Inspection on 26/01/07 for Milford Manor

This inspection was carried out on 26th January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milford Manor 21/01/09

Milford Manor 02/03/06

Milford Manor 08/09/05

Milford Manor 03/02/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Milford Manor Milford Manor Gardens Salisbury Wiltshire SP1 2RN Lead Inspector Ms Sally Walker Unannounced Inspection 09:20 26 January 2007 th 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 Manor DS0000062170.V317746.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 Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milford Manor Address Milford Manor Gardens Salisbury Wiltshire SP1 2RN 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) 01722 338652 Wessex Care Ltd Tracey Elizabeth Morris Care Home 29 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (29), Old age, not falling within any other of places category (29), Physical disability (1) Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may admit people to the home over the age of 60 years of age providing their assessed needs are similar to those of an Older Person. 2nd March 2006 Date of last inspection Brief Description of the Service: Milford Manor is an established home that provides care and accommodation for up to 29 older people, some of whom may also have dementia. All residents have single bedrooms; both double bedrooms currently are single occupancy only. There are several communal rooms. The home has a conservatory overlooking a large garden and car parking is available to the front of the building. Milford Manor is situated in a quiet residential area of Salisbury with public transport available into the city centre. Mr and Mrs Airey have made great efforts to improve the environment, staffing and recording systems since taking over the home. They also own 2 nursing homes in Wiltshire. Mrs Tracy Morris is the registered manager. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.20am and 5.40pm. Mrs Morris was present during the inspection and Mrs Sally Bellinger, Service manager, represented Mr and Mrs Airey for the feedback. As part of the inspection process some of the relatives, GPs and nurses were asked for their comments on the home. One of the relatives said that any problems had been sorted out straight away. They said they had a good rapport with the staff and that they were very aware of the resident’s needs. They said that their only concern was that there did not seem to be enough staff at the weekends. Another relative said that they were generally satisfied with the care and in some areas the senior staff did very well. They were concerned with the support to their relative with regard to eating which was not consistent. They had pointed this out to the home. One of the community psychiatric nurse’s said that they could only speak highly of the staff. They said that the home worked with sensitivity to the residents needs and had a genuine fondness for the residents. They also said that the home had dealt well with reducing smells associated with continence. One of the care managers said that this home was chosen for their client because of its holistic behavioural approach. Another care manager said that they were happy with the care and that staff were very thorough when reporting to reviews. They said that staff let them know if there were any concerns. A GP said “ I regularly see patients at Milford Manor and am extremely impressed by their knowledge of the patients, personal care and friendliness both to visitors and to the patients whom they know extremely well. It is one of the most caring establishments in the area.” Another GP said that from a medical point of view they had no problems with the quality of care their patient was provided with. Comment cards were also sent to the home prior to the inspection for residents to fill out. Seven responded. One resident said that due to the long time that they had lived at the home they felt there was nothing that could be improved upon. Four residents said they had received a contract and one could not remember. Six residents said they had received sufficient information before moving in. Seven residents said that they received the care and support they needed. Five residents said that staff listened and acted upon what they said; two answered no to this question. Three residents said that staff were always available when they needed them; three said usually and one said never. One Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 6 resident said that there were times when staff were busy. Another said that they had a high regard for all the staff who had been at Milford Manor for the time of their stay. They went on to say that when new staff arrived, they stayed. They said that the home was a happy and cheerful home to be in. They said the staff were very caring and dedicated with whatever task they undertake. Another resident said that staff were sometimes a little busy. One resident answered “not always” to the question as to whether staff listen and act upon what they said. They went on to say that staff were sometimes busy and also short staffed. Seven residents said they received the medical support they needed. Two residents said they did not always want to join in with the activities. Another said they congratulated the activities organiser for the task she undertook. They said that the organiser was often complimented by the families. To the question about whether activities were arranged that they could take part in; 6 answered always and one answered usually. One resident said that the meals were acceptable. Another resident said that the chef was excellent and had experience of Italian cooking. To the question about whether residents like the meals; 5 answered always and two answered usually. Four residents said they had been advised to go to the manager to make complaints. Five residents said they knew who to speak to if they were not happy, 2 were not sure. Five residents knew who to complain to and 2 did not. Six residents said the home was always fresh and clean and one said that it usually was. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The weekly fee is between £460.00 and £560.00. What the service does well: The home makes sure that it can meet prospective residents’ care needs by carrying out thorough pre-admission assessments. Information is gathered from the resident and all those involved in their care. Risks to residents are assessed and guidance on risk management identified in care plans. Care plans were regularly reviewed or more frequently if needs changed. There were good systems for recording some aspects of residents immediate needs, for example, fluid intake, turning charts and nutritional charts. Residents risk of developing pressure sores was being assessed and any early indicators referred to the district nurse. Pressure relieving equipment was in place. Any concerns regarding residents’ health were promptly referred to the relevant healthcare professional. Residents were well groomed. Staff were seen to Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 7 engage with residents. Residents were regularly weighed and any significant loss immediately referred to the GP. Food supplements were in evidence. Those residents who had difficulty in swallowing or chewing were offered meals in which the individual ingredients were pureed separately. Sauce or gravy was served separately. This meant that residents could still identify the meal. Staff were particularly vigilant in ensuring residents who were in bed for any reason were given regular drinks, meals and conversation. However this was not always consistently recorded. The home has a full time activities organiser so that nearly an hour and a half is provided for each resident each week. The home offers an excellent range of relevant activities both at the home and in the locality. There were group and individual activities. Those residents who were able to decide had a good degree of decision making on their day-to-day lives. Other residents had to rely on staff. Residents made very positive comments about the meals provided. They talked to the chef about what they liked. Ingredients were mainly sourced locally and all dishes were home made. Care staff have access to a range of appropriate and relevant training. What has improved since the last inspection? What they could do better: If fluid intake charts are indicated they must be regularly completed. Measuring of all drinking vessels used would assist with recording totals. The policy on the giving of intimate personal care should identify some of the issues presented when caring for people who may not be able to express themselves verbally. Whilst the home was cleaned to a general good standard, attention needs to be given to the undersides of toilet surrounds. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 8 The recruitment process must be more robust. “To whom it may concern” references should not be accepted. Referees must be asked in writing for their comments on the merits of prospective employees. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 9 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 Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good assessment tool to gather a range of information about potential residents. This process enables the home to make decisions about whether need can be met. EVIDENCE: The home carried out detailed pre-admission assessments with prospective residents to establish whether their needs could be met. Mrs Morris or Mrs Airey will carry out the assessments gaining information from a range of sources. The assessment tool highlights all aspects of potential need together with any diagnoses. The home gains sufficient information with which to compile the initial care plan. Milford Manor DS0000062170.V317746.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, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are now more resident centred. The care plans identify all care needs, not just the physical. Residents have good access to healthcare professionals. Residents can administer their own medication following a risk assessment. Residents’ privacy was respected by staff. EVIDENCE: Significant efforts have been made to establish a care planning system that focuses on positive outcomes for residents, identifying other care needs, not just the physical and medical. Care plans have a personal profile with social histories gained from the residents, their families and friends. Residents’ nutritional needs were identified with favourite food and how they liked to eat. Care plans identified what made some residents anxious and there was guidance to staff on reducing any anxiety. There was also guidance on managing behaviours. Staff also recorded residents preferred form of address, preferred dress, hobbies and interests, how they liked their room set out, personal hygiene and grooming and a list of strong dislikes. A requirement Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 12 had been made at the last inspection of 2nd March 2006 with regard to more person centred care plans. This has now been achieved. There was guidance to staff on the giving of personal care. The policy would benefit from the inclusion of examples of some of the issues presented when caring for residents who may not be able to verbally describe their preferred personal care routines. There was good evidence that care plans were regularly reviewed and revised as needs changed and on a regular monthly basis. Weights were regularly monitored. There was good evidence in one of the care plans that staff had discussed preferred foods with a resident who had lost some weight. The resident’s family had also been involved in the discussions. There was good evidence that staff referred concerns to the relevant healthcare professionals. Risk assessments were detailed and identified when some residents were never to be left unattended, for example, when bathing or using a commode. Resident’s risk of developing pressure damage was recorded and pressurerelieving equipment was in place. Charts were in place to record repositioning in bed to avoid skin damage, if this was indicated in their care plan. In certain circumstances wounds would be photographed following permission gained either from the resident or their families. This formed evidence of monitoring of progress in healing. Charts were also kept for monitoring other conditions, for example, frequency of seizures. There was clear guidance in the care plans of action to be taken in the event of an increase in seizures. It was assumed that one of the residents who was being cared for in bed was receiving regular mouth care as there was mouth care equipment in their room. However this was not identified in their care plan. Some of the residents had fluid balance chart in their rooms. However they were not being filled out regularly and inputs were not being totalled. One of these residents said they were thirsty and their chart over the previous few days recorded that they had only been given small sips of water with up to 5 hours of nothing recorded on one afternoon. The care staff who attended when the inspector rang the bell were adamant that the resident would have been given drinks during this time. They assumed that agency staff who had worked that afternoon may not have recorded their input. However, one of the other residents who was also being cared for in bed was seen to be given regular drinks by staff. The inspector discussed the importance of recording with the staff. The inspector advised that cups, mugs and other drinking vessels could be measured so that more exact totals could be monitored. One care plan identified that a resident had a medical condition but only vague reference to the condition was made. There were no details of how the condition might present or guidance to staff in supporting the resident to manage with their condition. The district nurse was treating 2 residents who had small pressure sores. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 13 One resident said they were always given their painkillers when they asked for them. Residents may administer their own medication following a risk assessment. The requirement that liquid medication was only given to the person for whom it was prescribed had been actioned. This related to only two bottles of liquid medication in the trolley, with more than 2 residents being prescribed that medication. Mrs Morris said that each residents had their own bottle of each liquid medication where taken, if prescribed. All of the residents were well groomed with clean teeth, glasses, hair, nails and clothing. An anonymous complainant had reported that residents clothing was often grubby and food stained and footwear was missing. The inspector found one resident who only had their socks on first thing in the morning. After an hour the resident had their slippers on. All other residents appeared to have suitable footwear apart from those in bed or lying on their beds. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that residents’ interests are known before they come to the home. Residents have access to a good varied range of activities both at the home and in the locality. The amount of staff time devoted to activities allows all residents to join group or individual activities. Those residents who are able to choose have some degree of control over their day-to-day lives. Other residents have to rely on staff for direction. Residents enjoyed the meals. Particular attention was given to those residents who may have difficulties eating. EVIDENCE: The home employs an activities organiser for 37½ hours each week. This provides the potential for at least an hour of one to one time per resident each week. There was a good range of individual and group activities provided both in the home and the locality. Activities were planned with a good outcome for those residents who may have a dementia. Time spans for the activities were also suited to people with a dementia. The activities organiser takes time to find out about residents interests. Residents had the opportunity to have a walk one to one with the activities organiser. A minibus or accessible taxis Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 15 would be hired to take residents out on trips in the locality, for refreshment or shopping in Salisbury and to the Salisbury market. The weekly and forthcoming activities were advertised on notice boards around the home. Some of these activities included: going out for an hour 2 days a week, music, arts and crafts, board games, bingo, musical exercises and holy communion. One resident talked about the priest who regularly visited them. Each month professional entertainers are booked for the activities programme and these were arranged for the whole of the year. There were also visits to the local theatres for the matinees. The activities organiser did not have a budget but said she could purchase some resources. The home also holds fundraising events not necessarily for their own amenities fund. A garden party was held in the summer raising money for a local charity. One of the residents said that they got up and went to bed when they wanted to. Those residents who were able to decide had a degree of choice over their daily lives. Other residents relied on staff to make choices for them. There was some evidence of choice and decision making in the care plans. All of the residents spoken with said that they enjoyed the quality and variety of meals provided. One of the residents said that the meals were always well presented and colourful. Another said they were never kept waiting for their meals. Some said that if they did not like any of the choices they would have something else. Those residents with whom the inspector could communicate said that the chef regularly discussed the food with them. The home operated an 8 week menu that had been updated within the last three months. Although there was only one choice for main course lunch and the evening meal, sandwiches, soup, omelettes, salads, baked potatoes and choice of fililngs were alternatives. Fruit or yoghurt were pudding alternatives. There was a hot dish for both meals. Some of the residents were having their lunch in their bedrooms. Those residents who may have having chewing or swallowing difficulties were offered a pureed or mashed meal. Each of the ingredients had been prepared separately and arranged on the plate so that they were easily recognised; a sauce was then provided separately. Mrs Bellinger said that all of the meals were prepared with fresh ingredients, much of them sourced locally, particularly the meat and vegetables. Food supplements were in evidence. As a matter of good practice Mrs Bellinger said that all the milk and yoghurts were full fat so that residents could make use of the extra calories where indicated. She confirmed that the chef would discuss the menus with residents. She said that residents had a milky drink during the evening and that all the soups were home made. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place for residents and their representatives to make comments or complaints about the service. Staff are aware of the local procedure for reporting allegations of abuse. Staff are confident in using the local Safeguarding Adults procedure. EVIDENCE: The home had a complaints procedure which was made available to residents and their representatives. There was a complaints log with details of investigations, outcomes and responses to complainants. Mrs Morris had recently taken on the delegated responsibility for managing complaints which had previously been held by Sally Bellinger, service manager. Mrs Morris had trained in complaint investigation. Some of the residents were confident in using the home’s complaints procedure. One resident said they would tell the person who cleaned their bedroom or one of the care staff if there was anything they were not happy with. Staff are confident in reporting malpractice and allegations of abuse. Mrs Morris and Mrs Bellinger had experience of the Safeguarding Adults process. Mr Airey trains the staff in reporting allegations of abuse and implementing the Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 17 Safeguarding Adults process. Staff have also received training from the local Safeguarding Adults Team in Wiltshire. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant efforts have been made to improve the comfort of the physical environment for residents. Whilst the home is cleaned to a general good standard, some areas that are not always visible need attention. EVIDENCE: All of the residents had single room accommodation which was personalised with many bringing items of their own furniture. Mr and Mrs Airey were in good progress with their plan to upgrade the building and grounds. They have made significant efforts to eliminate the unpleasant odours that had previously been experienced on entering the home by the front door. Carpets had been replaced in the main hallway, stairwell and the newer part of the building. No unpleasant odours were detected at any time during the inspection. The smell on entering the building had been part of an anonymous complaint investigated by Sally Bellinger last year. The newer wing of the building had Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 19 been redecorated throughout. The vanity units had been replaced and new curtains put up in all of the bedrooms. One of the bathrooms in the main building had been refurbished and fitted with a new specialist bath with hoist. The dining room was in the process of being redecorated. Mrs Morris said the grounds to the rear of the property would be landscaped in the spring. The slope would be reduced and paths installed to allow residents safe access. A sensory garden was also planned. All of the radiators were guarded for the safety of residents. One resident said that it was always warm and they had never felt cold. The majority of those residents who were visited in their bedrooms had their call bells within reach. One of these resident’s call bells was tied up around the box on the wall. Mrs Morris said this resident would not be able to use the bell and that staff were aware of this so would regularly visit them. When asked, the resident did not understand the alarms purpose. Mrs Bellinger said this was noted in the resident’s care plan. The requirement that cleaning staff were trained in infection control to maintain proper levels of hygiene at all times throughout the home had been actioned in that staff had been trained. However it was noted that two of the toilet surrounds and the underside of one bath hoists had dried yellow drip marks. These were in evidence at the beginning of the inspection at again at lunchtime when these facilities would have been cleaned at some time during the morning. Mrs Morris said that cleaning staff had had instruction in cleaning those areas which may not always be visible. She said she would discuss the matter further with the cleaning staff. One of the bathrooms had some tablets of used soap by the bath. Residents should have their own toiletries and not use communal soap for bathing at the risk of cross contamination. This was discussed with Mrs Morris who had also noticed this and said it was not normal practice as there were soap dispensers in each of the bathrooms and toilets. There were no other toiletries in the bathrooms and residents had their own products which were kept in their rooms. One of the residents described how the laundry was collected every day and promptly returned. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels across all areas enable residents to be well supported. Ancillary staff are employed throughout the day and at weekends so care staff can concentrate on care. Staff have good access to a range of relevant training and qualifications. The recruitment procedure is generally robust. EVIDENCE: The home works to a minimum of 4 care staff during the mornings, afternoons and evenings with 2 waking night staff throughout the week. Housekeeping staff work different shifts to ensure that cleaning and laundry are carried out during the mornings and afternoons. The requirement that the Commission was notified without delay regarding incidents specified in regulation 37, particularly when staffing levels could not be achieved or infections noted, had been achieved. All of those residents with whom the inspector could communicate made very positive comments about the staff. An anonymous complainant had reported difficulties in finding a member of staff who spoke English and concerns about residents being able to hear or communicate with staff. The complaint was referred to Sally Bellinger, service manager, last year for investigation under the home’s complaints procedure. Only 2 staff did not speak fluent English but could understand the language and had been inducted into the home’s policy Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 21 on greeting visitors. The inspector found no difficulties in communicating with any of the care and support staff on duty. Communication needs formed part of the care plans. Hearing difficulties were referred to audiology by the GPs and training in communication had been provided by the speech and language department. The anonymous complaint also identified that one of the male staff was more interested in watching TV than helping. Sally Bellinger in her investigations reported that staff often watched TV with residents and discussed programmes as part of their communication with residents. They also took breaks with residents who may be watching TV. The inspector found staff in the sitting room with residents watching TV during the afternoon. These staff had come on shift early and were spending time with the residents before going to the office for the handover. Mrs Bellinger gave access to staff personnel records which were kept at the Wessex Care main office. The recruitment procedure was generally robust with the majority of the information and documents required by regulation on file. One file did not contain 2 references and one of those references was headed “to whom it may concern”. There was no evidence that this referee had been further consulted. The inspector was not able to discuss this with the administrator who manages the employment files. From other documents that were in progress it was possible that the administrator may have been working on the anomaly. All of the files seen of recently employed staff showed that none had commenced duties without a negative Protection of Vulnerable Adults list check. Each member of staff had a record of training that they had completed whilst working at the home. Most recent training included dementia awareness and abuse awareness. The local Alzheimers Society provided regular training in dementia care. There was a plan for external and internal training for the year. Mrs Morris said that the Primary Care Trust and other agencies would come to the home at least once a month to give talks to staff on relevant subjects. Recent sessions had been on Parkinson’s disease, stroke, wound care, catheter care and communication and swallowing from the speech and language therapist. Mrs Morris was the home’s trained trainer in moving and handling and regularly updated staff. Three care staff had undertaken training to NVQ Level 3. Both the deputy managers had NVQ Level 4. One care staff had NVQ Level 2 and one had NVQ Level 1. One staff member said they had recently undertaken training in abuse and hazardous chemicals. All of the staff were seen to engage with residents. One of the domestic staff had taken time to offer one of the residents who was poorly a drink and read to them. This resident was visited very regularly by staff. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Morris has a good experience of working with people with dementia. She is clear about how she wants the home to develop. The home is run in the best interests of the residents. The home does not hold money on residents’ behalf. Services or items will be purchased and relatives invoiced if residents cannot manage their own finances. All staff have regular supervision. All risks to residents are assessed and form part of their care plan. EVIDENCE: Mrs Morris has managed the home for more than 18 months. She is a registered nurse but is not employed in that capacity. She keeps up her nurses registration by working some shifts in either of the nursing homes run by Mr and Mrs Airey and through regular training. Mrs Morris was about to Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 23 complete the Registered Managers Award and NVQ Level 4 in care and management. Mrs Morris was very clear about how she wants the home to develop. Mrs Morris has experience of working with people with dementia. No money is held on residents’ behalf. If residents are unwilling or unable to manage their own finances then the family or solicitors will be expected to take on the role. The home’s petty cash imprest will temporarily fund some expenditures, for example, chiropody, hairdressing or shopping if residents have no immediate cash. The relatives will then be invoiced each month for these expenditures. Those residents who like to manage their own money were provided with a lockable facility. One of the residents confirmed that they had been given a form to fill out about the service and to comment if there was anything they were unhappy with. Meetings with residents and relatives were regularly held. The requirement that the Commission must be notified without delay of any incident specified in regulation 37 had been actioned. A list of the monthly supervision sessions with all staff was posted on the office wall. The monthly staff meetings had been planned for the rest of the year. Staff were trained in moving and handling, fire safety, first aid and infection control. Staff are made aware of health and safety issues as part of their induction. Risks to residents had been assessed and guidance on management was recorded in the care plans. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 24 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 X 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 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 25 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 OP26 Regulation 23(2)(d) Requirement The registered person must ensure that the undersides of toilet safety frames and bath hoists are cleaned to infection control standards. The person registered must ensure that where frequent care charts are indicated that they are kept up to date and accurate. Timescale for action 26/01/07 2 OP37 17(3)(a) 26/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP8 OP10 Good Practice Recommendations The person registered should ensure that any mouth care guidance is recorded in residents care plan if indicated. The person registered should consider measuring drinking vessels so that a more reliable total can be made of amounts of fluids taken. The person registered should consider reviewing the intimate personal care giving to include examples of issues DS0000062170.V317746.R01.S.doc Version 5.2 Page 26 Milford Manor 4 OP29 often presented when caring for residents who may not be able to verbally express their preferences. The person registered should not accept “to whom it may concern” references. Referees should be contacted independently as part of the recruitment process. Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Milford Manor DS0000062170.V317746.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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