Inspection on 21/09/06 for Milford House

This inspection was carried out on 21st September 2006.

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 31/01/06

Milford House 20/09/05

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 Susan Richards Key Unannounced Inspection 21st September 2006 12.15 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 Milford House DS0000020056.V304428.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. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 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.V304428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Milford House is a converted stone country house located in a rural setting near the villages of Milford and Duffield, set back from the A6 within extensive grounds. The home is comprised of two link adjacent units being Milford House and The Coach House. Milford House provides personal care and support for up to 38 older persons, and The Coach House provides personal and nursing care for up to 27 residents. There is a majority of single room accommodation with a number of shared rooms available. Each unit is well appointed, with its own private and communal facilities, having suitable adaptations and equipment to assist those with physical disabilities, including a shaft lift and emergency call system throughout. There are also centralised kitchen and laundry facilities. The home is successfully run with a general registered manager and an appointed full time clinical nurse lead. Care staff work across both units, together with a dedicated team of hotel and administrative services staff. There are also defined external management arrangements and support. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Methodology used during the inspection, included case tracking. This involved taking a random sample of four service users whose care and service provision was closely inspected. Discussions were held with them and with their representatives and their care and associated records were examined and their private and communal accommodation inspected The manager completed a pre-inspection questionnaire about the home and its service provision and a total of 10 surveys were sent out to residents. Seven of these were returned as completed and are accounted for within the main body of the report. What the service does well: What has improved since the last inspection? Significant improvements have been achieved via the home’s quality assurance and monitoring systems. These include substantial and ongoing improvements Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 6 to the environment by way of a planned programme of upgrading and renewal and also with regard to the arrangements to enable residents to engage in recreational, social and leisure activities of their choice. Previous conditions of registration have been achieved, as have the requirements of the previous inspection report of 31/01/06 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.V304428.R01.S.doc Version 5.2 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.V304428.R01.S.doc Version 5.2 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&4 Quality outcome in this section is good. This judgement has been made using evidence available, including a site visit to the home. Residents’ needs are effectively assessed and well met. EVIDENCE: Discussions were held with four residents case tracked about their needs and how they were met and their individual recorded needs assessment information examined. Residents said they were regularly consulted about their needs and felt that these were well met and that they received care and support in accordance with their personal lifestyle preferences and choices. All felt that the care and services afforded to them were to a good standard and expressed their satisfaction. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 9 Individual written needs assessments were in place for each of those residents case tracked. These were formulated in accordance with a recognised assessment model and were regularly reviewed. Individual daily living arrangements and personal lifestyle preferences were detailed. There were no residents accommodated with special cultural or religious needs. Discussions were also held with the manager and staff about the arrangements for the organisation and delivery of care, which were in accordance with the home’s philosophy of promoting a personal centred/needs based approach to care. There was a clearly established system/framework for the delivery of individual’s care and support. Six of the ten surveys forwarded to individual residents were returned. These detailed a high level of satisfaction with the care and support provided to those residents by the home. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 10 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 Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. Residents’ health and personal care needs are promoted and appropriately met in accordance with recognised practise in agreement with them and they are treated with dignity and respect. EVIDENCE: Each of the four residents case tracked had clearly recorded care plans, which were formulated in accordance with their individual needs assessments within a framework of risk assessment. Care plans were reflective of recognised clinical and professional guidance concerned with the care of older people. They set out in detail action to be taken by staff to ensure that all aspect of their health, personal and social care needs are met and had regularly recorded reviews. Individual’s known lifestyle preferences and daily living routines were included and included agreements with them about their care. Residents spoken with said that their care was provided in agreement with them. Residents surveyed indicated that they always received the care and support they required. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 11 Policy and procedural guidance was in place in respect of recognised clinical practise and procedures and staff is conversant with these. Records of the arrangements for individual access to outside health care professionals, including for that for the purposes of routine health care screening were maintained for each resident. The arrangements for the management and administration of medicines in the home were examined and were on the whole satisfactory. However, there were occasions when staff had hand written the medicines instructions onto the medicines administration record (MAR) sheet, but these were not always signed by the person writing the instructions or counter signed by a staff member witnessing this and there was no identification list of staff signatures for those staff responsible for administering medicines to residents. Residents surveyed said that staff always listened to them and were available when they needed them. Residents spoken with said that staff were always mindful of their wishes and feelings and treated them with respect. All residents spoken with said that they had good relationships with staff. Do not disturb signs were provided for all bedrooms and quiet rooms. Recognised care packages were being developed in respect of the specialist care needs of the dying person with a view to developing good practise standards in the home. Staff training was also planned with regard to this. For one service user the Liverpool Care Pathway was in use in respect of their specialist needs in relation to death and dying. However, this standard was not fully inspected on this occasion via case tracking. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 12 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 Quality outcome in this section is excellent. This judgement has been made using evidence available, including a site visit to the home. The arrangements to enable residents to engage in social, community and leisure activities are developing well in consultation with them and the arrangements for meals and food provision is to a high standard, which accords with individuals’ preferences, routines and assessed nutritional needs. EVIDENCE: Routines of daily living and leisure together with the arrangements for social contacts and activities were discussed with residents and also the manager and staff. Positive feedback was given in respect of these. The organisation of trips outside the home was said by all to be developing well in response to feedback from residents obtained from a recent satisfaction survey undertaken with them by the home. An activities co-ordinator is employed. Details of social activities are posted on the residents’ notice board, which is accessible to them, together with regular newsletters and minutes of residents meetings. The latter are held regularly and used as a forum to provide information to residents about the home and its services and also to consult with them and gain their views and opinions. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 13 Details of local and community events were also posted there, together with leaflets and information regarding access to advocacy for service users. Residents felt that they were well informed and regularly consulted with in respect of these. All residents are provided with individual newsletters on a regular basis. Life history information is collated with individual’s permission, recording social and familial interests. This information is used to inform activities planning. Relatives are consulted in instances where residents have significant memory loss. Examples of activities include food-tasting sessions, baking sessions, reminiscence, painting and crafts, entertainments, coffee mornings, board games, bingo and religious activities. There had been a recent summer fayre held at the home and photographs of the event were posted on a display board in the main entrance and also a sponsored walk which had raised in order to raise monies for the residents fund. Records were maintained in respect of activities. A group of residents were about to go on a planned holiday with support from staff. Good links were established with local schools and there had been recent consultation with some of the residents in the home from a school theatre group project seeking to involve them in a proposed production. Visiting to the home is open and residents said they could see their friends and relatives as they chose. Newspapers are delivered daily to the home on an individual basis and a number of residents were reading these during the morning of the inspection. The atmosphere in the home during the inspection was relaxed and lively and friendly. Residents who chose were able to sit in quieter areas of the home. The Inspector observed the arrangements for breakfast and lunch for some of the residents. Tables were well set and the atmosphere was calm and unhurried in the dining rooms. Flexibility was promoted in respect of times and residents were able to choose where to eat. Discussions held with residents included their views regarding food provided in the home. All residents spoken with said the food was excellent, with variety and choice. Written feedback from residents’ surveys indicated the same. Copies of menus were provided. These detailed a nutritious and varied menu with a choice of food at each meal. Choices and arrangements made by residents in respect of the handling of their financial affairs and also bringing in their personal possessions into the home were recorded within their individual care records. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home Residents are confident to raise any concerns they may have and/or to complain using the home’s complaints procedure. Residents are protected from abuse. EVIDENCE: There is a clear complaints procedure details of which are openly displayed and also provided within the service user guide provided to each resident within welcome packs on their admission. A record is kept of all complaints and concerns, which includes full details of investigations and any action taken. Residents spoken with said they have no problems should the need arise in raising concerns. They felt that concerns they raised were usually dealt with. Residents and relatives meeting are also used to provide general feedback regarding any concerns/matters raised, as applicable. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 15 There are clear procedures in place in the home in respect of recognising abuse and responding to any suspicion or allegation of the abuse of any residents and the arrangements for staff training in respect of these are satisfactory. Staff spoken with is conversant with their responsibilities in relation to the above. Milford House DS0000020056.V304428.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. Residents live in a safe and comfortable environment, which suits their needs, and which is subject to pleasing progress with an identified programme of upgrading and renewal. EVIDENCE: A general tour of the premises was undertaken and the communal and private areas of those residents case tracked were inspected. Considerable upgrading has been undertaken to the home via a written programme of maintenance, redecoration and renewal, including the building of a link corridor from the main house to the Coach House. Residents and staff were pleased with this, particularly in respect of the Coach House, where considerable works are well underway for the total upgrade of communal areas. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 17 All areas of the building seen were safe, clean and hygienic and suitably equipped. Residents’ bedrooms were personalised with a number of bedrooms exceeding the minimum standard size. They were well furnished, decorated and equipped. All bedrooms are provided with welcome packs for residents, providing details of the services provided by the home. There is pleasant and well kept gardens, which residents can access. Milford House DS0000020056.V304428.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality outcome in this area is excellent. This judgement has been made using evidence available, including a site visit to the home. Residents’ needs are well met by well-trained and competent staff and they are engaged in and supported and protected by the home’s recruitment policy and practises. EVIDENCE: Records of staff employed, staff turnover and duty rotas were provided and examined. The arrangements for staff recruitment and selection, together with their induction, training, deployment and supervision were discussed with the manager and also with staff. Records were also examined in relation to these, including the personal files of four of the most recent staff starters. These were satisfactory with well-maintained records in their respect. There is a written training plan in place and individual staff profiles are openly provided for residents’ information. These are also available for access by relatives and residents’ representatives. Staff spoken with felt that they were well supported and supervised and that the arrangements for them to access training were good, including regular access to mandatory training and updates, NVQ s and training in relation to the conditions of the residents accommodated in the home. Staff training records reflected this. A total of Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 19 68 of staff had achieved at least NVQ level 2 or above. A further 3 had enrolled to undertaken these with others undertaking. Many staff had undertaken training in respect of positive dementia care. Developments were being undertaken in respect of supporting and enabling residents’ involvement in the recruitment and selection of staff, including the arrangements for residents to ask questions at staff interviews. Milford House DS0000020056.V304428.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 & 38 Quality outcome in this area is excellent. This judgement has been made using evidence available, including a site visit to the home. Residents live in a home, which is very proactively run and managed in their best interests and in consultation with them. The health, safety and welfare of residents and staff are well promoted and protected. EVIDENCE: Discussions were held with the manager about her training and experience, which is suitable and includes a recently completed NVQ level 4 in management and care. Discussions were held individually with the manager and staff regarding the arrangements for the running of the home, including communication and support for staff and residents and also its equal opportunities policy. There is Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 21 a clinical nurse lead appointed in the home. She has a clearly defined job description. The arrangements for the development of the home and quality monitoring and assurance were discussed with the manager and staff and also some residents in respect of consultation with them. There is a clear operational strategy in place in respect of these and the results of the most recent audits and satisfaction survey were posted in the dining area for residents and their representatives to access. Minutes of meetings with staff and residents also detail information/consultation and feedback in respect of these. Consultation is also undertaken with other stakeholders, including outside health care professionals visiting the home. The results of the most recent surveys were discussed including action being taken as a result of those. A relatives’ questionnaire was also in draft format. There is good external management/clinical support and a representative of the registered provider regularly visits the home. Reports of those visits are provided. The arrangements for the management and handling of service users monies were discussed and examined. These were satisfactory and in accordance with the home’s policy guidance. The arrangements for staff supervision were discussed separately with the manager and staff. These included regular one to one supervision and were satisfactory. Staff said that felt well supported by the management arrangements in the home, which they said was open and accessible. A number of records, which are required to be kept by the home, were examined during the inspection. These are referred to under the relevant sections of this report and were well maintained and kept. Individual’s records and home records were stored safely and securely. The arrangements to promote and ensure safe staff working practises were discussed and staff training records examined. (See also staffing section of this report). These were satisfactory. Details of the maintenance of equipment in the home were provided and were satisfactory. There are clear health and safety policies and procedural guidance in place, which staff said they had access to. They also said they were provided with copies of key policy guidance within their staff handbook and induction pack, provided to them at their induction. The system and arrangements for the reporting and recording of accidents and untoward incidents were discussed and records examined. These were satisfactory. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 22 Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 23 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 3 3 Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13 Requirement Where a medicines instruction is hand written on a medicines administration record (MAR) sheet it must always be signed and dated by the staff member writing it and countersigned by a witnessing staff member. An identification record of staff signatures must be kept in respect of those staff responsible for administering medicines. Timescale for action 31/10/06 2. OP9 13 31/10/06 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 OP19 Good Practice Recommendations It should be ensured that the well-established programme of upgrading and renewal of the building (specifically the Coach House) is fully completed in a timely manner in accordance with the expressed wishes of service users and their representatives. Milford House DS0000020056.V304428.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI Milford House DS0000020056.V304428.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!