CARE HOMES FOR OLDER PEOPLE
Milford House Derby Road Milford Nr Belper Derbyshire DE5 0RA Lead Inspector
Andrew Bailey Unannounced Inspection 31st January 2006 10:15 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.V281066.R01.S.doc Version 5.1 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.V281066.R01.S.doc Version 5.1 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.V281066.R01.S.doc Version 5.1 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. 20th September 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 residents. Services include personal care, nursing care, meals, laundry and accommodation in shared and single rooms. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the duration of the inspection was approximately five hours. Discussions were held with staff, six residents and with two relatives. A number of records were examined, including care plans (as part of the case tracking process, which is used to help determine how the home meets the needs of individual residents). The focus of this inspection was on key National Minimum Standards and the follow up of requirements from previous inspection of this service. Efforts were made to obtain the opinions of as many of the residents and relatives as possible about the quality of the service. What the service does well: What has improved since the last inspection?
There has been further redecoration and refurbishment of the home as part of the maintenance/decoration programme. The hall, stairs and a lounge area of Milford House have been re-carpeted. The management are proud of the on-going progress made in the training of staff. There has also been a process of realigning roles, with the resultant employment of an additional housekeeper and a breakfast assistant. Work has also taken place to develop the key worker role and there has been further integration of the staff working in the nursing and residential units. Quality monitoring is taking a high profile within the group and this further assures the quality of the service for residents, and is taking into account their views of the service.
Milford House DS0000020056.V281066.R01.S.doc Version 5.1 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.V281066.R01.S.doc Version 5.1 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.V281066.R01.S.doc Version 5.1 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): None EVIDENCE: (All key standards were assessed at the last inspection, with no requirements or recommendations made) Milford House DS0000020056.V281066.R01.S.doc Version 5.1 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): None EVIDENCE: (All key standards were assessed at the last inspection, with no requirements or recommendations made) Care plans were examined at this inspection in respect of the case tracking process only. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 10 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): 15 Residents report that meals are provided to a good standard, with choices available. EVIDENCE: The views of several residents were sought about the quality of the catering service. Two relatives were also able to comment about the food at the home. The general feedback was very positive about the quality of the food. The midday meal was being served in Milford House during the inspection visit and this appeared to be well received by the residents. The mealtime was unhurried and there was help on hand from care staff for residents who needing assistance. A rolling four-weekly menu is in operation and special diets are provided where appropriate. The opinions of residents are sought on an on-going basis about the food and menus through the residents’ meetings. There are comments about the dining furniture in The Coach House within the environment section of this report. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 11 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 A complaints procedure is in place, with confirmation from residents and relatives that they feel able to raise any issues formally or informally and that that any concerns will receive appropriate consideration. EVIDENCE: The complaints procedure is made known to residents and representatives. Residents and relatives spoken with felt able to raise issues with staff and reportedly most matters could be dealt with on an informal basis. Relatives praised the open-door policy adopted at the home and the general level of communication appears to be good. There had been one recent incident where poor communication on behalf of staff had been identified, but this did not appear to be a regular or on-going problem. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 12 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 & 26 Overall, the home provides a comfortable and well-maintained environment for residents. Planned improvements to The Coach House should further improve the surroundings for residents living at the home. EVIDENCE: The majority of the residents spoken with were living in the Milford House part of this care home. They reported being very satisfied with the standard and level of comfort provided. The management stated that there are plans to upgrade parts of The Coach House upon completion of the building work, which will provide a physical link between the two parts of the registered establishment. The planned improvements include the main communal areas (lounge/dining areas). There is a current requirement (timescale not expired) in respect of the dining furniture in The Coach House. There has been new carpeting laid in the hall, stairs and pink lounge areas of Milford House, and several more bedrooms have been redecorated since the last inspection of this service. The management stated that there were plans
Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 13 to refurbish further communal areas in Milford House, including the lounge and dining areas. A previous requirement in relation to electric lighting levels (Coach House) has been addressed. There is a current requirement for the provision of a sluicing disinfector in The Coach House (timescale not expired). The management is studying this requirement and the Development Manager stated that there was an intention to consult formally with the Environmental Health Officer on this issue. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 14 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): 28 & 29 Staff training is promoted and suitably prepares staff to meet the needs of the residents. The recruitment processes in place promote the protection of the residents. EVIDENCE: The management were pleased to describe the developments that have taken place in relation to staffing. There is continued progress in achieving a high percentage of staff trained (or in training) to National Vocational Qualification (NVQ) Levels 2 or 3. There are currently ten staff training for NVQ qualifications, with a further three staff due to enrol in the week following the inspection. Management reported satisfaction in having recruited a number of staff recently that were proving to be a credit to the home. There has been some realignment of roles, with the introduction of a housekeeper at The Coach House and a breakfast assistant at Milford House. There have also been steps to integrate staff across the two units to provide a more flexible staffing arrangement and further development of the key worker role. Staff training in core/essential subjects continues to be well-supported at the home, with adult protection, health & safety and basic food hygiene providing examples of recent training undertaken by staff. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 15 Residents and relatives spoke highly of the care provided by the team of staff. Staff were described as being caring, patient and committed in the provision of personalised care. Independence is promoted for residents as far as possible. A sample of staff recruitment documentation was examined at this inspection and there appeared to be a robust approach to the employment practices at the home. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 16 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, 33, 35, 37 & 38 The care home is well-managed and there are open and transparent systems in place to encourage residents and their representatives to shape the way that the home operates. The safe working practices systems promote the health and safety of the residents. EVIDENCE: The registered manager has completed the Registered Managers Award and has virtually completed the care qualification that managers of care homes are required to undertake. Residents and relatives spoken with were complimentary about the skills and the approach of the manager. The Development Manager is currently focusing on the quality assurance systems across the group of homes, with a view to developing the systems further.
Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 17 Visits to the home in accordance with Regulation 26 of The Care Homes Regulations 2001 are undertaken monthly, with written reports produced after each visit. Residents’ meetings take place and these provide one of the important feedback processes that seek the views of residents (and/or their representatives). An example of how residents’ views can then shape life at the home is feedback on the catering service being taken into consideration in the planning of menus. Periodic satisfaction surveys are also undertaken, with feedback made available subsequently. One area of resident/representative feedback supports the need to consider environmental aspects at The Coach House. There is minimal involvement with the personal finances of residents. The personal money accounting procedures for two residents (small monetary amounts only) were examined and seem to operate flexibly in the interests of the residents. There was a requirement made at the last inspection in respect of the storage of residents care records. The management are considering options to ensure that Data Protection Act (1998) is complied with, whilst ensuring that records remain easily accessible to staff and other authorised professionals. The timescale has been extended for this requirement. Staff receive on-going training in safe working practices, such as basic food hygiene and Health & Safety. Training records were examined at this visit. There was evidence that services had been regularly serviced/inspected (a sample of records was examined at this visit). However, there needs to be evidence of a valid certificate in respect of the electrical installation. Management reported that examination of the installation took place around June 2005, but there was no certificate on site to confirm satisfactory status of the installation. Management agreed to provide evidence of a valid certificate to CSCI. The overall approach to safe working practices provides assurance that satisfactory efforts are being made to promote the health and safety of the residents, staff and other persons visiting the premises. Milford House DS0000020056.V281066.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 2 X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP20 Regulation 16(2)(c) Requirement The registered persons must ensure that dining furniture is provided which is suitable to the needs of service users (Coach House). (This requirement, previously reported under NMS 15, is within the timescale issued at the last inspection) The registered persons must provide a sluicing disinfector in the Coach House, nursing unit. (This requirement is within the timescale issued at the last inspection) The registered persons must ensure that records held in the home are securely stored and comply with the Data Protection Act. (Previous timescale of 31/12/05 not met. Timescale extended) The registered persons must provide evidence of a valid electrical installation certificate. Timescale for action 31/03/06 3. OP26 23(2)(k) 31/03/06 4. OP37 17(1)(b) 31/03/06 5. OP38 23(2)(b) 31/03/06 Milford House DS0000020056.V281066.R01.S.doc Version 5.1 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. Refer to Standard Good Practice Recommendations Milford House DS0000020056.V281066.R01.S.doc Version 5.1 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. Extracts may not be used or reproduced without the express permission of CSCI Milford House DS0000020056.V281066.R01.S.doc Version 5.1 Page 22 - 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!
