Inspection on 20/09/05 for Milford House

This inspection was carried out on 20th September 2005.

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

The inspector 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

Milford House 21/09/06

Milford House 31/01/06

Milford House 21/07/04

Similar services:

Carlton Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE Milford House Derby Road Milford Nr Belper Derbyshire DE5 0RA Lead Inspector Eileen McHale Unannounced Inspection 20th September 2005 10:00 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 Milford House DS0000020056.V250984.R01.S.doc Version 5.0 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. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Milford House Address Derby Road Milford Nr Belper Derbyshire DE5 0RA (01332) 841753 (01332) 841753 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) Mr Keith Sidney Dobb Mr Gerald Hudson Sharon Kay Price Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Plus Two (2) Day Care Places. Service Users requiring nursing care are not to be admitted to the Milford Unit until such time as a link corridor is provided. The appointment of a first level nurse as Clinical Lead in the home. The completion by the registered manager of NVQ 4 in care by the end of June 2006. 8 March 2005 Date of last inspection Brief Description of the Service: Milford House is a converted stone country house situated near the villages of Milford and Duffield and is in a rural setting. The home is set back from the A6 in extensive grounds. The home is comprised of two separate units within the grounds; these are Milford House and The Coach house. Milford House has provision for 38 older people requiring personal care only and the Coach House provides personal and nursing care for 27 service users. Services include personal care, nursing care, meals laundry and accommodation in shared and single rooms. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In the course of this inspection, the inspector visited both units of the home and spoke to staff, service users and one family member. Residents’ care plans were examined. What the service does well: What has improved since the last inspection? Since the last inspection considerable progress has been made in the introduction of a new system of care planning which addresses the history of residents, their social and recreational needs as well as their physical and health care needs. There has been an on-going programme of refurbishment, which is particularly noticeable within the Milford House unit. Levels of lighting have improved considerably and the manager has made every effort to introduce pictures, ornaments and features, which enhance the natural elegance of the home. Similarly for both units attention has been made to increase the range of social activities available in the home. The home was formerly two separate establishments and the managers of the home have worked hard to ensure the integration of staff into one staff team able to provide a coherent and flexible service to residents within both units. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 7 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 Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Service users needs are known to the home before admission. EVIDENCE: Three care plans were seen at the time of the inspection. All of these contained detailed information on the needs of service users including risk assessment. New documentation was being introduced within the home and this documentation was at varying points of completion but it was clear that full information on needs was identified. The home did not provide intermediate care. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents benefit from planned responses to their individual needs and the courteous attention of staff. EVIDENCE: New care plan documentation was completed for some residents and in process of completion for others. Care plans identified and addressed medical conditions, the care required by residents to maintain their preferred way of life. Since the last inspection improvements had been sustained to records of service users personal history and of their social and recreational needs and preferences. Risk assessments were in place for moving and handling, the risk of falls, tissue viability, nutrition and infection control. In addition any individual risks for residents were identified and assessed. Records were maintained of the health care needs of residents and these included the inputs of health care professionals. Attention was paid to the needs of residents for optical, dental and foot care services. The home had the Nomad system of medication. This was stored in metal cupboards secured to the wall. Since the last inspection additional security measures had been put in place in the Coach House unit. At the time of the Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 10 inspection it was noted at the Coach House that although there was a controlled drug cupboard, no controlled drugs were administered other than Temazepam. Records were maintained of levels of the drug remaining and recorded in the MAR sheet. At the time of the inspection, unused medication was being returned to the pharmacy although the clinical lead was aware of changes in these arrangements. Those residents who spoke to the inspector were positive about the standard of care in the home. The inspector observed that the privacy of residents was respected. One resident and a visitor explained that residents who wished to spend time in their rooms were supported to do so. The manager reported that residents were asked before they were admitted whether they wished to have a lock on their door. No further locks had been fitted since the last inspection. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents were supported to keep to their preferred lifestyle and effort was made to increase the range of recreation available in the home. EVIDENCE: Residents who spoke to the inspector expressed high satisfaction with the lifestyle on offer in the home. Service users have the choice of spending time alone or living a communal life. Where residents chose a more solitary life, staff members kept frequent contact with them. Others enjoying a more communal life had opportunities to have their own favoured activities. One resident reported she had recorded books and a radio. There was a programme of activities available for residents. This included a recent fete and entertainment had been in the home that morning. Particular progress had been made in increasing activities within the Coach House unit. There were numbers of visitors in the home at the time of the inspection. This was consistent with the inspectors experience at all previous visits. Residents indicated that the meals prepared in the home were enjoyable. The home had a four-week rotating menu. A cooked breakfast was available every day, which included poached fish, or full English breakfast and the manager said that some residents had a full breakfast every day. There were choices in Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 12 place at each meal and supper was provided. The menu was extensive and balanced. Meals were taken within the dining rooms in each unit. The Milford House unit provided well dressed tables in an attractive well presented area. Within the Coach House unit however the tables and chairs were plastic, as might be used for patio dining. This matter had been raised at previous inspections. However, the manager showed that work to make a physical link between the two units was progressing well and that this would provide an opportunity to remodel the kitchen and dining area within the Coach House. It was anticipated that this would present an opportunity to provide an attractive dining area with domestic furniture. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents have been protected by the provision of adult protection training to staff working in the home. EVIDENCE: Since the last inspection, in-house training had been provided to staff on adult protection. This had included a video and questionnaires. In addition some staff had received training provided by Derbyshire County Council. The authority had initiated a 4 day training programme to train trainers and the Development manager was due to take the course. This would enable training to be cascaded within the company. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 Service users comfort has been improved by measures already taken and will be further enhanced when other proposed measures to make changes in the Coach House have been carried out. EVIDENCE: There was evidence within the Milford unit of on-going improvements to the quality of the environment. A programme of redecoration of bedrooms continued and significant improvements had been achieved to standards of lighting within residents’ rooms and other areas used by them. The manager had ensured that pictures, flower displays and ornaments were used to improve circulation areas as well as the main communal areas. The carpet to the main entrance and stair required replacement but the manager reported that agreement had been given for its replacement. Within the Coach House unit, some redecoration had taken place of bedrooms and bathrooms had been redecorated. Some delay in other work was as a result of the link between the buildings, which was at the time of the inspection incomplete. The manager and development manager indicated that Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 15 on completion, the kitchen and dining area would be redesigned and reused, as food would be delivered from the main kitchen. At that point any redesign would take into account natural light levels in the dining room. It was noted that lighting levels in bedrooms and bathrooms were at a low level. This impacted on the nursing staff’s ability to examine patient’s skin. It appeared that low wattage bulbs were used in the areas. It was noted that residents rooms were maintained to a comfortable condition and residents were encouraged to personalise their rooms. In most instances residents had taken full advantage of this encouragement. The home was being maintained to a clean condition and it was noted that additional housekeeping staff were being used. On this occasion the laundry was not inspected, but the manager confirmed that there was still no sluicing disinfector fitted in the nursing unit. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 Staff cover to the two units had improved by the recruitment of additional staff and more flexible cover. EVIDENCE: Since the last inspection work had progressed to integrate the two units as one home. It was reported that two additional nurses had been recruited from overseas, providing additional cover for the nursing unit. In addition more care staff had been appointed and their conditions of employment were said to ensure that they covered both units. The home had also appointed additional housekeeping and cleaning staff. Levels of training to NVQ 2 continued to increase and at the time of the inspection 5 staff members were undertaking NVQ2 and 1 was undertaking NVQ3. Nurses recruited from abroad were to undertake adaptation training approved by the University of Derby. The development manager reported that she had spoken to the CRB (Criminal records Bureau) about some young people of school age who were employed to work in the kitchens. She had been informed that CRB checks were not needed for anyone under 16, but that these must be in place as soon as they reached 16.She indicated hat the home met this advice. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected on this occasion. It was however noted that residents’ records were held in an open area in the corner of the lounge in the Milford unit. Although accessible to staff and more easily accessible to residents who might wish to see their own notes, the inspector queried whether the storage, which was open met the requirements of the Data Protection Act. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 18 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 x x x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? ¦#ZTREQT¦# Use Section 1 button to insert Standards in the Standard column 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 OP15 Regulation 16(2)(c) Requirement The manager must ensure that dining furniture is provided which is suitable to the needs of service users.(Coach House) Timescale for action 31/03/06 2 OP19 23(2)(p) 3 OP26 23(2)(k) This matter is outstanding from the previous inspection The manager must ensure that 31/03/06 lighting levels within bedrooms in the Coach House are improved and are sufficient to ensure proper examination of service users by nursing staff. 31/03/06 The responsible individual must provide a sluicing disinfector in the Coach House, nursing unit. This matter is outstanding from previous inspections. The manager must ensure that records held in the home are securely stored and comply with the Data Protection Act. 4 OP37 17(b) 31/12/05 Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations The manager should ensure that staffing levels are established in line with the Residential Forum formula. Milford House DS0000020056.V250984.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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