Inspection on 08/09/05 for Milford Manor

This inspection was carried out on 8th September 2005.

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

The inspector 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 26/01/07

Milford Manor 02/03/06

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 Sally Walker Unannounced 8 September 2005 th 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 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 D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Milford Manor Address Milford Manor Gardens Salisbury Wiltshire SP1 2RN 01722 338652 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wessex Care Ltd, Mr Matthew Airey Mrs Tracy Morris Care Home 29 Category(ies) of DE Dementia (29) registration, with number DE(E) Dementia - over 65 (29) of places OP Old Age (29) PD Physical Disability (1) Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may admit people to the home over the age of 65 years of age providing their assessed needs are similar to those of an Older Person. Date of last inspection 3rd February 2005 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 buliding. Milford Manor is situated in a quiet residential area of Salisbury with public transport available into the city centre. The home changed ownership in November 2004 and Mr and Mrs Airey have made great efforts to improve the environment, staffing and recording systems. They also own 2 nursing homes in Wiltshire. At the time of the inspection Mrs Tracy Morriss application to register as the manager was in progress. She has since been registered. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 9.55am and 5.25pm. Mrs Morris was on leave but Julie Oakes and Jennie Waters, Deputies, assisted with a tour of the building and access to records. Sally Bellinger, Clinical Nurse Manager, was also present during the inspection. Some care plans and the daily reports were inspected together with the staffing rota and care charts. Six residents were spoken with and three staff. The main purpose of this inspection was to examine progress in complying with the 17 requirements made at the last inspection, many of which had been ‘inherited’ from the previous registration. Mr and Mrs Airey, who were present for the feedback, had actioned the majority of the requirements of the last inspection and had an ongoing plan for the remainder. What the service does well: What has improved since the last inspection? Significant effort has been made to improve the environment for residents and there are plans for further improvement. Ornaments are displayed although they may be moved or broken. Daily care charts show specific interventions and are a good tool for monitoring progress. The recruitment of a member of staff with a remit for providing activities has improved the quality of activities provided, particularly allowing residents to access the locality and have one to one input. The range of choice meals has improved with more fresh ingredients being sourced locally. Residents are consulted about the quality of the food. A quality assurance system has been set up and meetings have been held with residents and their families as part of that process. Mr and Mrs Airey have ensured that the Commission’s comment cards have been given to residents and their relatives. Comments received are shown in Standard 33 below. Staff are expected to attend training in dementia. All staff have access to NVQs with 3 staff having attained NVQ Level 4. Support staff have been employed so that care staff can spend more time providing care. The care staffing rota has been rationalised so that residents receive continuity of care Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 6 and there is a balance in numbers throughout the day according to residents needs. 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 Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 standard(s) 1 & 4 The statement of purpose outlines what the service provides. Some personnel changes did not prompt a review of the document. The home could not demonstrate how they were meeting the needs of people who did not speak English. EVIDENCE: Mrs Bellinger described the admission process with assessments being carried out with each prospective resident and information gained from previous placements or carers The home could not show much evidence in meeting the needs of residents who were originally from overseas and now used their birth language, probably related to dementia. One care plan showed that discussion had taken place with relatives and a list of key words in the language with English pronunciation available. One of the staff did speak this person’s language but not necessarily the dialect. There was no written evidence of staff communicating with the resident. The inspector had a discussion with a member of staff about their communication and use of language with this resident. It was very clear that they did in fact have a good knowledge of the words and used them when working with the resident; they also used body Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 9 language, gesture and objects of reference. They had a very good knowledge of the resident and their care needs. However the care records did not necessarily support whether all staff were working in this manner. The requirement that the Statement of Purpose must be reviewed with the range of needs that the home intends to meet in the future has been actioned in part. The Statement was reviewed and revised in January 2005 but still showed the previous manager and the inspector advised the home to delete the name of a previous Commission manager and just include the title. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10 Residents are well supported with health and personal care, although the records did not always support this. Residents care plans give generally good detail of what care needs are and how they are to be met. Some medical conditions are not described and little detail of how staff should support that resident. However, monitoring of progress is well recorded and residents have good access to healthcare professionals when necessary. Concerns over staff not respecting residents’ private space were dealt with immediately. EVIDENCE: The care plans were in each resident’s bedroom; daily reports and other information were kept in the office. A daily care chart to record special interventions, for example, nutritional monitoring or turning in relieving pressure points. However, one resident who was indicated as needing regular fluids had not had a drink recorded since 6.00am that morning. Five hours later at 11.00am this resident was not able to confirm to the inspector whether they had had a drink or not. Other immediate care charts were checked and found to be properly completed. The home was in the process of obtaining social histories from residents and their families to augment the care plans. The care plans detailed all aspects of residents’ physical care needs. The comments section at the end of the plan gave more information about the Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 11 residents’ social, communication needs and aspects of their personality. There was a separate plan for activities. The requirement that residents had up-to-date risk assessments that reflect their current care needs had been actioned. Potential risks were identified and were subject to regular review. The reference to self-harm was no longer relevant as that resident moved from the home. Detailed assessments were in place to show which residents may be at risk of developing pressure sores and appropriate pressure relieving equipment was in place. The inspector advised that body maps would be useful in documenting wounds. Also, where the district nurses were involved in treatments and keeping their own notes, the home should keep their own notes on treatments and progress in healing. The requirement that care plans were up-to-date and included all identified needs and how they were to be met was in progress. Details of some medical and behavioural conditions need to be expanded and specific guidance needs to be included in the plans on how to deal with behaviours or how to support residents with depression. The inspector was of the view that the care plans could be developed further to reflect Mr Airey’s philosophy that dementia care should be person centred. Currently the plans identified ‘problems’ and had statements such as ‘unable to…’. Discussions were held with the deputies about the need to expand the guidance to staff in the care plans with less ambiguity. The requirement that steps were taken to enable all care staff to identify residents’ personal care and hygiene needs to ensure they are appropriately managed had been actioned. Mr Airey said some work had been done with staff on record keeping. The daily care charts were a useful tool in providing this information. The requirement that the risk assessments must be reviewed for those residents who self-medicated, including the safe storage of that medication was actioned. Only one of the current residents was assessed as able to administer their own medication and they showed the inspector the safe storage facilities. The inspector was concerned that one resident’s tablets were left on their bedside table as they had not got up yet. Mrs Bellinger reported that this resident was able to take their tablets when they were ready and no other residents were at risk of taking them. The requirement that nonclinical items were removed from the medication cabinets had been actioned. The requirement that all medication administered to residents was correctly recorded on the medication administration record was still in progress. The inspector advised that the GP should be contacted to ensure that the repeated prescription was amended to reflect their previous directions regarding reduction in medication, as the pharmacist was required to record the information on the prescription. The inspector advised that where handwritten entries were made, they must be signed, dated and witnessed by another member of staff. Any invasive treatments were being carried out by the Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 12 district nursing service. The requirement that a controlled drug register was obtained for use in the future remains although no controlled medication was being administered at this time. The inspector advised that liquid medication must be administered to the named person rather than having one bottle for many residents. This was probably due to not having sufficient space in the drug trolley and staff were advised to discuss the provision of smaller bottles with the supplying pharmacist. Homely remedies had been agreed with the GPs for compliance with other medication. The requirement that care staff were provided with appropriate training in caring for residents with dementia which should include communication, has been met, with a programme of ongoing training in place. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 The range of activities has improved with more opportunity for one to one sessions and more contact with the local surroundings. Activities are provided with positive outcomes for people with dementia taking into consideration abilities and concentration span. Significant improvements have been made to residents’ diet with the provision of fresh locally sourced produce. EVIDENCE: Residents who did not have a diagnosis of dementia were able to follow their own routines during the day. One resident said they could lie on their bed in the afternoon for a rest. Another said they came and went as they wished and could go for a walk on their own. The requirement that the range of activities provided was improved with specific activities for adults with dementia has been actioned. A person responsible for activities is employed and a range of group and individual activities was in place. The activities took into consideration positive outcomes for residents with different abilities and concentration spans. This member of staff said they worked between 2 of the company homes, about 4 hours in each. She said there was in house entertainment and group activities as well as taking residents out for a walk in the locality or supporting with an individual activity. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 14 The requirement that the range of fresh fruit and vegetables provided was improved and that residents were fully aware of what food is available throughout the day and evening has been actioned. A delivery of fresh vegetables was seen and Mr Airey confirmed that a new chef had been employed to develop the range of meals provided. He went on to say that fresh meat and fish was now sourced locally. The chef will meet with all new residents or their families to discuss their likes and dislikes as part of the admission process. The menu was displayed and Mr Airey said that residents were given snacks and drinks throughout the day when they expressed that they were hungry or had forgotten that they had had a meal. This was evident from the daily reports, nutritional monitoring charts and the weight monitoring charts. Food supplements were available if indicated. Meal times had been changed slightly so there was not so much time between some meals. There were lots of positive comments from residents about the food and one resident said they followed a vegetarian diet which was well catered for. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 Neither of these core standards were inspected. EVIDENCE: Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 standard(s) 19, 25 & 26 The environment has been significantly improved with a programme of redecoration and replacement of furniture. Further improvements are planned to the bathrooms and gardens. Cleaning issues were immediately actioned by Mrs Bellinger. EVIDENCE: All the residents’ bedrooms were personalised to reflect their tastes and personality. The bedrooms were comfortable and clean. One of the deputies said that all of the beds had been replaced with new. The requirement that radiator guards were fitted in all communal areas to guarantee low surface temperatures had been actioned. Most of the radiators in residents’ rooms were also guarded with a plan in place to have all radiators covered. Risk assessments were in place for those radiators which were not guarded as required. The requirement that the decoration in some bathrooms and toilets was improved to ensure that appropriate levels of hygiene were maintained at all times throughout the home was in progress. Most of these areas had been Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 17 repainted and deep cleaned. However, brown drip marks were noted on the undersides of some of the toilet surrounds. Mrs Bellinger immediately addressed this with the appropriate staff. Mrs Airey said that the next stage of the programme of upgrade to the building included a gradual replacement of all the bathroom and toilet furniture over the coming year. Mr Airey reported on the other improvements made to the building: all areas had been repainted, the kitchen had been totally refitted and remodelled, a new bedroom had been created to provide respite care, the carpet to the main entrance was new, many of the bedrooms had new carpets, beds and chairs. A conservatory area which was little used had been designated as a staff training room. The inspector was shown the new separate laundry facility. All of the bedding and towels had been replaced with new and there were plans to replace all the commodes and bedside tables. Mr Airey talked about his plans to develop the garden to the rear to make it more accessible to wheelchair users and with a sensory garden. There was also a maintenance plan for the building with accompanying budget. Mr Airey said he planned to make the environment more visually accessible to people with dementia and had identified some rooms with signs. One of those residents spoken with in their bedroom did not have their call alarm near and confirmed to the inspector that they would not be able to reach the alarm from where they were sitting. Residents were able to have a key to their bedroom subject to risk assessment. The inspector was pleased to note that the home displayed ornaments even though they may be moved or broken. Mrs Bellinger reported that the home aimed to provide a homely environment and residents were not prevented from moving or collecting ornaments. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 Staffing levels supported residents with their care needs. Support staffing levels ensured staff could concentrate on providing care. Staff were friendly but professional. Staff training had improved with a regular programme of relevant training and more staff having access to NVQs. EVIDENCE: The inspector was pleased to note the sensitivity and calmness that staff were using in supporting a resident who had fallen just as the inspection began. Although the resident had sustained no injury, they were trying to make sense of what was happening and staff were reassuring them. The staffing arrangements on that day were 2 deputies, 1 senior carer, 1 carer and a junior carer. They were supported by the chef, a kitchen assistant, a domestic and a laundry person. There were 2 waking night staff. There was concern that none of the staff who entered residents’ bedrooms whilst the inspector was visiting knocked on the doors or waited to be invited in. Mrs Bellinger immediately addressed this with those staff on duty. The requirement that proposed changes in staffing levels was discussed with the Commission was in progress. The care staffing levels remained the same as at the last inspection. However the care staffing rota showed that there was more continuity and balance in numbers of care staff during the day, more ancillary staff had been employed and 2 senior staff had been promoted to deputies. Mr Airey said he planned to introduce the role of junior carer to support the care staff in all duties except the provision of personal care as they would be under 18 years of age. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 19 The requirement that steps must be taken to increase the number of staff who have obtained NVQ qualifications was in progress. Sally Bellinger, Clinical Nurse Manager, was the home’s NVQ assessor and reported on progress in this area. Two staff had NVQ Level 3, 2 had Level 2 and 3 had Level 4. One staff was undertaking NVQ Level 4 and 3 were about to start Level 3. There was a training programme and staff said the most recent training had been in moving and handling and fire prevention. Mrs Morris was the home’s trained trainer in moving and handling. All forthcoming training was displayed on the notice board in the care office, including dementia training from the Alzheimers Society which was deemed compulsory for staff. The local Alzheimers Society were to be consultants to the home. Other training included information abut dressings and wound care from a supplier of products used, swallowing difficulties, nutrition and medication. Regular staff meetings were held and all staff had regular supervision. Staff were seen to have a professional but friendly approach to residents. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 &35 Mrs Morris is approved as registered manager. At interview she displayed a sensitivity to the individual needs of people with dementia and was clear about her plans for delivering care. The home is run in the best interests of residents. However the holding of residents’ monies in the business account was not in the best interests of the residents. Quality assurance systems ensure that residents and their families can air their views on the service. EVIDENCE: Mrs Tracey Morris was approved as registered manager on 14th September 2005. At interview she had a very positive attitude about how care should be offered to people with dementia. She was also clear about her plans to improve the service with support from Mr and Mrs Airey and Mrs Bellinger. The requirement that the keypad to the front door was either removed or that the code to unlock the door was clearly displayed in a prominent position had been actioned. The code was displayed and the keypad was linked to the fire alarm system so it opens when the alarms sound as required. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 21 The requirement that a more suitable bank account was found so that monies held on residents behalf is not paid into the main business bank account, had not been actioned. Mr Airey said that full records were kept of all transactions and the home’s accountant regularly audited the account. The inspector advised that this arrangement did not comply with the regulation which states that residents’ monies is not paid into an account that is used in connection with carrying on the management of the home. The Commission’s policy guidance has been sent to Mr and Mrs Airey and a new date for compliance has been set. Mrs Bellinger said that they had met with residents and their families to discuss the service as part of the quality assurance system. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x 2 x x x Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 23 yes 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 OP 4 Regulation 6 Requirement The registered person must review the existing Statement of Purpose for the home and the range of needs that the home intends to meet in the future. this should be part of ongoing discussions with the Commission. (This had been done but needs further amendment to include the new manager and to delete the name of a previous Commission manager.) The registered person must take steps to ensure that all care plans are up-to-date and include all identified needs and how these are met. (This is in good progress with some more detail needed with regard to dealing with behaviours and progress in monitoring wound care.) The registered person must take steps to improve the decoration in some bathrooms and toilet areas and to ensure tht appropriate levels of hygiene are maintained at all times throughout the home. (The bathrooms have been redecorated and there is a Timescale for action 01/11/05 2. OP 7 12 & 15 01/11/05 3. OP 26 23(2)(d) 08/09/05 Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 24 4. OP 35 20 5. OP 37 17 6. OP 10 12(5)(b) 7. OP 9 13(2) programme for the replacement of all bathroom suites over the next year. The undersides of toilet safety frames must be included in cleaning schedules.) The registered person must take steps to find a more suitable bank account for managing clients monies that does not involve paying money held on residents behalf into the main business bank account. (The Commissions policy guidance has been sent to the home). The registered person must ensure that staff record interventions with residents, particularly with regard to communication and fluid intake. The person registered must ensure that staff respect residents personal space by knocking and waiting to be invited into bedrooms before entering. The person registered must ensure that liquid medication is only given to the person for whom it is prescribed. The pharmacist may supply in smaller containers. 01/11/05 08/09/05 08/09/05 31/10/05 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. Refer to Standard OP 9 OP 9 Good Practice Recommendations The person registered should ask the GP to revise repeat prescriptions when they make a change in medication dosage. The person registered should make sure that when handwritten entries are made on the medication administration record when new medication is prescribed or there is a change in mediaction that these entries are D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 25 Milford Manor witnessed, signed and dated by 2 members of staff. Milford Manor D51_D01_S62170_MilfordManor_V240359_080905_Stage4.doc Version 1.40 Page 26 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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