Inspection on 25/05/05 for Mill House

This inspection was carried out on 25th May 2005.

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

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

Other inspections for this house

Mill House 07/06/07

Mill House 07/06/06

Mill House 08/11/05

Mill House 04/10/04

Mill House 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Mill House 15 Mill Road Great Ryburgh Fakenham NR21 0ED Lead Inspector Dot Binns Unannounced 25 May 2005 2.00pm 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 House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mill House Address 15 Mill Road Great Ryburgh Fakenham NR21 0ED 01328 829323 01328 829554 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) Prime Life Limited Care Home 44 Category(ies) of Dementia - over 65 (44) registration, with number Old Age (44) of places Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No Service Users who need to use a wheelchair are to be accommodated in rooms 22, 23, 24 and 25. Date of last inspection 4 October 2004 Brief Description of the Service: Mill House accommodates 44 service users in a large extended country house. The main house is on two floors, with a single storey extension. Nine terraced bungalows also provide semi independent accommodation comprising, bedroom, sitting room and kitchen and a bathroom. The Home until last year provided nursing care to older people and to those who are mentally frail. However nursing care is no longer provided and the nursing staff have left. The Home now provides personal care to older people including those who are mentally frail. A new manager has just been installed but has yet to be registered.The Home is situated in a rural position at the end of a country lane in the village of Gt Ryburgh and overlooking the river. Most of the rooms are single and several have lovely views. The Home has a large garden and patio which has recently been redesigned and made safe. There is a bus service to Fakenham from the village. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection to follow up what had happened in the Home since the Commission investigated a recent complaint and made several requirements for change in the way things were done. Time was spent with the new manager who came in to post after the circumstances surrounding the complaint. She was not therefore part of the complaint but had had to lead the staff into the necessary changes. Records and procedures were examined and two staff were seen in private. Only some of the standards or some parts of the standards were examined and the requirements of the last inspection which were largely to do with the building were not examined. What the service does well: What has improved since the last inspection? The overall supervision of staff has improved with better communication between staff and manager and a formal system which allows staff individual time to talk about their work. Staff are clear that there are limits in their responsibility and that some tasks must be overseen by the district nurse. There is better liaison with community medical services with the GP and district nurses having a more transparent and supportive relationship with the Home. There is more structure in place to ensure that problems are communicated to senior staff who know what to do about them. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 6 These improvements have been brought about by the new manager who has shown leadership by tightening up on procedures, and in creating an open and inclusive atmosphere. 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 House I55 S15661 Mill House V230187 250505 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 House I55 S15661 Mill House V230187 250505 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) Not inspected on this occasion. EVIDENCE: Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 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 standard(s) 7and 8 The individual care records are detailed and set out clearly what assistance each person needs. Some improvement is still required on reviewing the care but the new manager has put steps in place to deal with this. This will be inspected further. There has been considerable improvement in the way the Home meets the health care needs of the service users. EVIDENCE: One of the main requirements made as a result of the investigation was that there should be an integrated system in the record keeping. There had been faults in the system where the care records were saying one thing but information was not being picked up and acted upon in others. An examination of the records was carried out to see what improvements had been made. Three care plans were examined at random. The records contained detailed information gathered during the assessment of the person. This is used to highlight where the person needs assistance and what tasks the staff need to carry out. The record also contained risk assessments for instance regarding falls. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 10 The care plans are reviewed monthly but the reviews were of limited value usually recording that the care plan needs to continue. There was no cross referencing to the daily reports of the previous month and they appeared to be completed routinely without a full review. The new manager discussed the changes she will be making as a result of the recent investigation. These included the need to have more than one person reviewing the care, the appointment of key workers who will attend reviews, and the reading of the daily reports during the intervening period so that the review will reflect any changes occurring. There has not been time to put this in place as the new manager has only been there a month, but the inspector was satisfied that improvements are planned. In addition, it is reported that a handover meeting is now taking place and a book records incidents or concerns about particular service users. This means that information is not left in the care records but brought to staff attention if action is needed. This record was seen. The manager reports that staff read this book, for instance when coming on night duty so that they are particularly aware of those who need special monitoring. The information was brief in this handover book and there was a discrepancy regarding how staff saw it and how the manager saw it but nevertheless it is an improvement and can be built on. In addition the manager stated that there is now a system where she has a meeting with the senior carer when she arrives on duty to ensure she is aware of any problems. She also goes round to see all the service users to see for herself how they are. This is good practice. At the recent investigation, there had been concerns about the speed at which the doctor was called in and this inspection looked at what had been done as a result. The new manager has had a meeting with the local GP to discuss how she wants to take the Home forward and she feels this has been of help. The manager has also had a meeting with the district nurses to discuss the assistance she needs and how best to work with them. This again is good practice. There was also some confusion about what tasks care staff could carry out, the home previously providing nursing care. Having changed to providing personal care only, the district nurse now must be involved in those nursing tasks. The manager said that clearer instructions have now been given to care staff and when two staff were interviewed they confirmed that this had been clarified. The manager has also arranged for staff to have some training from the district nurses on for instance, diabetic management and catheter care which will improve the staff’s understanding. Where the district nurse wishes a care staff to carry out a particular nursing task, the manager is aware that the district nurse will need to train the staff and be accountable. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 11 In terms of ensuring that the doctor is called, the handover book did show whether the GP had been in and there was also a doctors visits record. The manager is hoping that communication is now much better between staff and management with better handovers to ensure appropriate assistance is sought. Mill House I55 S15661 Mill House V230187 250505 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) 13 The number of activities is being reviewed to find ways of meeting individual interests. The new manager is taking steps to ensure relatives feel comfortable in the Home and know they can approach her. EVIDENCE: The outcomes for this standard was only briefly examined as part of the wider picture. The manager said that she was looking at the activities and more training in working with elderly frail people was planned. She has also hired the company’s bus for outings and has requested that this is increased to twice a month. Staff confirmed that they do provide activities twice a week though would like to do more. They said they do take service users out for walks. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 13 The new manager says she is making herself known to relatives and suggesting that they come to see her if they have any worries about the Home. This had been a problem highlighted in the investigation. She gave an example where relatives had come to talk to her. The manager is also making sure that relatives are kept informed about hospital appointments and significant changes in the health of the service user. This will be further explored at the next inspection. Mill House I55 S15661 Mill House V230187 250505 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) Not inspected on this occasion. EVIDENCE: Mill House I55 S15661 Mill House V230187 250505 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) Not inspected on this occasion. EVIDENCE: Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 The number of staff hours is satisfactory though the distribution of hours particularly in the evenings could be better and needs to be increased. Some shifts are too long and tiring for staff. There is still no clear evidence that the staff in charge at weekends are trained and competent enough. EVIDENCE: From the rota provided for the week of the inspection, and assuming that at least half of the service users are mentally frail. the staffing hours easily met requirements. If more than half the service users are mentally frail, then a higher staffing ratio would have to be calculated. There are currently some very long shifts from 7am to 11pm which the staff mentioned to the inspector as “shattering”. It is acknowledged that there are some recruitment problems at the moment which are being dealt with, but such long shifts need to be phased out once a full staff complement is recruited. Such shifts put a strain on staff and do not lay the foundation for the best care. The recommendation of the Commission is that shifts should be no longer than 10 hours and those would usually be a night shift. It is also a feature of the rota that day staff generally do a 7am to 7pm shift leaving a reduction of staff in the evenings – usually four staff but on two evenings only three. For a Home with forty four service users, this looks particularly thin. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 17 The weekend rota was scrutinised as the investigation had questioned how staff take decisions when the manager is not there. The rota showed that no senior staff were to be on duty on the weekend following the inspection. The manager said that some changes were being made in the responsibilities of staff and she was aware of the need to ensure the Home was in good hands at all times. The Commission will be looking for further reassurance that weekend staffing is satisfactory. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 32,36 and 37 Service users are starting to benefit from the new management approach which is taking a more structured course. Staff are appropriately supervised. Service users are now better served by the record keeping and policies in the home. EVIDENCE: The new manager has had to take the lead in meeting the requirements of the Commission made as a result of the recent complaint. Staff confirmed that there has been a tightening up of procedures and better decision making processes with the manager being kept involved. They felt that improvements had been made and there was more support. Staff confirmed that they have had meetings with the manager to discuss policies and changes. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 19 More training is being offered, for example in medication and dementia. Requirements from the Commission regarding how the home operates are being attended to and some are met. Staff also confirmed they are now receiving one to one supervision sessions on a regular basis which they spoke positively about. The manager said that she is also trying to have an open door policy to ensure staff can easily approach her. Only a few of the records required for regulation were inspected on this occasion but those which were, were being maintained properly. The staff record was particularly examined as more detailed information had been required by the Commission. The accident record was also checked to see that falls and incidents to the service users were cross referenced with the care plans. This was seen to be done. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 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 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 3 x x x 3 3 x Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 2. 3. 4. Refer to Standard 7 27 27 32 Good Practice Recommendations To continue the plans for reviewing the care in a more constructive way. To review the long shifts of staff and the cover in the evenings. To ensure that the staff in charge at weekends are trained and experienced and supported by clear policies to aid decision making. To continue to improve the communication between staff and between shifts by having an effective handover. Mill House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF 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 House I55 S15661 Mill House V230187 250505 Stage 4.doc Version 1.30 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. 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