Inspection on 28/06/07 for Mill Brow Care Home

This inspection was carried out on 28th June 2007.

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

The inspector 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 17/07/06

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 Unannounced Inspection 08:30 28 and 29th June 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 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) www.fshc.co.uk 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.V338507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 52 service users in the OP (older pesons) 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. Date of last inspection 30th January 2007 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 £318 to £470 per week. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 28th and 29th June 2007 and lasted Fifteen hours. A Regulatory Inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents and staff were also spoken with and they gave their views about the service. What the service does well: What has improved since the last inspection? Activities based on what residents enjoyed were being provided. The manager arranged activities around the time of year and events taking place. There were regular entertainers visiting Millbrow. Outcomes of personal plan reviews were more informative but some staff did not record if personal plans supported the health and social needs of residents were working or not. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 6 Medicines audits identified where errors were being made so errors were detected and rectified. The manager had improved how she deals with poor practice and performance and used the disciplinary procedure when necessary. Vulnerable adults were protected from poor practice as the manager was informing the local council of allegations of poor practice and cooperating with the vulnerable adults procedure. 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. The summary of this inspection report can be made available in other formats on request. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 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.V338507.R01.S.doc Version 5.2 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. 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 so appropriate care can be provided to them. EVIDENCE: Millbrow accommodates mainly people from the Widnes area of Halton and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. One personal plan was examined of a resident who moved into Millbrow. The resident had met with the manager to discuss their care prior to moving in. Information was gathered and this was recorded. This included information on their physical and mental health. Copies of these documents were on the resident’s plan. Copies of the social worker’s assessment and care plan were on file from the local council that placed the resident at Millbrow. Two residents that had moved into Millbrow were spoken with. A resident said, “I moved here in January 2007. It’s really nice and we have a nice group of staff. I don’t really like to spend time with the other residents, but will have my meals and Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 9 watch the odd TV programme with them. I would say I’m well looked after and the care is very good. I don’t always call for help as I don’t like to put on the staff and they remind me I need to. Everything is fine I have no complaints”. Another resident said, “ This is my home from home, everything I want is here. My son wanted me to live here as I lived down the road. When I needed care this was the one as it has a good reputation locally. I came and had a look around and I said yes. I have lots of my own possessions but didn’t want furniture. The staff are lovely and helpful. There is a lady carer from Poland who’s an angel, nothing is any trouble at all. When I first moved in I was having dizzy spells and being sick. They have saved my life. I fell at home and would have been dead. Here I called for help and they came within minutes, cleaned me up and called the doctor. He came and they now have tablets for me. They look after them as I couldn’t at home and I couldn’t now. I have improved and am back to normal looking after myself”. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Completed records of care, liaison with health and social care professionals and good medicine management ensures residents’ health and welfare needs are met but improvements in staff’s understanding of records and training needs could improve so residents’ needs are accurately identified. EVIDENCE: Three residents’ personal plans were looked at. The personal plan format used had changed to one developed by Four Seasons Healthcare the Dependency Assessment Rating Tool (DART). This was used with support plans and risk assessments. Using the DART staff was able to make judgements on the needs of residents’ physical and mental health by using a set of descriptions about care needs. If residents’ needs were given a certain score then staff had to complete the additional risk assessments or risk monitoring forms. The DART was introduced as part of a remedial action plan from the provider In February 2007. This was introduced as the local council and Primary Care Trust (PCT) identified a number of concerns about record keeping. The annual quality assurance assessment of the service completed by the provider and manager before the site visit recorded that improvements of documentation had been Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 11 made and improvements in supervision and training were to be made in the next twelve months. The manager and staff confirmed that they had training from the provider’s training department on using the new documents. Two staff had been promoted to senior care positions and had not been responsible for writing care documents before. Training on the documents had been on site and other venues and included person centred planning. A Malnutrition Universal Screening Tool (MUST) was introduced without training and training from Four Seasons and was provided by the dietician on 20th June 2007. Staff said no one from the training department had shown them examples of how to fill in the new documents or come to see how they were progressing with them to offer advice and guidance. The manager was auditing personal plane and highlighting errors by staff, identifying improvement and setting targets for them to be put right. From looking at residents’ personal plans it was clear that staff did not clearly understand how to use all of the documents introduced. One resident accommodated for personal care was assessed as needing nursing care and another accommodated for nursing care was assessed as requiring personal care needs for dementia care. Personal plans demonstrated person centred thinking as staff were recording to provide support and assistance and encourage a resident to be independent but there was no person centred plan format used. There were improvements noted using the new format and the personal plans in place described residents’ needs. Personal plans were in place to provide personal and healthcare support to residents. Wound care plans were in place for a resident, but in the changeover to the new format the wound management chart had not been used for two months. This was a tool to record the management and progress of the wound. Personal plans recorded regular contact with General Practitioners, tissue viability nurse and dietician. A dietician wrote, ‘Staff comment they have been issued with care plan documentation regarding nutrition but have had no training or guidance on how to use this paperwork by the company. I have given the staff some training. Approachable friendly staff. Do take things on board’. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 12 A sample of medicine administration records was examined. There was only one error noted. The manager or deputy was completing checks on the administration of medicines. Where they identified mistakes they did not identify who was responsible or accountable for rectifying them and what action would be taken if serious mistakes were found. In discussion the manager and senior carer said they were going to discuss the idea of reducing the morning medicine round by having once a day items moved to later in the day and not administering medicines during meal times which were busy and caused distractions. These would reduce the incidents of making errors. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is 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 and coordination of social activities and choice of meals needs to improve so they have a varied lifestyle. EVIDENCE: The annual quality assurance assessment of the service completed by the provider and manager before the site visit recorded that more could be done to offer residents activities and have an activities coordinator. It recorded that more activities had been offered and records of these were kept. Improvement for the next twelve months was to recruit an activities coordinator. The manager was able to demonstrate that an activities coordinators post had been advertised and someone recruited but employment checks not completed. Records of the activities residents were involved in were kept but detailed information on their life history and social and recreational preferences were not routinely completed. Two residents’ surveys received as a result of the site visit differed in opinion. One said activities were always arranged and the other said they were never arranged. The manager had produced activities information for June 2007, which included a father’s day celebration and cream tea for Wimbledon. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 14 Residents said they were happy with their lifestyle. A resident wrote in a survey,’ ‘I wouldn’t be here if I wasn’t. I’m happy with the care and my family are happy’. Yes staff listen and act on what I say, they are good girls, they treat you right and we are all friends together’. Another resident said, “I don’t know what I pay for this as my son deal with all that. I know it covers meals, staff, electricity and everything. It’s value for money. I don’t have to worry about anything. I like all the residents and help when I can. I like to sit in the lounge and watch TV, which I did at home. I like to watch sport and don’t enjoy reading. They have turns that visit regularly and we have a great sing along in the dining room which is used for the parties and we all have a good time”. A relative spoken to during the site visit said they were involved in their mother’s care and said, “I have had some niggles but things are improving. I’m very involved in her care and visit twice daily to give her drinks, breakfast and tea. Meals have really improved with the new chef and she presents pureed diets nicely so they are not mashed together. I asked for fluid balance charts to be put in her room so I can see what she’s drinking. I see her care plans monthly and sign that I agree with them. Healthcare is good and they always act on their concerns and keep me up to date. The manager is much better at sorting things out but there needs to be more consistency from the staff” Staff said they had time to sit and talk to residents and to be involved in social activities. Staff said the current occupancy allowed time for them to spend with residents. An agency carer who regularly worked at the home knew residents’ names and socialised with them. A resident requested some country and western music. He put these on and got residents up to sing and dance. The annual quality assurance assessment of the service recorded that a handbook ‘food for thought’ had been introduced to provide guidance on nutrition and menu planning. Residents’ comments about food were positive but they said they didn’t have a choice at mealtimes. A resident said, “I enjoy the meals and eat what I’m given they just bring me something and I eat it. I don’t refuse anything. Do I choose not really, I just accept what I’m given. I enjoy the food but we have a lot of soup and sandwiches”. Another resident said, “Meals are really good I don’t want a cooked breakfast; I’ve never had one just porridge and toast. You have soup as a starter and a choice of main meals and pudding. They know the only meat I eat is corned beef and I get this. Meals are enjoyable and I eat them all. Residents were able to have a cooked breakfast but the lunchtime menu was soup and sandwiches with a choice of a savoury alternative. The menu for the evening meal did not offer an alternative and the cook said she did not keep a record of alternative meals served. The ‘food for thought’ handbook was not in use. No resident had chosen the savoury alternative at lunchtime and only soup and sandwiches served.. A staff member was seen serving resident sandwiches in a dessert bowl and when a resident requested custard as a sweet the same staff member put a dessertspoon full of sugar into it without consulting the resident. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 15 In discussion with the manager about this practice she said meals were flavoured accordingly and could not understand why staff would sweeten desserts. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are acted on to demonstrate they are taken seriously. An informed staff group and manager protect residents from abuse. EVIDENCE: Complaints records contained details of allegations that had been dealt with under the local council vulnerable adults procedure and had not been dealt with using the Four Seasons complaints procedure. The manager said she had recorded them as complaints as she understood them as such. Other than allegations of poor practice no complaints had been made to Millbrow but a number of concerns and allegations had been made to the local council. The manager said she intended to review how complaints were dealt with as when residents or relatives raised a concern they were offered the complaints procedure but did not wish to use it and she resolved their concerns within her role as the manager. She said she intended to use a format of concerns; complaints and allegations so there was a clear direction of how these matters were dealt with. This would have to be agreed with her manager. Residents’ surveys and comments received from them said they were aware of the complaints procedure and knew how to make a complaint. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 17 The manager had made several referrals to the local council under the protection of vulnerable adults. Millbrow cooperated with the local council and suspended staff. The local council asked the provider to look into the concerns raised and to provide a plan for improvement. The local council also looked into the concerns raised and monitored progress. The regional director for Four Seasons voluntarily suspended placements at Millbrow until the provider and local council had noted improvements. The local council were satisfied that improvements were made. Examples of decisions following the completion of investigations were that a staff member was disciplined and another was dismissed and referred to Protection of Vulnerable Adults Register. All staff had completed further adult abuse training. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well-maintained environment, which is equipped to meet their needs. EVIDENCE: The home is set in its own grounds and has its own enclosed garden. The grounds were well maintained and pleasant areas had been provided to the rear of the building for residents to sit and walk in. The ground and first floor corridors had been re decorated along with the first floor and ground floor dining room and first floor lounge. Carpets were replaced in the ground and first floor corridors and first floor lounge. Two bedroom carpets had been replaced and four others planned to be done. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 19 There was planned refurbishment of the shower rooms on the ground and first floors to create wheelchair accessible facilities, remove shower trays and retile the bathrooms. A grant had been given by the local council, which was to be used to refurbish the large dining room on the ground floor, provide storage, drinks making facilities for residents and purchase of furniture and curtains. New bedding, towels and flannels had been purchased. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures that residents are protected. The induction and training programme provides a skilled workforce that protects residents’ welfare but staff’s understanding of records and training needs to improve so residents’ needs are accurately identified. EVIDENCE: Staffing levels were appropriate and the manager confirmed that staffing numbers were determined by the dependency of residents and could change. Agency staff was being used due to sickness, annual leave, dismissal, death of a staff member and vacancies. Agency staff completed an induction when they were placed at Millbrow. Millbrow was using approximately seventy to one hundred agecy hours a week. These were the same staff from one agency. Of the twenty three care staff employed eight hold an NVQ level 2 qualification. Two staff were undertaking an NVQ level 2 qualification and another two were registered for an NVQ level 2 qualification. Two staff were registered for NVQ level 3 qualifications. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 21 Four records of recently employed staff were examined. Staff had commenced employment and had been supervised through an induction programme, which included training on the protection of vulnerable adults. All contained appropriate identification documentation and completed POVA First and Criminal Record Bureau disclosures. All files had two written references. Files contained copies of the induction programme. Personnel files had been completed for theses staff. A new starter checklist was completed recording dates when employment checks were sent out and received. Application forms had an employment history. Files contained information on identification, application for Criminal Records Bureau disclosure, application form and references, offer of employment letter, terms and conditions of employment, contract of employment and personal and training information. Staff had been provided with and had completed a variety of training. This included: care planning and documentation, health and safety, CoSHH, infection control, food awareness, fire, and moving and handling as some examples. Training had been repeated as part of the action plan for improvement requested by the local council. Staff confirmed they were using training materials in the form of workbooks and had to complete death and dying training. A training plan for 2007 was provided and the manager planned training from the corporate training programme. Training records were updated each month and figures sent to the training department. Staff said that training and new documentation benefitted them doing their jobs but the training and documenta had been hurridly introduced and they did not have continued support from the training department following training. A staff member said, “ I was made up to a senior about six months ago. When I was a carer I didn’t have as much responsibility like writing the care plans. We have had new ones introduced and I went on training. I hadn’t been responsible for writing them before which takes a lot of time and thinking. For example the MUST tool. Four Seasons introduced this and I did some training. Someone came to see how we were using them but we got no feedback as to whether we were using them right, so I made some mistakes. We are working through the whole workbooks at the moment on mandatory training. We do them and the manager checks them. If you don’t get the information right you are told about it. I attended person centred planning training, it was good but I didn’t remember it all. I remember saying it was a good idea but we didn’t have the time to do a person centred plan or if it would work here. The information was all about dementia and we don’t provide dementia care. I have a problem with my confidence and won’t always speak out but did about the person centred planning. I didn’t feel the trainer listened to me. Training is very good but once you have travelled to Preston and Birkenhead, arrive and don’t have time for a drink and then go straight into training it’s hard. It’s even harder when the training is fired at you all day, how can you learn. We didn’t have lunch or proper breaks and were in a large group all day with different grades of staff. Nurses and other managers, so I didn’t feel confident and don’t retain information if I’m nervous”. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 22 Another staff member said, “Our training helps us support residents in respecting their choices more. The changes have meant that if residents don’t want to join in things then they don’t have to. We are more involved in activities and do them when we have the time. A lot of the resident enjoy the bingo and some are difficult to motivate and want to spend time in their bedrooms watching TV and don’t choose to join in. There are residents I know very well and recent training has helped me to look at how I help them to make choices and to do things in their own time. I am completing training using the workbook on adult abuse, moving and handling and care planning. They are useful and help you think about how you do your job”. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good quality assurance systems, financial procedures and maintenance of the building and equipment safeguards residents and ensure they are safe. EVIDENCE: The home manager has been in post for several years. She was a registered general nurse and had the registered manager award. She was previously the deputy manager for several years. She said of her own personal development, “I have learned a lot recently when we went through a bad patch. I realised I had to be closer to the team in some ways and not be thought as, as one of the staff. I have had to be stricter in my approach to the staff team and if difficult decisions had to be made then I have made them. I have had to demonstrate that I am the leader of the staff team. I cannot rely on them to get things right all the time and they have to be accountable and responsible for their mistakes. I have set the deputy manager and another male registered Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 24 nurse some areas for improvement over document keeping and medicine administration. I will be speaking to them in supervision, as they are not meeting the targets I set them. My managers have been very supportive and I communicate the difficulties I have. We have used the disciplinary procedure against staff and dismissed when necessary and I won’t rule out using the disciplinary procedure again. I have delegated specific areas of improvement to the deputy manager and registered nurses. I see it as my responsibility for putting things right. We have had a lot of support and I can see the staff have responded really well, especially the care, domestic and catering staff”. There were thorough quality assurance checks in place. There is a health and safety forum at Millbrow. In May 2007 a health and safety audit and training commenced. This comprised of domestic, catering staff, handyman, deputy manager, and senior care and care staff from both days and nights. They formed a health and safety committee which met In May 2007. A senior care staff was a moving and handling faciltator and completed a training update in June 2007. The manager completed a health and safety audit including the building, working practice and how health and safety is discussed at staff meetings. This is repeated every three months. Other audits were completed throughout the year with theemed audits completed monthly. Examples being catering, records, finance and nutrition. These were verified by the regional manager as part of her quality assurance check of the service. The manager and deputy completed quality assurance checks on the housekeeping and management of medicines. Reports for these were available. The medicines audit in May 2007 found some errors in missing signatures on medicine administration records. The audit did not identify who was accountable/ responsible for making mistakes or rectifying them. Senior carer staff were responsible for completing carer audits where they monitor that housekeeping and cleaning of equipment such as wheelchairs. How clothing was put away, safe storage of chemicles and how staff adhere to policies and procedures.The manager had requested residents to complete information on what they thought of the social activities within Millbrow. This information had not been colated. Staff meetings were held at approximately six weekly intervals. Minutes of the staff meeting from 20th June 2007 were available. All staff was given copies of a ‘smoke free workplace’. A staff meeting for catering staff took place on 4th May 2007. The menu was discussed and decisions made to change it to include two main course choices and alternative choices. On 4th May 2007 a trained staff meeting took place. The management and administration of medicines was discussed. Improvements in recording were noted and all staff were to have a distance learning medication management and administration course through Skelmersdale College. On 3rd May 2007 the manager held a care staff meeting as concerns were raised that a former carer was discussing confidential information with relatives. Staff were given copies of the confidentiality policy. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 25 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. Information provided by the manager in the annual quality assurance assessment and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 26 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 2 13 3 14 2 15 2 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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 Staff should receive support and training before new documents, assessment tools and best practice ideas on planning residents care are introduced so staff’s understanding of record keeping and training ensures residents’ needs are accurately identified. Audits of medicine management and administration should identify who are responsible/accountable for mistakes and the actions taken to rectify them so residents receive their medicines safely. Residents, The complaints procedure should be revised so residents. Relatives, visitors and staff are clear on what is a concern, complaint or allegation so they will be confident the appropriate action will be taken. their relatives or representatives should be consulted about their life history, lifestyle and meal preferences so activities are coordinated around their recreational and lifestyle choices and meals of their choice provided. DS0000005173.V338507.R01.S.doc Version 5.2 Page 28 2. OP9 3. OP12 Mill Brow Care Home 4. OP16 The complaints procedure should be revised so residents. Relatives, visitors and staff are clear on what is a concern, complaint or allegation so they will be confident the appropriate action will be taken. Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill Brow Care Home DS0000005173.V338507.R01.S.doc Version 5.2 Page 30 - 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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