Inspection on 26/10/06 for Mildred Stone House

This inspection was carried out on 26th October 2006.

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

Mildred Stone House 30/08/07

Mildred Stone House 15/02/06

Mildred Stone House 01/06/05

Mildred Stone House 12/01/05

Mildred Stone House 08/07/04

Mildred Stone House 04/06/04

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

CARE HOMES FOR OLDER PEOPLE Mildred Stone House Lawn Avenue Great Yarmouth Norfolk NR30 1QS Lead Inspector Maggie Prettyman Unannounced Inspection 26th October 2006 10:45 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 Mildred Stone House DS0000034268.V317694.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. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mildred Stone House Address Lawn Avenue Great Yarmouth Norfolk NR30 1QS 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) 01493 855797 01493 332128 mildredstone.socs@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care In Progress Care Home 32 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (32) of places Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: Mildred Stone House is a two-storey residential care home for older people and is managed by Norfolk County Council. The home is situated beside the river Yare within easy reach of the local amenities of Great Yarmouth. The home offers long and short-term care for older people. The accommodation comprises 32 single rooms with one having en-suite facilities. The home is divided into four living areas and can accommodate up to 32 people with dementia, all who may be older people but 5 of whom may be people who are not yet 65 years old. Attached to the building is a day centre that is separate from the main house and independently managed by NCC. The home is surrounded by landscaped gardens with an enclosed area at the rear. There is ample parking at the front entrance. The weekly charge for services is £368. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the home and current judgements for each outcome group. What the service does well: What has improved since the last inspection? Following a period of uncertainty, an experienced new manager has been appointed who is determined to bring about the change that this home needs to provide an appropriate service to it residents. A new recall and reminiscence room has been identified and staff trained in activities for people with dementia care. Some service users have new care plans and the remainder are in progress. Great effort has been made to improve the system of medication in the home. A new MDS system is now in place and staff are properly trained and confident in its use. Staffing hours have been increased at critical times during the day. Staff have been trained both in statutory subjects and in NVQ qualification. A system of supervision has been introduced for all staff. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 6 What they could do better: The shortfalls that this home experiences are mainly due to lack of resources and chronic unplanned absence of staff. A number of requirements and recommendations have been made at the end of this report. Requirements made are as follows; • • • • • • • • • An immediate requirement that the call bell system must cover every room and be excessible. Care plans must be completed in full for all service users Service users health care needs in relation to dementia care must be met. A programme of activities that support service users with dementia care needs must be provided. Significant improvements to communal areas and corridors must be made to support service users with dementia care needs. Work must continue to reduce unplanned staff absence and staffing shortages. Agency staff training and vetting must be validated by the home. The quality assurance survey must be completed and used to develop the service according to the needs and expectations of its service users. Monitoring visits by the provider must ensure that the purpose of the home and the health and safety needs of its residents are met. Recommendations made are as follows; • • • • • • • The service user guide should be produced in a more accessible form for service users. It could also be more detailed. The service user guide should be available in service user rooms A system for the prompt disposal of specialist medication should be identified. Plans for greater community involvement should be implemented. Further work should take place to record and implement independent choice for service users. The new system of supervision should be further developed and implemented. A more accessible system of comment compliment and complaint should be considered. Please contact the provider for advice of actions taken in response to this Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 7 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. Mildred Stone House DS0000034268.V317694.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 Mildred Stone House DS0000034268.V317694.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, 2, 3 and 6 Quality in this outcome area is good. The information given to service users could be more accessible. Each service user has a written contract with the home. A needs assessment is undertaken for all prospective service users. Service users referred for intermediate care are supported in life skills if possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide is in written form only. It is recommended that this guide be amended to be more accessible to prospective service users. Evidence of contracts was seen in service user files. It is recommended that some of this information is also put in the service user guide and that these should be placed in service user rooms. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 10 Evidence in service user files and observation of the service user group demonstrates that appropriate referrals are being made to the service. These are supported by good information and a home visit by senior staff from the home. Most people receiving respite care attend the day centre attached to the home. Consequently information about life skills and daily routines is readily available to the home. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate. The home is working towards completing work on new care plans for all service users. Service users health care needs are met, but support for dementia care is restricted by environmental and staffing shortfalls. A new system of medication is now in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspection of service user plans demonstrates that considerable work has been undertaken to complete new care plans for service users. Unfortunately some detail is lacking from plans, particularly in relation to positive intervention plans for service users with dementia, and others have not been done. This work has undoubtedly been frustrated by shortage of time caused by staffing shortfalls identified later in this report. It is required that work on updating all care plans is completed as a matter of priority. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 12 Examination of care records, discussion with staff, information from service users and health professionals and observation of service users demonstrate that service user health care needs are met. As previously stated, there is a shortfall in one area, dementia care support which is caused by environmental and staffing shortfalls. It is required that the healthcare needs of service users in relation to dementia care are met. All the requirements and recommendations made in the previous inspection in relation to medication have been met. A new MDS system of medication administration is in place and staff have been trained in its operation. Issues remain with the prompt disposal of some drugs. It is recommended that the home investigate more efficient system of disposing of some specialist drugs. On the day of inspection staffing shortfalls had undermined the efficient administration of medication in the home. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is poor. The home lacks organised activities to support the needs of its service users. Service users have little contact with the local community, except that provided by their family and friends. The new manager intends to improve the level of autonomy and choice available to service users. Good standards of food and support at mealtimes enable service users to enjoy a varied and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a number of staff who are trained in promoting activities. A reminiscence room is being developed. The new manager has positive plans for the implementation of a structured activities programme. However staffing and environmental shortfalls undermine a consistent, planned and promoted programme of activities. Events are planned but are not advertised. Chronic staff shortages mean that daily activities and stimulation do not currently take place. It is required that a programme of activities that support the Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 14 needs of people with dementia are planned, promoted and implemented. Very few community groups and organisations have contact with the home. Relatives visit regularly, but this is the only community contact that many residents receive. The new manager is planning to involve more groups and external organisations in the daily life of the home. It is recommended that plans for community involvement be implemented as soon as possible. The new manager intends to improve the level of involvement of independent persons to support service users in making individual choices and decisions. Personal histories detailing likes and dislikes are in place for some, but not all, service users. It is recommended that further work takes place to improve knowledge of service user likes and dislikes, as well as involving independent persons to support service users in life choices. Observation of the dining room demonstrated a positive and caring environment. Tables were attractively laid with individual menus. Staff were observed to be supportive and caring, offering choice and support. A snack bar is available at all times. Staggered mealtimes make the environment peaceful and pleasant. Kitchen and care staff were found to be knowledgeable of service user needs. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. The home has a system of complaints which could be made more accessible to service users. Staff are trained in recognising the signs and symptoms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Few complaints are received from service users. The home does not currently record verbal compliments, comments and suggestions. It is recommended that the home finds ways of making an accessible system of comments, compliments, complaints and suggestions available to service users. All staff are trained in recognising the signs and symptoms of abuse in older people, as well as in whistle blowing. Training in management of behaviour that challenges is provided as necessary. Service user valuables are recorded and stored securely. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 16 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, 20, 21, 24 and 26 Quality in this outcome area is poor. Service users live in an environment which requires redecoration and had significant safety risks relating to the emergency call system. Many of the communal facilities do not meet the dementia care needs of service users. Service users have sufficient lavatories and washing facilities. Service user rooms are usually personalised with individual possessions. The home is mostly clean, pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building demonstrated that the call system in one case had been completely removed from a toilet. This removal of an accessible safety call system seriously compromises the health, safety and autonomy of service Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 17 users. An immediate requirement that this system be reinstated was made during the inspection. This requirement was also identified at the previous inspection and not implemented. Observation of the homes’ environment demonstrated that décor fails to support the needs of service users with dementia care needs. Colours used are bland, very few pictures can be seen on walls, lighting was dull and in some corridors totally inadequate. Service user rooms are identified by name only, with no individualised pictorial markers. Some rooms had torn wallpaper. A leak was identified behind one toilet. Items such as a mattress, hoists and boxes of continence supplies were stored in one residents lounge. A light socket accessible to service users was without a bulb. It is required that urgent action is taken to significantly improve the communal areas of the home, both in terms of decoration that supports the dementia care needs of service users, and in terms of general maintenance and storage. Inspection of lavatories and washing areas demonstrated that these are kept clean and tidy; thermometers were available to check bath temperatures. Pictures identifying these rooms were on their doors. Service user individual rooms contained a variety of personal possessions. Safety in individual rooms had been compromised by the removal or inaccessibility of the call system. The staff team work hard to maintain a clean and hygienic environment. New flooring is planned for some areas to assist in maintaining a fresh atmosphere. Laundry was found to be appropriately sorted, with industrial machines providing good laundry facilities. An external contractor washes linens. Staff were seen to be careful and caring of service user garments. Sluices are available to appropriately dispose of foul waste. These areas were also found to be clean and hygienic. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 18 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 and 29 Quality in this outcome area is poor. Some aspects of service users care are seriously compromised by chronic staff absence or shortage. A good level of NVQ training is in place. Service users are not always protected by the homes recruitment policies and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection two staff had rung in sick. As a consequence the senior officer on duty had been involved in care work as well as dispensing medication, meeting with a visiting social worker and trying to organise cover for the afternoon and following morning shifts. Disruption to the medication round meant that some residents’ medication had been delayed. Inspection of rotas demonstrated that such unplanned absence is common and seriously affects the ongoing care provided and management of the home. The new manager is taking positive steps to tackle this problem. It is required that work continues in tackling staff absence and staffing shortages in the home. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 19 Discussion with the manager demonstrated that good levels of NVQ achievement are in place. Examination of staff files demonstrated occasional shortfalls in paperwork available for inspection. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good A newly appointed manager is in place Quality assurance systems are poor. Service users money is safeguarded. A system of supervision is being implemented. Safe working practices are in operation in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A competent and experienced new manager has been recently appointed who understands the shortfalls of the home and the urgent need to significantly improve its service. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 21 The previous requirement for a quality assurance survey has not been met. It is required that the quality assurance survey is completed. Section 26 inspections by the provider have been undertaken, but have failed to ensure that a good standard of service in respect of dementia care is provided by the home. These visits have also failed to meet the health and safety need for an operational call system to be in place. It is required that section 26 inspection by the provider ensures that the purpose of the home and the safety of its residents is met. A variety of internal audits take place by independent persons and are documented. This system of audit will provide a good source of information for the home to develop self-monitoring in the future. Service users monies held by the home were checked and found to be in good order. The new manager is implementing a system of staff supervision and accountability. It is recommended that this system is further developed and implemented to support the staff of the home. In general safe working practices are in place in the home. Statutory training is in place for all staff. Water temperatures are regularly checked and recorded. Risk assessments are in place and accidents and incidents are recorded and audited centrally. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 22 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 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 3 X X 2 X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 2 X 3 Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement All residents, including those on short stay, must have an up to date care plan composed that reflects their needs. Repeated requirement Work should continue to reduce staff absence and staffing shortages in the home. Repeated requirement The planned collection and review of the views and opinions of the service of residents, their relatives and staff members must proceed as planned without further delay Repeated Requirement Service users must have health care needs in relation to dementia care supported. A suitable programme of activities that support the needs of service users with dementia must be provided An immediate requirement that the call system covers every room and is excessible. Communal areas and corridors must be improved both in terms of decoration that supports the DS0000034268.V317694.R01.S.doc Timescale for action 31/12/06 2. OP27 18 (1)a 31/01/07 3. OP33 24 (1) a 30/03/07 4. 5. OP8 OP12 12 1a, 4b 16 1, 2 m n 13 (4) 23 1(a) 31/12/06 31/01/07 6. 7. OP19 OP20 30/10/06 30/04/07 Mildred Stone House Version 5.2 Page 24 8. OP33 26 needs of service users with dementia and in terms of general repair. Monitoring visits by the provider 30/11/06 must ensure that the purpose of the home and the health and safety needs of its residents are met. 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. Refer to Standard OP1 OP9 OP13 OP14 OP36 Good Practice Recommendations The service user guide should be more accessible and contain details of contractual entitlements, and should be placed in all service user rooms. A method of promptly disposing of specialist drugs should be identified Plans for community involvement in the home should be progressed as planned. Further work to record and implement individual choice for service users, as well as involving independent persons should take place. The new system of supervision should be further developed and implemented to support staff working in the home. Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Mildred Stone House DS0000034268.V317694.R01.S.doc Version 5.2 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. 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