Inspection on 28/08/07 for Milbanke HFE

This inspection was carried out on 28th August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Milbanke HFE Station Road Kirkham Lancashire PR4 2HA Lead Inspector Denise Upton Unannounced Inspection 28/29/30 August 2007 09:15 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.V346229.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.V346229.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milbanke HFE Address Station Road Kirkham Lancashire PR4 2HA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 684836 Lancashire County Care Services Ms Elizabeth Pelmore 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.V346229.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. 20th September 2006 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.V346229.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of a mid-week day and half a day on the following two days. In total, the site visits spanned a period of approximately twelve 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 registered manager, six care assistants, the cook on duty and two District Nurses who were visiting the home. In addition, individual discussion took place with five people living at the home and two relatives. Several other residents were also spoken with in various communal areas of the home. A second inspector also spent a period 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 staff to be kind but extremely busy. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. In addition, a number of residents and relatives/friends also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether resident’s needs and requirements were being met. 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 £342.50 to £396 00 per week. What the service does well: The routines of the home are flexible and aimed to allow residents their freedom, independence and control over their lives therefore promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. Visitors spoken with all said that they were made very welcome. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 6 A variety of external professionals are involved in the care of people living at Milbanke Care Home to ensure that resident’s health care needs were being appropriately met. Good recruitment practices and financial arrangements are in place at the home, which demonstrates that those living at Milbanke Care Home were adequately protected. The people living at Milbanke Care Home spoke highly of the manager and staff. One relative wrote “In the past I have had very bad experiences with care homes when my mother needed care. In contrast, I feel that at Milbanke Dad is treated with respect and care by all the staff and is settled and very happy”. The physical environment at Milbanke Care Home is well furnished and decorated to a good standard. The premises both internally and externally are well maintained providing those living at the home with a safe, clean, comfortable and homely environment in which to live. What has improved since the last inspection? What they could do better: There is serious concern that care plans that tell staff what each resident’s needs are and give direction as to how each needs is to be addressed are inadequate. This does not provided staff with the information they need to provide a consistent service. However in all but one unit, residents were provided with a good level of care within the current staffing structure. During the period of observation on the dementia care unit there were insufficient staff to ensure a safe environment. On occasions, resident’s dignity was compromised because staff were not available to offer assistance when required because of attending to the needs of other people. This posed a number of health and safety concerns and did not provided a good quality service. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 7 All care staff must be provided with mandatory health and safety training that includes manual handling training and first aid training. This would help to protect residents and staff. All staff that work in the dementia care unit must receive specific dementia care training to ensure they understand the needs and requirements of the people living in this unit. Leisure activities are not always provided in accordance with the individual capabilities, so that people may not be able to continue their interests while living at the home. 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.V346229.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.V346229.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 in part & 3. Quality in this outcome area is adequate. The Service User Guide is currently been revised. However the existing Service User Guide has not been routinely given to newly admitted residents to provide written information about the services and facilities offered at the home. 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 Care Home has available an existing Statement of Purpose and Service User Guide. However these are not routinely made available to residents or prospective residents. It is understood that there is a planned review of the Statement of Purpose and the Service User Guide is currently not fit for purpose until it has been rewritten as the existing document is out of Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 10 date and does not reflect facilities and services now provided. In consequence, newly admitted residents have not been provided with an individual copy of the home’s Service User Guide. This booklet is specifically written and designed to provide enough information to newly admitted residents about the home and the facilities and services provided in order to make an informed choice. This includes the home’s complaint procedure, the terms and conditions in respect of accommodation and existing residents views of living at the home. Whilst it is commendable that this written information is being reviewed, at the last inspection the situation was the same with newly admitted residents not being provided with detailed written information about the service they will receive while resident at Milbanke Care Home. In accordance with Regulation 5(2) Care Home’s Regulations, Care Homes for Older People, it is essential that all newly admitted residents be provided with an individual, up to date copy of the Service User Guide, that includes the most recent Commission for Social Care Inspection report. The registered manager at Milbanke Care Home undertakes a structured pre admission assessment of all prospective residents 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 to undertake an initial assessment of current needs and requirements and to provide further information about the home. This is coupled with an invitation for the prospective resident and/or their family to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to 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 the registered manager. 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 the more recently admitted resident’s individual care plans. It is important however that the dependency needs of existing residents and the number and skill mix of the staff group are taken into account before a decision is made as to whether the strengths and needs of any prospective resident could be adequately and holistically met before an offer of accommodation is made. Milbanke Care Home 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. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 11 Prior to admission to the intermediate care unit, a care manager assessment is provided and designated professional staff that includes an occupational therapist, physiotherapist and district nurses from the local district nursing team also undertake assessments soon after admission. Following these professional assessments, a plan of individual care is devised and it is the responsibility of the care staff to ensure the requirements of the care plan are carried out as directed. Specific risk assessments are in place and communication systems have been strengthened. There is a structured formal review system in place that includes the professional staff involved and care staff working in the intermediate care unit. The resident and family where appropriate are also fully involved in order to determine a rehabilitation programme to enable to individual to return to their home environment or select alternative accommodation. A resident in this unit and her relative were spoken with during the course of the site visit. Both were very pleased with the level of care provided and the kindness and concern of the staff group. It was clearly evident that there was a comfortable relationship between members of staff, the resident and the relative. Positive comments were also made about the meals served, accommodation provided and the provision of the intermediate care service. The resident commented that the “carers are nice, good and listen to you” and that she was, “happy and well looked after”. Her relative also commented that she was very satisfied with the level of care provided and the kindness of staff. The relative has to travel some distance in order to visit but staff had invited her to stay for a lunch that had been greatly appreciated. Milbanke HFE DS0000032617.V346229.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 a little evidence to suggest that a clear and consistent care planning system is in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs and requirements. The medication in this home is well managed promoting good health. Personal support is not always 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. EVIDENCE: Whilst some improvement was noted regarding the quality of very recently developed care plans, this is an area that still requires further attention. All care plans must be up to date, regularly reviewed and sufficiently detailed to provide staff with clear directions as to the actions required in order to fulfil an Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 13 identified objective. At present not all residents, have an up to date, written detailed plan of care in place. Some individual risk assessments are in place but not necessarily personalised to the individual. For example, two risk assessments randomly looked at relating to the same risk both stated the same thing (1) staff awareness (2) staff trained to deal with challenging behaviours (3) enough staff to be on duty at all times according to the needs of service users. There was nothing about the individual risk for the specific resident in question or how the identified risk was to be minimised. Risks are initially identified by way of a generic tick box risk assessment. However even when a risk had been identified by this process, there was not necessarily a specific risk assessment undertaken in respect of the individual risks identified. In addition, the outcome of any formal specific risk assessment undertaken was sometimes vague and not necessarily incorporated in the care plan. One specific risk assessment evidenced stated that “staff to observe when people are entering or leaving the building” but gave no indication of how this was to be achieved. Staffing levels are not sufficient to enable that a carer would always be available in order to achieve this outcome especially when attending to the needs of other people in the unit. In the main care plans evidenced were generally poor with little direction provided to staff on how a strength or need was to be addressed. This does not promote opportunity to provide a consistent service. Care plans observed were inconsistent both in content and the document used to record the required information. At times it was difficult to clearly identify what was an assessment of strengths and needs and what may have been a very basic care plan. However in one instance with regard to a recently admitted resident, the pre assessment information was not sufficiently detailed to provide a holistic account of requirements. The record focused on mobility, mental state, communication, diet, self-care, continence and sleep pattern. Nothing was written about any social interests past or present, cultural needs or social networks. The professional assessment of other professionals involved indicated that this particular resident exhibited particular behaviours that staff needed to be aware of however there was no recognisable risk assessment to inform or direct staff. Other care plans observed were often minimal in content with the writer not appearing to understand how a care plan should be developed. For example, one care plan evidenced had a section to identify cultural needs. The section was divided into Strengths, Needs and Goals. In the strengths section had been written, “Needs guidance and support due to her learning disabilities”. In the Needs section was written, “Awaiting wheelchair assessment, reassurance from staff on a daily basis”. The goals section stated, “To give *** support and praise with her achievements”. It is difficult to see how these comments relate Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 14 to the individual’s cultural needs and staff appeared to almost to be filling in boxes for the sake of completing the task rather than developing a meaningful care plan. As recommended in the last inspection report all staff with responsibility for the development and review of individual plans of care should receive appropriate training to ensure that they have the skills and understanding for the task to be undertaken. Routine monthly reviews of individual care plans are not necessarily taking place. Even when a review does take place the actual care plan is not necessarily updated. One care plan evidenced was written some considerable time ago, the reviews had identified significant changes but no actual amendment had been made to the original care plan or a new care plan developed. Often care plans and risk assessments were unsigned and/or undated making it difficult to establish just what information was current and what was outdated. All written documents should be signed by the member of staff making the entry and dated to take ownership of the recording. Two members of staff spoken with in one of the more dependent units stated that they never looked at individuals care plans but relied on the brief information written in the staff communication book to identify any changes to the care plan. A comprehensive, up to date plan of care must be in place in respect of each resident accommodated. A formal documented risk assessment must be in place wherever a specific risk is identified with significant outcomes incorporated in the care plan. All care plans and risk assessments should be formally reviewed on at least a monthly basis or more frequently if required with amendments clearly identified. When there is a significant change to the existing care plan it is highly recommended that a new care plan be written to clearly advise and direct staff in what they should be doing and how they should do it. All care plans should wherever possible be developed in full consultation with the individual resident and/or their family (with prior agreement) and signed by the resident/family to confirm their acceptance and agreement. If the resident is unable or unwilling to participate in the care planning process and cannot sign or does not wish to sign their individual care plan this should be clearly recorded. In the main however, except for the dementia care unit, residents were receiving an adequate service within the existing staffing structure. Residents spoke highly of the staff group and staff were seen to be kind and caring towards residents accommodated. Staff spoken with were familiar with the preferences and wishes of each resident and residents spoken with were very pleased with the care provided. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 15 Through discussion with a number of residents and staff and observation of documentation, it was clear that resident’s health care needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social well-being. Discussion took place with two District Nurses who were visiting several residents. The District Nurses felt that there was good input from the home when requesting medical assistance, confirmed that when necessary there is discussion with a member of the management team regarding the requirements of a specific resident and that the District Nurses were involved in discussing the specific requirements of a resident who was diabetic to improve his diet. The suggestions made were acted upon. In the main the District Nurses felt that a good service was generally provided however concerns were expressed about the number of staff working in the dementia care unit when they stated, “The staff are too busy to provide good care”. The District Nurses were also concerned about the communication systems in the home and cited various incidents when information was given to one member of staff but then the information had not been passed on to the next member of staff on duty. It is imperative that robust written communications systems are in place that staff understand and use appropriately. Comments on the Commission for Social Care Inspection, survey forms confirmed that residents felt that they receive the medical support that they needed when they needed it. The home has good systems in place for the administration and recording of medication. Since the last inspection improvements have been made to the medication administration procedures. A new medication trolley has been provided on each floor that is stored in a locked cupboard. The way medication is received at the home has been improved to help ensure that the administration of prescribed medication is clear and detailed. A review of medication is undertaken by the Primary Health Care Trust on a routine basis and the pharmacist who supplies the home with prescribed medication also undertakes a periodic medication audit. Staff with responsibility for the administration of medication have 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. It was noted however that there were occasional dose omissions on the drug administration record without explanation. This suggests that some staff are not completing the drug administration record immediately after the drug has been administered. It is important that the drug administration Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 16 record is completed in line with the corporate policy and procedures regarding the administration and recording of medication to ensure that an accurate record is kept. Although all residents actually spoken with felt that their privacy and dignity was well respected while living at the home, an instance occurred during the period of observation when the dignity of one resident was severely compromised. The related to lack of staff on duty in the dementia care unit to ensure that the needs of all residents could be adequately addressed and sufficient staff were on duty to ensure that residents were supervised at all time. One resident was unhappy with her cup of tea and wandered off towards the kitchen area. A staff member assumed she needed the toilet and took her away; after 10 minutes the resident wandered back to the lounge alone with her trousers down and fully exposed. There were no staff and she stayed like this for 5 minutes with some of the residents becoming very concerned before a staff member came in to the lounge and realised the situation. This situation should have been avoided, there should be sufficient staff on duty without the need for care staff to be attending to more than one resident’s personal care tasks at a time. This practice does not promote the privacy or dignity of people living at the home or provide an adequate service. Another incident was noted when residents were left alone by staff on several occasions as they were busy toileting three residents; this continued for at least three quarters of an hour with staff very briefly walking through the lounge. One resident required three staff to help her up out of her chair to be taken to the toilet; staff physically lifted her into the wheelchair. The resident also had some difficulty in alerting staff to her need for the toilet and was fairly desperate by the time the staff member had rounded up enough staff (including staff from another unit) to help carry out the request. This same resident asked for a cup of tea when brought back from being toileted but staff did not hear her request. On another occasion when carers were not present in the dementia care unit when a lady stood up from sitting in the chair. Shortly after a carer who had not been seen before entered the room and immediately asked the lady to sit down again in her chair. The carer did not try to ascertain what the resident might require or if she simply needed to stretch her legs and get some exercise. The carer then left the room again. Whilst the carer may have felt that this particular resident would have been safer sitting down rather than standing up, the carers were too stretched to even consider what the person’s actual wants were and therefore restricted the independence and self will of the individual. It was obvious throughout the observation that there were inadequate staffing numbers, staff were struggling to cope and unable to provide any additional Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 17 care and attention that would have made a great deal of difference to the residents. Residents had difficulty making their needs known to staff who were either not in the lounge or busy in the kitchen area; residents were looking after each other and looking concerned when there was a situation developing such as the resident coming back from the toilet on her own with her trousers down. It was clear that during the two-hour period of observation that there was not sufficient staff on duty within the dementia care unit to ensure the privacy, dignity, safety and independence of people living there. This must be addressed as a matter of urgency. People living in the unit must be provided with a safe, responsive and individualised level of care that takes into account individual dependency needs when determining the number of staff required during each period of the day. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 18 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 adequate. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Not all residents may 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: Several residents spoken with confirmed they are able to exercise choice in their chosen daily life style and choose to do what they want to do. As observed at the time of the visit, social relationships are encouraged either by family/friends visiting at a time of the resident’s choice or social stimulation in the wider community either independently or accompanied by relatives/friends. One resident spoken with was going to the local shops on his motorised Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 19 wheelchair, this same resident also enjoys attending to the outdoor tubs and planters of flowers near the main entrance of the home, a task he undertakes every year. At the time of the site visits several relatives were seen to be visiting people living at the home. It was clearly evident that residents can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. A friend of one resident and the sister of another resident both explained that they were always made welcome and keep informed of any important information. The provision of “in-house” activities was mixed. On units accommodating older people there was a programme of activities and a record kept of the residents who enjoyed the activities provided. However on some occasions this amounted to the same smallish group of people enjoying the ‘in-house’ activities but little evidence to suggest that any attempt had been made to introduce alternative activities for those who did not wish to participate in the activities provided. However there is a designated community day centre on site that is managed independently. A number of residents who live at Milbanke Care Home do attend this facility for varying period of time and enjoy the company of other people who do not live at the home. A relative wrote on a Commission for Social Care Inspection survey form in answer to the question ‘what do you feel the care home does well’ that “Very caring towards mum and all residents. The staff constantly organise activities to entertain residents. Overall an exceptional home”. There was no formal activity programme available in the dementia care unit. Staff spoken with clearly stated that there was no time available to offer a suitable activity programme during the daytime because of the demands of the personal care needs of residents accommodated in this unit. However impromptu activities do sometimes take place. During the evening of the first site visit it is understood that residents had enjoyed dancing. A suitable activity programme should be developed that takes into account the needs, preferences and capacities of all residents accommodated. It is especially important that particular consideration is given to people with dementia and other cognitive impairments, visual or hearing impairment and those with a physical disability or learning disability to ensure that the activities offered are suited to individual needs and expectations. 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. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 20 From observation when speaking with a number of resident’s, 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. All residents spoken with stated 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. Several residents described the meals served as ‘much enjoyed ’, ‘very good’ and ‘a good variety of foods’ and “the food is good. Residents are offered a varied, wholesome and nutritious diet and specialist diets in respect of religious, cultural or medical need can be accommodated. Discussion with the cook on duty confirmed that there is an adequate budget for the provision of foods and that a new rotating menu was about to be introduced. The cook explained that any specialist diets were made known by care staff. It is recommended that the cook be provided with some written detail as to the particular needs and requirements of any specialist diet required to ensure that a record is kept of specific requirements that should also be detailed in the individual care plan. Fresh fruit and vegetables are provided and residents can select an alternative from the menu choices if required. A cooked breakfast is available and as observed, hot and cold drinks and snacks are also made available throughout the day to supplement main the meals. The kitchen appeared to be a well-ordered and well-run area of the home. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 21 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 adequate. The home has developed a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. Some existing members of staff have been provided with formal adult abuse training that further helps to protect residents. However more recent employees have yet to receive this training. Refresher training has not been provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milbanke Care Home has a corporate complaint policy and procedure. There was clear evidence that any complaint/concern raised is taken seriously. A small number of complaints have been made since the last inspection that were upheld. Each complaint/concern was investigated with a written record maintained of the complaint/concern, how this was investigated and the outcome of the investigation. The person making the complaint/concern had been informed of the findings. The relationship observed between staff and residents is relaxed and friendly and residents and relatives spoken with all stated they would have no hesitation in raising any concern or complaint directly with the registered manager. However one resident spoken with who has lived at Milbanke for Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 22 some considerable period of time stated that she had “nothing to complain about”. Milbanke Care Home continues to have available 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. Whilst the majority of staff employed at the home for an extended period of time have received specific adult abuse training that helps to protect residents, newer members of staff have not received this important training and refresher training has not been provided. Discussion with several members of the care team confirmed that they had not received specific adult abuse training that incorporated the local protocols and the staff-training matrix evidenced indicated that no members of staff had undertaken this training. However basic adult abuse training is covered during common induction standards training and National Vocational Qualification (NVQ) training. Most members of the care staff team have achieved this qualification at Level 2. Staff spoken with did have some understanding of what they must do if an allegation of suspected abuse was made to them. Never the less all staff should receive appropriate adult abuse training that incorporates the local protocols for reporting an allegation of abuse to ensure they have a clear understanding of what they must do and must not do. It is understood that a new corporate adult protection training pack has just been developed and will be introduced in the near future. All staff will then receive this training. Since the last inspection an issue was raised under the adult abuse procedures regarding two residents who were living at the home. The matter is now concluded and although the allegation was unfounded, systems have been put into place to help ensure that a similar incident does not occur in the future. Further corporate policies and procedures for the protection of residents are in place that includes aggression, restraint and financial procedures. Residents are informed with regard to personal insurance and also that staff are not permitted to accept gifts or witness any legal documents. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 23 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 provides excellent accommodation. The home is bright, attractive and welcoming and provides a comfortable and safe physical environment for people to live. The building is divided into four separate units each comprising of a large communal lounge/dining 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. 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 Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 24 dementia care unit and the remaining unit provides short term, time limited intermediate care with the aim of enabling the individual to return to their home environment. 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. It is understood that a new type of hoist is to be provided to meet the needs of more recently admitted residents. All residents spoken with and the relatives spoken with were all very pleased with the communal areas of the home and the private accommodation. Outdoor areas of the home are spacious, provided with seating, hanging baskets and tubs and a sensory garden. Further improvements are planned. Climbing plants are to be provided to soften the effect of the railings and handrails and other safety provision such as non slip surfacing to the ramping is to be provided to ensure access for all residents including those with disabilities. The home remains clean, hygienic and very well maintained with a variety of policies and procedures to advise staff in the control of infection. New laundry facilities are sited away from food preparation areas and do not intrude on residents. The laundry has been provided with new equipment and the wall and floors are readily cleanable. According to the Annual Quality Assurance Assessment (AQAA) completed by the registered manager, all staff have now received infection control training. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 25 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 adequate. After a period of considerable instability in staffing by having to rely on agency/casual staff to supplement core staff members, improvements have been made. However at present a full staff complement is not in place and the home is still reliant on some agency/casual staff. There is a good match of permanent members of staff who demonstrated an understanding of their roles. However on one of the units staffing is inadequate to ensure the safety of residents or provide a high quality service The standard of vetting and recruitment practices are good with appropriate checks being carried out to protect service users. The arrangement for the induction of newly care appointed staff has been limited. This does not provide staff with basic skills to provide a good quality service. However ‘Skills for Care’ common induction standards are now available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 26 From observations it was clear that the current staff complement is stretched in providing a consistently high quality service that takes into account the personal, emotional and social care needs and requirements of each individual resident. This is especially so given the high level of dependency needs of residents in the dementia care unit. During the period of observation in this unit, a substantial number of residents were left unsupervised for extended periods of time while care staff attended to other residents in the unit who required assistance with personal care. This left the remaining residents at risk. One resident was provided with a plastic beaker with a lid, full of tea; a member of staff told her to hold the handles and not spill it and left her to it. The resident had difficulty holding the cup, which was obviously hot, and seemed unsure which way to hold the cup, it turned up side down and it spilt burning her. Staff had to be alerted by the inspector who then took her away to be changed. It would have been better if the staff member had taken more time to show the resident how to hold the cup and stayed with her whilst she took the first sips; the resident was in a wheelchair and there was nowhere for her to put the cup down. The resident was not offered another cup of tea when back in the lounge having been changed Staff confirmed that they struggled to care for the residents. One of the residents needs a hoist and this takes two staff and can take up to 20 minutes; the other residents have to be left on their own. For another resident with restricted height, it takes three staff to assist her and it is a struggle. There was no time for any social activities although they had help from another staff member the previous evening and residents enjoyed some music. Staff also stated that the dishwasher had broken and the microwave and this was reported some time ago with no action taken; this was not helping them to spend more time with the residents. From later discussion with the registered manager and area manager it is understood that the dishwashers are of a domestic type that were inappropriate for the needs of the units. It is unlikely that they will be replaced with more suitable equipment in the near future because of financial constraints. Although used crockery and cutlery are meant to be returned to the kitchen for washing, this takes care staff away from the task of caring. In addition, care staff time is taken up with laundry duties. Milbanke Care Home provides accommodation for a substantial number of people. The care staff hours appear to be minimal given the number of residents accommodated and individual dependency needs. Care staff hours should be used for care duties. Improvement would be made if either the care staff hours were increased to take into account the domestic tasks care staff undertake in the units and laundry tasks in the laundry or alternatively an additional domestic/laundry post created to ensure care staff only undertake care duties. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 27 Staffing levels should always be determined to ensure that the personal care, health and safety, emotional, psychological and social care needs of all residents are met. This is not necessarily the case when a certain number of care staff are assigned to a unit without taking into account the specific individual needs of the people accommodated. This should also remain at the forefront when assessing any prospective new residents. The individual dependency needs of any prospective resident must also be assessed in relation to the dependency needs of existing residents and the number and skills of the staff on duty. It is entirely possible that a new resident should not be accommodated simply because there are insufficient staff on duty to ensure all residents needs and requirements in a particular unit would be met adequately even if the unit has unused bedroom accommodation. In the main, staff spoken with considered that the level of staff in other units was more appropriate in order to provide a better service. However staff did feel that excessive time was taken up in laundry duties and in the kitchen area of the units that prevented social activities sometimes taking place. Staff also reported that the ‘float’ member of staff did not always work, as all the units required the ‘float’ at the same busy periods and in consequence residents had to wait for a member of staff to be available before they could receive the attention they needed. Although the staff group were consistently praised by residents and relatives spoken with, it is essential that in order to ensure a high quality service and a safe and stimulating environment for all residents accommodated, that sufficient staff be on duty throughout the waking day. One relative wrote on a Commission for Social Care Inspection survey form”. The staff are all very caring and helpful but often, especially in the evenings there are not enough staff to give individual people the time they need”. Currently Milbanke Care Home is still using casual/agency staff to cover a substantial number of shift periods. This has been managed by ensuring that only a very small number of casual/agency staff visit the home on a regular basis in order to provide some continuity of care. There are currently five care staff vacancies and a domestic staff vacancy. However people have been appointed for a number of these vacancies but clearances are still required before these individuals can take up post at the home. National Vocational Qualification (NVQ) training is very much encouraged with the good majority of the care staff team having achieved this award at Level 2. Few members of staff have however achieved a higher level of this qualification. It is understood that care staff are enabled to improve their NVQ qualifications but budget restrictions restrict the number of care staff that can undertake a higher level of this award at any one time. Currently one member of the care staff team is self-funding an NVQ Level 3 qualification to improve her skills and knowledge. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 28 Since the last inspection, a number of staff have been appointed. Through observation of the three staff files and discussion with the home’s manager, it was evident that the staff recruitment practices required by regulation had been followed. Appropriate references and clearances had been obtained and deemed to be satisfactory before the applicants actually started working at the home. Staff are provided with the a copy of the General Social Care Councils ‘Code of Conduct’ that advises staff and homeowners of the council’s expectation with regard to a facility that provides care to vulnerable people. There was evidence of ‘Skills for Care’ common induction standards being available in the home. However it is unclear if all recently recruited care staff had undertaken this training. Completed induction booklets were not evidenced during the course of the site visits, nor was a recently recruited member of staff spoken with. The AQAA completed by the registered manager stated that in the section ‘what the home could do better’ was “we need to provide high quality induction training for all new starters”. New employees do however undertake ‘in-house’ induction training that covers basic information about working at the home. All care staff should be provided with the ‘Skills for Care’ common induction training standards for care staff within the first six weeks of their employment to ensure that newly appointed care staff have basic care skills in order to provide an acceptable level of care to residents accommodated. Members of the staff team also undertake a variety of other training to increase their individual skills and knowledge. This has included some health and safety training, challenging behaviour training and dementia care training. However it was identified that a number of people who work in the dementia care unit have not received specific dementia care training. It is essential that all staff that work in the specialist area of dementia care receive appropriate dementia care training in order to understand and address the specific needs and requirements of people with dementia. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 29 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 manager is supported by senior staff in providing clear leadership throughout the home and has a good understanding of the areas in which the home needs to improve. The systems for resident consultation are good with some evidence that the views of people living at the home are sought and acted upon. Individual staff supervision is patchy and 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. However care staff must undertake all required health and safety training to ensure residents are kept as safe as possible. This judgement has been made using available evidence including a visit to Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 30 this service. EVIDENCE: Since the last inspection a new manager has been appointed who is now registered with the Commission for Social Care Inspection. The person appointed is a registered nurse and has a good understanding of the needs of older people living in a residential care environment. To further increase her skills and knowledge, the registered manager is about to commence the registered managers award and has also periodically undertaken a variety of other training courses. A relative commented on a Commission for Social care Inspection that, “Christina (manager) has been especially supportive of both my mother and myself in relation to mum’s admission into residential care”. The registered manager is supported by a senior staff team within the home and also by external line management that visit on a regular basis. From information contained in the AQAA, the organisation ‘operate an open style of management which encourages the participation of staff members in decision making but also provides them boundaries and a clear idea of what is expected of them.’ The registered manager and external line manager have a good understanding of the areas in which the home needs to improve and are taking steps to address some of the issues. Systems are in place to find out the views of people living at the home. Several examples were identified in the AQAA. In once instance, two television sets were replaced when it is discovered that the existing television sets did not receive all the television programmes that people wished to view. On another occasion, one of the sitting room carpets was laid in such a way that it had to be replaced. The replacement provided by the contractors was of good quality but the pattern was considered unsuitable. However residents, when asked what they thought of the replacement carpet, the majority liked it very much and so the carpet stayed. From discussion with residents and relatives on the unit for people with dementia, it became apparent to the management team that several residents had had to leave a pet at home when they became resident at Milbanke Care Home. In another unit there was a long-term pet cat. The cat was encouraged to spend some time in the dementia care unit to gauge the reactions of resident’s. As a direct result of this, two middle-aged cats now live in the unit. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 31 In accordance with the corporate policy and procedures in respect of resident’s monies and valuables, all residents are encouraged to maintain control of their own financial affairs or assisted in this task by their family or an external advocate. Appropriate systems are in place for the safe keeping of resident’s monies if and when required and accurate and up to date records of financial transactions are maintained. As at the last inspection care staff were unable to confirm that formal one to one supervision takes place on a regular basis. Although some formal supervision has taken place more recently, a number of staff spoken with stated that they had not received formal one to one supervision for some considerable period of time. Some supervision records were available however these varied in quality. The supervision records undertaken by the registered manager were well written and constructive with future planning identified. However other supervision records seen were of poorer quality and unstructured. A member of the care staff team spoken with individually also confirmed that annual appraisals are also not taking place as they should. The registered manager of Milbanke Care Home and the area manager are aware that this is an area that requires development. The AQAA completed by the registered manager identifies that the development and implementation of a staff performance and training development programme and a supervision for all staff forms part of the organisations improvement plan for the next twelve months. Care staff are informally supervised on a day-to-day basis by the registered manager and residential care officers as part of the management role. However a number of staff felt that the residential care officers did not spend a lot of time in the units, stated they were too busy to help and “nothing seems to get done” to improve matters. It was also said that handovers at change of shift are sometimes less than adequate with the care assistant coming on duty only told the area of the home that they are to work in rather than a proper hand over of information. Whilst it is acknowledged that there have been a lot of new staff appointments and staff changes of late including the management team, some staff spoken with seems to be demoralized with the present situation and felt unable to influence change. Staff spoken with confirmed that regular staff meetings do take place that provides opportunity for them to have their say, but the reintroduction of regular, structured one to one supervision for all staff would enable staff to air their views individually and be provided with an individual response. 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. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 32 Policies and procedures are in place to ensure as far as possible the health and safety of residents, staff and visitors. The AQAA confirmed that maintenance checks are complied with. Records viewed included, the testing of electrical appliance certificate, manual handling equipment, kitchen equipment and call bells. However a relative expressed some concerns about the length of time it takes to undertake maintenance work. The relative wrote that there was an insecure fire door and that it took some time for it to be made safe. The same relative also said that her father use to enjoy watching sport on television “but it took months for the aerial in his room to be made usable, consequently because of his dementia he has now got out of the habit of enjoying this which is a shame. I think the general maintenance procedures needs looking at”. All staff are expected to undertake mandatory health and safety training that includes manual handling, fire safety, food hygiene, first aid, and infection control. Whilst all staff have recently undertaken infection control training, from the staff-training matrix, not all staff have received all of the remaining mandatory health and safety training topics. A member of staff spoken with confirmed that she had not received refresher manual handling training or refresher first aid training for many years and fire training had consisted of some written material that she felt was inadequate. It is essential that all staff that have not done so, receive first aid training and manual handling training as a matter of priority. Food hygiene training should also be provided for all staff that assist/support residents at mealtimes and fire safety training should be undertaken by all staff. Refresher health and safety training should also be provided on a periodic basis to ensure that staff understand current best practice to deploy in the home. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 33 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 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.V346229.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? NO 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 5(1)(2) Requirement An individual, accurate and up to date copy of the Service User Guide must be provided to each newly admitted resident that incorporates the most recent Commission for Social Care Inspection report. All residents must have an accurate and up to date plan of care that is regularly reviewed and amended as required. Relevant risk assessments must be in place with significant outcomes incorporated in the care plan. Risk assessments must also be reviewed on a regular basis. All staff that have not done so must receive training in adult protection. Staffing levels in all units must be determined by the assessed needs of people accommodated in each unit. All staff that work in the dementia care unit must receive specific dementia care training as a matter of priority. All care staff that have not done DS0000032617.V346229.R01.S.doc Timescale for action 31/10/07 2 OP7 15 15/11/07 3 OP7 15 15/11/07 4 5 OP18 OP27 13(6) 18(a) 31/12/07 15/10/07 6 OP30 18© 31/12/07 7 OP38 13(4)(5) 31/12/07 Page 35 Milbanke HFE Version 5.2 so must receive manual handling and first aid training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP7 OP7 OP7 Good Practice Recommendations All care plans and risk assessments should be signed and dated by the writer. All care staff should be required to read care plans/risk assessments and put onto practice the directions recorded in the care plan to ensure continuity. All care plans wherever possible should be devised in consultation with the individual resident, signed by the resident or if previously agreed, by a family member, as acknowledgement and understanding of the content. Care plans should be rewritten if the outcome of the review process indicates significant change. All staff with responsibility for the development and review of care plans should receive appropriate training to ensure understanding of the reason and process of care planning. A regular audit of care plans should take place to ensure care plans are accurate, up to date and reflect current requirements of the individual resident. Written communication systems should always be used by staff when important information is to be passed on to others. If a dose omission is noted on the drug administration record this should be immediately addressed. All identified social care needs should be clearly highlighted in the care plan including how the aims are to be achieved. A range of activities should be provided ‘inhouse’ to suit the needs, requirements and capabilities of all residents. It is recommended that the cook be provided with written detail as to the needs and requirements of any special diet required by a specific resident to ensure that a record is kept. The specific diet required should also be detailed in the care plan. All newly appointed care staff should receive ‘Skills for Care’ induction training standards within the first six DS0000032617.V346229.R01.S.doc Version 5.2 Page 36 4 5 6 7 8 9 OP7 OP7 OP7 OP8 OP9 OP12 10 OP15 11 OP30 Milbanke HFE 12 13 OP36 OP38 weeks of employment. All care staff should receive formal one to one documented supervision at least six times a year. All staff that have not done so should receive mandatory health and safety training. Milbanke HFE DS0000032617.V346229.R01.S.doc Version 5.2 Page 37 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.V346229.R01.S.doc Version 5.2 Page 38 - 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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