write a written medication handling procedure for the rehabilitation unit that describes actual required practices. A controlled drugs register of standard format should be obtained and staff trained on how to use it correctly. The medicines fridge should have the temperature F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 24 Milbanke Home For The Elderley 9. 10. 11. 12. 13. 28 31 33 38 monitored and recorded on a daily basis. At least 50 of the care staff team should have achieved NVQ Level 2 by 2005. The registered manager should achieved an NVQ Level 4 or equivalent in care and management by 2005. It is recommended that annonumous questionnaires be developed and introduced in respect of all stakeholders. It is recommended that a qualified first aider be on duty at all times. Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court, Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milbanke Home For The Elderley F57 F09 S32617 Milbanke HFE V191937 260405 Stage 4.doc Version 1.20 Page 26 - 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. 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