Inspection on 28/06/05 for Mill Brow Care Home

This inspection was carried out on 28th June 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 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 17/07/06

Mill Brow Care Home 02/12/05

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 Road Widnes Cheshire WA8 6QT Lead Inspector Wendy Smith Unannounced 28 June 2005 09:30 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. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mill Brow Care Home Address Mill Brow Road Widnes Cheshire WA8 6QT 0151-420-4859 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) Laudcare Limited Elizabeth Carson Care Home 52 Category(ies) of OP - Old Age (52) registration, with number PD - Physical Disability (2) of places DE - Dementia (1) MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The total number of Service Users must not exceed 52 2 3 4 5 1 Service User in the category PD may be aged 39 years or over 1 Service User in the category PD may be aged 50 years or over 1 named service user in the DE category The registered provider must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 11 January 2005 Brief Description of the Service: Millbrow is a purpose built two-storey care home for older people requiring nursing or personal care. It is situated in the Millbrow area of Widnes. The home is within easy reach of shops and other amenities, public transport and the M62 motorway. Widnes town centre is within one mile.The home provides a range of communal living areas. 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. At the time of the inspection all bedrooms were singly occupied, although several are large enough to be shared if wished. There is a car park to the front of the home and a garden to the rear. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 29th June 2005 over a period of four and a half hours. The inspection was carried out using a process of crossreferencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. A tour of the building, including all communal areas and a number of bedrooms, was completed. Health and safety records were inspected. On the day of the inspection 41 residents were living at the home. Of these, 24 were receiving nursing care and 17 were receiving personal care. One resident had been admitted to hospital. One resident was under 65 years of age. Five residents spoke about their experience of living in the home and five of the staff on duty and one visitor were also spoken with. Information was provided by the registered manager. What the service does well: What has improved since the last inspection? There have been improvements to the environment including some new beds and commodes, re-painting of exterior woodwork, re-decoration of some bedrooms and improvements to the garden. The general standard of cleanliness had improved. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 6 Staff recruitment procedures were being followed more consistently. There had been an increase in training opportunities for staff. 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. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 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 MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 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, 2 and 3. Standard 6 is not applicable. Prospective residents are provided with information about the home to help them make a decision about whether they wish to live there. Residents do not have a contract of terms and conditions with the provider. Prospective residents are always assessed before admission is agreed to ensure that the home will be able to meet their needs. EVIDENCE: Four Seasons Healthcare provides a Statement of Purpose and a range of other information leaflets about the home, the company and services available. These are displayed in the entrance foyer of the building where they are available for residents and visitors. A copy of the service user guide is also provided in the bedrooms. A requirement relating to the provision of terms and conditions for residents is outstanding from the last inspection. This is being addressed by Four Seasons Healthcare and it is hoped that a contract will be available in the near future. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 9 One of the registered nurses working at the home, usually the manager, carries out a pre-admission assessment for all prospective residents. There is a standard pre-admission assessment form used to identify the needs of prospective residents and there was evidence of this being in use. All of the care plans inspected contained pre-admission assessment information about the individual. There were also assessments carried out by health and social services professionals. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 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 and 8. Each resident has a plan of care but the standard of the care plans was not consistent. Resident’s health needs are met in full. EVIDENCE: A sample of four care plans was inspected. The first had been written in November 2004 and a number of the plans for meeting specific needs had not been reviewed since then This person was identified by a relative and by staff as being at risk of choking, and a choking episode of a serious nature had occurred a few days prior to the inspection. Whilst it was evident that this had been dealt with appropriately, there was no plan of care in place to instruct staff how to prevent this from occurring again or how to deal with any further episodes. It was not included on her risk assessment. The second care plan had been written some while previously and had been reviewed each month up till May. In the care plan the use of a lap strap for the person’s wheelchair was mentioned, however there was no risk assessment for this and no record of why a lap-strap was being used. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 11 The third care plan was for a resident who had been admitted on 5th May 2005. This had been written on 8th May but had not been reviewed since and a pressure sore risk assessment had not been completed since admission. The fourth care plan was for a recently admitted resident. A very comprehensive care plan had been completed to a good standard within the first week of this person being admitted. All of the care plans contained good daily records which detailed the care that had been provided each day and recorded any changes. Care plans contained good records that residents had been visited by GP, social worker, speech therapist and other medical professionals as needed. See Recommendation. 18 residents required assistance with meals and three had PEG feeds. Five people were frail and being cared for in bed. They had adjustable beds and pressure relieving mattresses. The manager said that there were no residents with a pressure sore. Two people had previously had pressure sores but these had healed following advice given by the tissue viability nurse. Two residents spoken with on the first floor said that they were very happy with the care they received. One person said that she required help frequently to go to the toilet and she considered that the staff were patient with her and she never had to wait an undue length of time for attention. Another resident said ‘they look after us very well’. The relative of one resident was spoken with. She visits the home most days and is encouraged to continue to participate in her mother’s care. She said that she is very satisfied with her mother’s care, the staff are ‘excellent’, and the manager and senior nurse very approachable. She is kept informed of any changes and had been involved in reviews. Two staff spoken with showed their understanding of the care needs of the residents. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 12 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 and 13. Residents can exercise choice in their daily lives, however social opportunities for residents could be improved. Residents are able to maintain contact with family and friends. EVIDENCE: Mealtimes are flexible to meet the needs of residents and at 10am a number of residents were in the dining room having breakfast and receiving their medication. Residents spoken with confirmed that they can chose their time of getting up and going to bed and are not hurried. A number of more frail residents were assisted to have a rest on their beds after lunch. Care plans contained a social assessment of each resident which had usually been completed by a family member. The home has not been successful in recruiting an activities organiser, however two members of the care staff provide activities some afternoons and they can be rota’d to work additional hours to do this. The home would benefit from an activities coordinator so that a more diverse range of social opportunities could be provided on a daily planned basis and the home should continue to try and recruit a suitable person. See recommendation. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 13 A ‘street party’ is planned for July and a member of staff said that they would all be supporting this. Visitors are welcomed into the home at any reasonable time and a letter received recently from the relatives of a resident who had died read ‘Thank you for the affection you showed and for the support you gave us’. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 14 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) 16 Complaints are addressed appropriately. EVIDENCE: The home has policies and procedures for dealing with complaints. The complaints procedure was displayed in the home and is included in the statement of purpose and service user guide. Three complaints had been received since the last inspection. There was evidence that the manager had followed the procedure in dealing with complaints. All had been fully investigated and appropriate follow up action taken where needed. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 15 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 and 26. Some work had been carried out to improve the appearance of the home and facilities provided. This needs to be continued. There was a good standard of cleanliness. EVIDENCE: External woodwork has been re-painted since the last inspection. The garden at the back of the home had been improved and has been planted with a variety of plants chosen for their scent. The manager said that a fence is to be erected at the side of the building to combat the problem of stones being thrown at the windows. Parts of the grounds of the home need attention to keep them in a tidy condition and prevent them from being overgrown with weeds. See recommendation The manager said that requirements made by the environmental health officer regarding hygiene in the kitchen had been addressed. Requirements made by the Fire Officer were being addressed. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 16 Some bedrooms had been decorated since the last inspection and the home’s maintenance person was continuing with this work. New divan beds were stored in an empty bedroom and the manager said that staff had been asked to identify where they were most needed. A number of adjustable beds had been provided for the more frail residents. New commodes had been purchased and had improved the appearance of the bedrooms. The manager said that she has no difficulty in getting authorisation for the purchase of any new equipment needed by residents. The programme of refurbishment and redecoration needs to be continued in order to bring all parts of the home up to a good standard. See recommendation. The general cleanliness of the home appeared to have improved since the last inspection and there were no unpleasant odours. A new carpet shampooer had been bought. The home provides laundry and sluicing facilities to meet the required standard. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 17 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 and 29. The home provides appropriate numbers and skill mix of staff to meet the needs of residents. The home follows recruitment policies and procedures for the protection of residents. EVIDENCE: The staffing rota showed that there were two nurses on duty between 8am and 8pm and one at night. Six care staff were on duty in the morning, four in the evening and three at night. A cook and a kitchen assistant are on duty during the day. There are usually two cleaners each day and a laundry assistant morning and evening. The home manager is supernumerary to these numbers and the home also has an administrator. There were vacancies for two night care assistants and a part time evening laundry assistant. The manager had recruited new staff and was awaiting POVA checks and references for the new staff to start. Staff spoken with, and seen going about their work, were cheerful and pleasant and seemed well-motivated. A new member of domestic staff said that she was really enjoying the job and had received COSHH training for the products she was using. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 18 The home procedures. information received for manager demonstrated her awareness of good recruitment She had been reviewing staff files to ensure that all of the required was included. Criminal Records Bureau disclosures had not been two of the existing staff and these had been re-applied for. Six members of the care staff have almost completed NVQ level 2 and several others are waiting to start. NVQ training is now being provided by Four Seasons Healthcare. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 19 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, 32 and 38. The home has a manager who is registered with the Commission for Social Care Inspection and is working towards achieving the Registered Managers Award. More attention is needed to ensuring that all equipment is serviced and maintained regularly and accurate records kept. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She has started working towards a Registered Managers Award and hopes to complete this in six months. A member of care staff said that the staff were very pleased with the appointment of the manager as they found her to be very approachable and understanding. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 20 The manager and a senior care assistant are moving and handling trainers for the home. They have recently completed an update and have a new training programme to deliver to the staff. This will include ancillary staff as well as nurses and care staff. Eight staff attended COSHH training recently. Catering staff have all completed basic food hygiene training. Health and safety records were inspected but were found to be in disarray. There were several different folders and the information contained went back in some cases to 1998. It was difficult to find the most recent records. See recommendation. Fire extinguishers had been inspected in July 2004, weekly fire alarm tests were carried out and recorded by the home’s maintenance person. Fire training had taken place for all staff in December 2004 and January 2005. A fire risk assessment was in place and had been revised earlier this year. Fire alarms and emergency lighting had been serviced in May 2005 and necessary replacements made. PAT testing had been carried out in March 2005. The latest gas safety certificate was dated June 2004 so was now due to be renewed. Portable hoists and fixed bath hoists were due to be serviced in March 2005 but it appeared that this had not yet been carried out although there were records of some repairs being done. During the inspection the manager arranged for this to be done in July. The five yearly electrical wiring certificate was also due for renewal. See requirement. MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 21 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x x x 2 MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 22 NO 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 OP38 Regulation 23 Requirement Plant and equipment used in the home should be serviced and maintained at appropriate intervals Timescale for action 31/8/05 2. 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 OP7 Good Practice Recommendations Care plans must detail all of the residents needs and how they are to be met. They should document any form of restraint used. They should be reviewed on a regular basis. The home should endeavour to recruit an activities organiser. A programme of planned redecoration and refurbishment should continue. The grounds of the home should be improved to prevent unused areas from being overgrown with weeds. Health and safety records should be maintained in good order. 2. 3. 4. 5. OP12 OP19 OP19 OP38 MILL BROW CARE HOME F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, 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 F51 F01 S5173 Mill Brow V232984 280605 Stage 4.doc Version 1.30 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. 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