Inspection on 24/01/06 for Milkwood House

This inspection was carried out on 24th January 2006.

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

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

Other inspections for this house

Milkwood House 04/10/06

Milkwood House 15/08/05

Milkwood House 15/11/04

Milkwood House 03/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Milkwood House Hill Brow Liss Hampshire GU33 7PB Lead Inspector Mrs A Taggart Unannounced Inspection 24th January 2006 02:30 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 Milkwood House DS0000014630.V279416.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. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milkwood House Address Hill Brow Liss Hampshire GU33 7PB 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) 01730 895485 Milkwood Care Limited Mrs Linda Walker Care Home 43 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (43) of places Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total of 43 persons at any one time, one of whom is under 65 years of age. 15th August 2005 Date of last inspection Brief Description of the Service: Milkwood House provides accommodation and care for forty-three older people including those with dementia. The Home is located on the West Sussex/Hampshire border a few miles from Petersfield with its shops and other amenities. The building consists of a large converted 3-storey house with an extension to the rear. In addition a more recent purpose built extension to the side of the building provides additional rooms to the ground and lower ground floor. The accommodation consists of thirty-one single and six double rooms, some of which have en-suite facilities. There is a large landscaped garden to the rear of the property and parking facilities are available at the front. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit as carried out at 9.30am and lasted for six hours, which covered the early and late shifts at the home. During the visit the inspector spoke to most of the people living in the home and also to seven staff members and two visitors. A tour of the home was undertaken during which all communal areas and all but one bedroom were seen. Six care plans and five staff files were seen with any relevant issues being tracked and discussed with the manager. The inspector saw lunch being prepared and served and a discussion about the food provided was held with the cook. Records for the running of the business were seen including health and safety, maintenance and fire files and the storage and administration of medication was also seen. Prior to the visit, the last two reports were read along with any other correspondence or documentation relating to the service. The Registered Manager Mrs. Walker was working at the service and assisted during the visit. What the service does well: What has improved since the last inspection? Several bedrooms have been redecorated and re-carpeted and a movable hot serving table has been provided to facilitate meals being dished up in the dining room. Five further staff members have achieved the NVQ award. Milkwood House DS0000014630.V279416.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. Milkwood House DS0000014630.V279416.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 Milkwood House DS0000014630.V279416.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): 23456 Prospective residents have their needs assessed in order to ensure that the home can meet their needs. Visits to the home are encouraged and residents receive a statement of terms and conditions. EVIDENCE: To ensure that the home can meet individual needs, the manager carries out a comprehensive pre-admission assessments in the prospective residents present accommodation. Residents and visitors confirmed that they had been able to visit the home to view the facilities and meet the other residents. All residents receive a contract setting out the terms and conditions of occupancy. During the visit a new resident was admitted to the home. There was sufficient information available to inform the staff team of the person’s needs and a contract of terms and conditions was also signed. Staff were seen greeting the person and their family member in a kind and friendly manner and asked the person how they would like to be addressed. Milkwood House does not provide intermediate care. Milkwood House DS0000014630.V279416.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): 7 8 9 10 The home has detailed care plans in place, which are regularly reviewed and updated. Residents are treated with dignity and respect and wherever possible are supported stay in the home until the end of their lives. Medication procedures need to be reviewed in respect of administration recording charts. EVIDENCE: Each resident has a comprehensive plan of care in place, which details his or her health, personal care and social needs. There is also a separate plan compiled for care needed during the night. Plans are reviewed and updated monthly and staff members said they are made aware of any changes in the plans through shift handovers, daily recording and discussion with the manager. Records show that the home works with a variety of healthcare professionals including psychiatric services, district nurses and physiotherapists. The manager said that the local Community Psychiatric Nurse also provides training for staff on the specific needs of individual residents. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 10 Staff members were seen to be kind and friendly in their dealings with residents and were aware of individual needs and wishes. Residents in the home confirmed that they were treated with dignity and respect. The home has an agreement with a local pharmacy and medication is suitably stored and generally well managed. However a number of gaps were found in the medication administration charts and topical creams were found in the rooms of two people for whom they were not prescribed. All staff members who administer medication receive accredited training but a requirement has been made that the system should be reviewed and updated. A risk assessment should also be carried out in respect of residents who purchase large amounts of homely remedies to ensure they do not react with people’s prescribed medications. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Activities are available to provide interest and stimulation and religious beliefs are respected. Visitors are made welcome and a variety of freshly cooked meals are available EVIDENCE: The people living in the home said they were very happy with the facilities provided and one person said, “It’s the little things that make the difference and we are cared for very well indeed”. During the visit Communion was brought to the home for a resident and other people said that their religious needs were respected and catered for. There is a programme of activities provided in order to ensure stimulation and interest and outings in the home’s mini-bus are arranged. One person said they especially liked these outings and another said they enjoyed joining in with a quiz. During the afternoon a craft session was taking place and two residents were going out for a walk. Two visitors to the home said that they were always made welcome and were offered drinks and a resident said that her family member could stay for a meal if they wished. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 12 There are a variety of fresh home cooked meals available and people said they could always have an alternative if they wished. Lunch was sausages and onion gravy with potatoes and two fresh vegetables with fruit crumble to follow. The food was freshly cooked and attractively served and people could choose where they ate. To ensure that food is hot and fresh, a heated serving table has been purchased to enable the meals to be served up in the dining room. Special diets can be catered for and drinks and snacks can be prepared at any time during the day or night. Fresh fruit bowls are also made up daily and residents can choose to take these to their rooms. All resident’s bedrooms contained jugs of fresh juice or water. Residents were very complimentary about the food provided and there is evidence of food and menus being discussed in the resident’s meetings. One person said, “The food here is almost too good as I can’t resist any of it and we are always given a choice”. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Complaints and “grumbles” are recorded and acted upon and the staff team receive training in the protection of vulnerable adults from abuse. EVIDENCE: The home has a formal complaints procedure in place and no formal complaints have been recorded since the last visit. There is a book for “grumbles” to be recorded kept in the dining room of the home and also a suggestion box is also in place. There is also evidence that residents are encouraged to talk about the service provided during resident’s meetings and the outcomes to any comments or complaints are recorded. The people living in the home confirmed that they were able to vote should they wish to do so and people have access to advocates and legal representatives. The staff team attend training in the protection of vulnerable adults from abuse but during discussion with the inspector some staff members were not clear of their responsibilities should they suspect an abuse had taken place. The homes own policy also needs reviewing and updating to ensure it fits with current guidelines. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 The home provides an attractive, warm and comfortable environment for the people who live there. Bedrooms are well decorated and personalised by residents and communal areas are well maintained. To ensure the safety of residents at all times some risk assessments need to be compiled. EVIDENCE: There are two lounges, a dining room and a quiet room available for use by residents and all are attractively decorated and furnished. The home is clean and hygienic and during the visit some bedroom carpets were being shampooed. The gardens are large and attractive with several sitting areas and people said they really enjoyed using the gardens in better weather. One resident has asked for raised flowerbeds so that they can carry out some planting and growing and the manager said that this was going to be made available. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 15 Sufficient toilet and bathing facilities are available and the district nurse team provides pressure relieving and other equipment when required. Resident’s private bedrooms are light and airy and furnished and decorated to a high standard. The rooms have been personalised by the people living in them and are comfortable and warm. People said they were very happy with their rooms and one person said, “This is just a home from home”. All radiators in the home are covered but some residents have additional heaters placed in their rooms. In one room an electric radiator had a very high surface temperature which could present a scalding hazard and a risk assessment should be carried out on the safety of all additional heaters. In one bedroom there were no restrictors on a waist-high window that opened outwards which could present a fall-hazard and a risk assessment should be carried out in respect of the need for restrictors on this window. In several bedrooms that were occupied by residents during the day, doors had been wedged open with a variety of objects which could constitute a risk should a fire occur. The manager said that a programme of fitting magnetic closures to all bedroom doors was in place, but until this is completed individual risk assessments should be carried out for people who wish to keep their bedroom doors open during the day, while they are in their rooms. Several bedrooms have been redecorated and re-carpeted since the last visit and the manager said this would also be carried out whenever rooms were vacated. Comprehensive environmental risk assessments are in place and all are reviewed on a monthly basis. As good practice the new risk assessments should be added. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 The staff team receive training and support and are only employed following a robust recruitment procedure. There are sufficient staffing numbers to meet the assessed needs of the current residents. EVIDENCE: Five care staff were working on the early shift in the home and in addition there were three cleaners a cook and kitchen assistant. The manager of the home was also working in addition to the rota. There is a robust recruitment process in place, five staff files were seen and all contained the required documentation including job descriptions, contracts of employment references and Criminal Bureau Checks. The manager said that there is a very low turnover of staff and that many people had worked in the home for a number of years. The home is to be commended on the number of staff who have achieved NVQ 2 or above. Seventeen staff members have received the award with five people currently working towards NVQ 3. The manager is an assessor and people work in conjunction with local colleges. There is a comprehensive programme of induction and training in place and recently people have attended dementia awareness, medication handling and all mandatory training. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 17 Staff members were very enthusiastic and appreciative about the amount of training provided and one senior carer said they had been able to progress their career by having been enabled to gain the NVQ award and attend training relevant to their job role. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 36 37 38 The manager of the home is competent, caring and committed to providing a high standard of care for the people she supports. The staff team are well supported and supervised and records are generally in good order. EVIDENCE: Mrs. Walker has completed the Registered Manager’s Award, the NVQ4 in Management and is also an NVQ assessor. Mrs. Walker is working towards the verifier award and is also booked to attend the Level 2 Certificate in Dementia Care. Residents, staff and visitors to the home spoke very highly about the way the home is managed and said that Mrs. Walker was caring and approachable and ran the home in the best interests of both the residents and staff team. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 19 One staff member said, “ I stay here because the home is well organised and managed and we get really good support and training”. The manager said that she meets on a regular basis with the Registered Providers and senior managers to discuss finances and agree budgets and she confirmed that there was a financial plan in place for the home. The home does not hold money on behalf of residents and their families and legal representatives carry out financial affairs. Staff members receive regular supervision and annual appraisal. Staff members confirmed that the sessions include discussion about work practices and a list of supervision dates was posted on the staff notice board. Records for the running of the home were seen including maintenance records, Fire, health and safety files, water temperatures and gas and electrical appliance tests, all were current and in good order. As previously stated, to ensure the safety of residents at all times, medication procedures and training needs to be reviewed, the adult protection policy should be updated and risk assessments carried out regarding additional heaters, window restrictors and the practice of wedging open bedroom doors. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 20 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 2 2 Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 21 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 OP9 Regulation 13 Requirement Timescale for action 24/01/06 2. OP9 13 3. OP19 38 Topical creams should not be used other than for the person for whom they are prescribed. Outstanding from last inspection. The system for the 30/01/06 administration and recording of medication should be reviewed and staff training updated. Risk assessments should also be completed for residents who purchase homely remedies Risk assessments should be 30/01/06 compiled with regard to additional heaters in bedrooms, window restrictors and wedges in bedroom doors. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations The policy regarding the protection of vulnerable adults from abuse should be reviewed and updated and staff training updated to ensure staff are informed. Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Milkwood House DS0000014630.V279416.R01.S.doc Version 5.1 Page 24 - 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!