Inspection on 17/07/06 for Mill Brow Care Home

This inspection was carried out on 17th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mill Brow Care Home 28/06/07

Mill Brow Care Home 02/12/05

Mill Brow Care Home 28/06/05

Mill Brow Care Home 11/01/05

Mill Brow Care Home 22/07/04

Mill Brow Care Home 11/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Mill Brow Care Home Mill Brow Care Home Mill Brow Road Widnes Cheshire WA8 6QT Lead Inspector Anthony Cliffe Key Unannounced Inspection 09:00 14 and 17th July 2006 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 Mill Brow Care Home DS0000005173.V294419.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. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mill Brow Care Home Address Mill Brow Care Home Mill Brow Road Widnes Cheshire WA8 6QT 0151 420 4859 0151 424 0186 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) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Elizabeth Carson Care Home 52 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (52) of places Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 52 service users in the OP (older persons) category may be accommodated. * Within the 52, 1 named service user in the DE(E) (dementia over 65 years of age) category may be accommodated. 2nd December 2005 Date of last inspection Brief Description of the Service: Mill Brow is a purpose built two-storey care home situated in the Mill Brow area of Widnes. The home is within a mile of Widnes town centre and is close to local shops and other amenities. It is accessible by public transport and convenient for the motorway network. The home provides care for older people requiring either nursing or personal care. It is registered to accommodate 52 residents, however the maximum is usually 47 as rooms that were formerly shared by two people are now singly occupied. On the ground floor there is a large lounge and a spacious dining room. On the first floor there is a lounge and a hairdressing room. There is a car park to the front of the home and a garden to the rear. Fees range from £314 to £440 per week. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A regulatory inspector undertook this unannounced site visit. The Key inspection was arranged as part of the Commission for Social Care Inspection’s (CSCI) regulatory programme under Inspecting for Better Lives. The site visit took place over 13 hours. Feedback was given to the manager. Records were inspected and staff practice was observed. Discussion took place with residents, visitors and staff. A tour of the premises was undertaken. Information was collected from a pre inspection questionnaire and people who returned questionnaires sent out by the CSCI. What the service does well: What has improved since the last inspection? What they could do better: Provide a range of activities based on residents’ choices so residents can pursue leisure and recreational interests. Test the fire alarms as required by the fire authority to ensure they are operational and residents are protected. Record the outcomes of care plan reviews to record if the care plan is effective or not. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 6 Ensure staff that manage and administer medicines audit the administration and recording of errors regularly so errors are detected and rectified. Produce the minutes of any meetings about the quality of care and management of Millbrow so staff and relatives can see how they are being addressed. Produce the results of satisfaction surveys so residents are aware of how any concerns are addressed. 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. Mill Brow Care Home DS0000005173.V294419.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 Mill Brow Care Home DS0000005173.V294419.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed prior to moving in. EVIDENCE: Records were examined of two residents who most recently moved into Millbrow. Both residents had a pre admission assessment prior to moving in. Care plans were in place for both residents. One resident’s daily records recorded some inappropriate behaviour toward staff. The resident had been referred to a psychiatrist and a care plan put in place to monitor the behaviour. Mill Brow Care Home DS0000005173.V294419.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 and 10. Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to the service. Residents’ plans ensure their health and social care needs are recorded and reflect residents’ needs but reviews of care need to record the outcome of the review. Medicine management and administration is safe. EVIDENCE: Four care plans showed that a wide range of assessment documents were completed; with a care plan to address residents’ needs. From looking at care plans, observing staff working practices and talking with residents, staff and visitors the health needs of residents were generally met. There were several examples of good practice regarding the care of residents and recording of personal, social and health care. The records for a resident with pressure ulcers recorded these were healing. There were photographs of the wounds to demonstrate the healing process. Care plans were in place to guide staff on the dressings in use and how frequently these were changed. Records noted review by the tissue viability nurse. Following an allegation under the local authority adult protection procedures a resident’s care plan was revised to record how staff were managing personal care issues. The daily records for the resident noted a review by her General Practitioner and referral to the continence advisor and psychiatrist. A resident’s records described antisocial behaviour toward staff Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 10 and other residents that raised concern about the resident’s privacy and dignity. A care plan had been put into place to monitor the behaviour and also guide staff to ensure the resident had privacy when needed. Another resident was registered blind but could communicate. Her care plan recorded that she enjoyed social contact with other people and staff ensured she spent time in the lounge with other residents. Some care plans used a core care plan format. Where these had been reviewed they recorded ‘continue as plan’ or ‘no changes to plan’ and did not record the outcome of the care plan review. A relative talked about being involved in her husband’s care and said, “ He has lived here for about six years. I visit him three times a week. I am very involved in his care. I know all about his care and his medicines. The staff keep me informed of what’s happening with him. He is settled on his medicines and I don’t need to look at his records as staff keep me up to date. I am involved in his annual review, this was last done in October 2005”. Medicines management and administration was examined. Only some minor errors were noted on medicine administration records where a signature for the administration had not been recorded. Medicines audits done by the manager had highlighted the error and the manager confirmed the staff member had been identified and the matter would be discussed in supervision. The registered manager completed monthly audits up to June 2006 but did not complete one for June 2006. Staff administering medicines do not complete a medicine audit. See recommendations 1 and 2. Mill Brow Care Home DS0000005173.V294419.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 and 15 Quality in this outcome area is assessed as adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices in their lifestyle, but the provision of social activities needs to improve so they have access to a variety of activities. Residents have a choice of meals in pleasing surroundings. EVIDENCE: Activities are not routinely planned or organized for residents to participate in. There was no information provided for residents on daily or weekly activities. Residents’ questionnaires returned as part o the information gathering process said that activities were sometimes or never planned. The activities organiser’s post had not been filled for two years despite regular adverts in the job centre and local newspaper. The two senior care assistants provide some hours for activities but this is not regularly planned. The manager said these were more ad hoc and dependent upon time. She provided details on some planned events that had taken place at Millbrow. A clothes party and an old style cinema show were held in June 2006. External entertainers had been booked to provide a summer extravaganza show in August 2006. A resident talked about living at Millbrow and said, “ I have lived here a few years and enjoy living here. I am fairly private and enjoy staying in my bedroom. I will join in the sing a long and things. I wouldn’t say they are what a man of my age would do but I join in. It’s up to me who I socialise with. I live with these people but don’t have to socialise with them. I have my television, videos, books and newspaper. I like to go out on trips and we do go out, but we don’t Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 12 have enough trips out. I’m not saying I want to go to place only I would like”. Resident’s records contained detailed social profiles of them. One resident’s daily records referred to regular visits to his family home but no other interests. Another resident’s key worker diaries last recorded her being involved in a social activity in October 2005 despite reviews of her social care plan stating she enjoyed watching television and the company of other residents. Residents commented about moving into Millbrow and a resident said “ I transferred form another home a few weeks ago. I really like it here it’s much roomier, with lovely gardens to sit in. The care is very good and the staff very attentive. They come and ask you if you want help or anything like that. They ask you if you want a drink and will sit and chat to you when they’re not busy. The care is good here, I have settled in and it’s a good move. A visiting relative said, “ I visit any time I like as do my daughters. They say it’s very friendly and are always offered a drink. He seems very happy and enjoys living here”. Residents were seen having breakfast and lunch. Several residents who made positive comments about this choice enjoyed a cooked breakfast. The lunchtime choice was soup, sandwiches or a jacket potato with assorted fillings. No residents had chosen the jacket potato and no records of meals ordered were retained. Records for the ordering of the evening meal were available and the manager said they were used to serve the hot meals but again not routinely kept. Residents requiring a pureed meal could choose from alternatives offered on the menu. The manager advised the chef to keep all records of meals ordered so staff were aware of residents’ dietary preferences. See requirement 1. Mill Brow Care Home DS0000005173.V294419.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 and 18 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Complaints are acted on appropriately. An informed staff group and manager protect residents from abuse. EVIDENCE: No complaints had been received since June 2005. The complaints procedure was displayed in the entrance foyer. In discussion about raising concerns a relative said, “Betty will always listen and support me. If I have any difficulties or things need sorting out she listens and puts them right”. Six residents’ questionnaires were returned and recorded residents were aware of whom to make a complaint to. Prior to the site visit the manager had referred a matter pertaining to the care of a resident under the local authority adult protection procedures. Staff involved in not reporting the incident were interviewed to ascertain their understanding of the procedure. Staff confirmed their awareness of adult abuse and how to report an incident. Staff confirmed they had received training on adult abuse awareness. Two staff confirmed they had been disciplined and had further training as not reporting an incident. A staff member confirmed she had not reported an incident for personal reasons and later realised her error in judgement. Mill Brow Care Home DS0000005173.V294419.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 and 26 Quality in this outcome area is assessed as good. Residents live in a clean, safe and well-maintained environment. EVIDENCE: The manager received confirmation on 14th July 2006 that a complete refurbishment of the building would commence at the end of July 2006. The building was clean and hygienic throughout the site visit. Since the last visit the garden had been refurbished. The patio area was levelled and flower beds created. Large plant pots had been purchased containing bedding plants. A water feature had been added and gazebo and garden furniture purchased. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 15 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 and 30 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The numbers, training and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures residents are protected. EVIDENCE: Information provided by the registered manager was that eight out of eighteen staff had an NVQ level 2 qualification. Two senior care staff was undertaking an NVQ level 3 and three staff were undertaking an NVQ level 2 qualification. A recently appointed staff member said she had received a two-day induction when she shadowed staff but was supernumerary to the staff rota. She said, “I was shown all the fire exits and what he alarm sounded like if you open a fire door. I have not been involved in a fire drill but it’s only my second week. Staff have been helpful, I can ask them anything. They are very supportive and I see them treating residents very well. They talk to them politely and have a laugh but it’s not taking the Mickey. Staff tell you important things about residents. When I have been on duty I haven’t seen anything that worries me. I couldn’t start work until I had the Criminal Records Bureau check done”. Three staff files were looked at. All contained appropriate identification documentation and completed Criminal Record Bureau disclosures. All files had two written references. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 16 Staff training records were examined and recorded staff had undertaken training appropriate to their roles. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is assessed as adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance needs to improve so good practice is recorded and published. Financial procedures safeguard residents. The maintenance of the building and equipment does not ensure the safety of residents. EVIDENCE: The manager was proactive in protecting residents. At the time of the site visit a manager form another Four Seasons care home had conducted a disciplinary hearing into the conduct of staff member whom had been suspended. The outcome of this was that the staff member could return to work and the manager of Millbrow informed of this decision. The manager decided against the decision until she knew the findings of an adult protection procedure as agreed under the local authority procedure. No personal monies other than personal allowances were held on behalf of residents. Relatives were billed directly for additional services such as chiropody or hairdressing. Residents’ personal allowances were safely secured and records for credits and debits maintained. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 18 The manager had partially completed a Four Seasons Care Home Audit Tool commenced in March 2006. This partially addressed a number of areas for improvement highlighted in the previous audit. It noted that actions had been taken to fit magnetic closures to fire doors located on main corridors and self closing devices or door guards to bedroom doors. A new carpet shampooer had been purchased and menus updated. It did not however address all the areas for improvement identified. The manager stated she had commenced 1 to 1 sessions with families, as residents’ meetings were not held regularly due to poor interest. She said she had recently held staff meetings but could not produce minutes of either meeting. She confirmed that residents’ satisfaction surveys are sent out from head office and the results of these are not sent to Millbrow to be published for residents to read. Information provided by the manager in a pre inspection questionnaire was examined. The testing of fire alarms was not completed from 12th May to 13th July 2006 when no maintenance personnel were employed. See requirement 2 and recommendations 3 and 4. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP12 Regulation 16(2)(M)( N) Requirement Timescale for action 01/09/06 2. OP38 23(4)(c) The registered person must consult residents; their relatives or representatives about their social interests and about a programme of activities arranged by or on their behalf and provide activities in relation to recreation and record residents participation in them. Ensure fire equipment is tested 17/07/06 at the intervals specified by the fire authority. 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 OP7 OP7 Good Practice Recommendations The outcomes of the reviews of care plans should be accurately recorded to verify if the care plan is effective or not. Staff administering medicines should complete regular audits of medicine administration and record keeping. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 21 3. 4. OP33 OP33 The quality assurance system should include the minutes of any meetings about the quality of care or management of the care home. The results of satisfaction surveys should be sent to Millbrow so they can be shared with residents. Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Mill Brow Care Home DS0000005173.V294419.R01.S.doc Version 5.1 Page 23 - 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!