CARE HOMES FOR OLDER PEOPLE
Mill House Salters Lane Faversham Kent ME13 8ND Lead Inspector
Graham Cummings Announced 27/09/05 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 H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Mill House Address Salters Lane, Faversham, Kent, ME13 8ND 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) 01795 533276 Mrs Renuha Francis Mrs Heather Karslake Registered Care Home 24 Category(ies) of Care Home for Older People, 23 and for Older registration, with number People with Dementia, 1 of places Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14/04/05 Brief Description of the Service: Mill House is a large detached property, which is a listed building situated a few minutes from Faversham town centre. Faversham is a town steeped in history with a railway service to most parts of Kent. The M2 motorway is nearby and there is a shop within walking distance of the Home. The Home is registered to provide personal care and support to 24 Service users who are over the age of 65 years. The property has been adapted for its present use and the Provider has completed an extension and alterations to provide further en suite bedrooms. Most of the accommodation is provided in single rooms, however there are three rooms for shared occupancy. All bedrooms have a call bell system, telephone point and television point. The Home has a large rear garden with an ornamental fishpond, bird aviary and seating for Residents. There is off road parking for several cars. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Graham Cummings carried out the Announced Inspection on the 27th of September 2005. The Inspection was carried out through information gathered from the completed Pre Inspection Questionnaire, 16 relative/visitor comment cards and 12 Service User comment cards. The Inspector met with the Manager Heather Karslake and the Provider Mr Francis, 7 Residents and 2 staff as well as looking at 4 staff files and 3 Resident files, the Inspector also toured the home. The new report format was explained and discussed with the Manager and Provider, this covered areas relating to positive outcomes for residents, judgements and evidence and that there was no longer a form for written responses, both the manager and Provider were told that they could contact the inspector to discuss the draft report or put it in writing if they wished, but this must be done within 28 days of receiving the draft report. The home has a relaxed and welcoming atmosphere and was well furnished, clean and free from offensive odours. The Residents spoken to were all very happy with the way they were cared for, comments from Residents included ‘you wouldn’t get the service we get here in a top class hotel’ ‘as long as I let people know I’m going out I can do as I want’ ‘the food is excellent’ ‘staff are great’. All of the work on the extension and garden are now complete much to the delight of all concerned, the home is more spacious and many of the rooms are now en-suite, as with most extensions and upgrades there have been some difficulties, this included a lack of hot water at peak times and some flooding, both of these issues were dealt with swiftly and with the minimum of disruption as possible to the Residents, this was confirmed to the Inspector by some of the Residents spoken to. All of the requirements from the last inspection have been addressed, the Manager is still looking for further improvements in the recording of daily notes and activities and is planning some changes in the near future that will make it easier for the carer/family/care manager/Inspector to get an overall picture of the individuals daily routine. The staff spoken to were complimentary about the manager and the care given to the Residents, one staff member said ‘they would be happy for their parents to live there’. The Inspector had a discussion about numbers of staff on duty to meet the needs of all the Residents and it was agreed between the Provider and Manager that the evening rota would be extended to 9.00pm or until all of the more needy Residents were settled so that the night staff were not over stretched. The Manager is to monitor the possible need to increase the wake night cover should Residents needs are not able to be met quickly. The Inspector left the home with no concerns for the health, safety and welfare of the Residents. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection?
All of the Requirements from the last inspection have been addressed, the Inspector looked at 3 of the Residents care plans and found them to be detailed and contain individual risk assessments. The Manager informed the Inspector that the individual who had diabetes now had a protocol and procedure in place, this was confirmed later in the Inspection when a member of staff had contacted the Doctor following a slightly higher reading than usual and was recording the details of the conversation. The home has purchased a lockable drugs fridge so that appropriate medication can be stored safely and a dishwasher for the Kitchen. The Inspector did not check all of the rooms during the inspection, those visited were all free from offensive odours. The Inspector found the home to be free from hazards. The number of staff on duty has been increased so that there is always 3 staff on duty throughout the day, the Manager also wanted 1 member of staff to stay with the 2 night staff until all of the Residents needing personal care had been completed, this would be until approximately 9:30pm. The Provider agreed for this to be implemented as soon as possible. The fire doors have been repaired and are now working effectively. The new extension has now been fully completed along with the garden and has been well used by the Residents, one Resident told the Inspector that he had his meals in the covered patio area most days as he liked the fresh air. New carpets have been fitted in the lounge and the dining room has been redecorated. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 7 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 H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 8 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 H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 9 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) 2,3,6 Residents have a written contract on file. Residents moving into the home have had their needs assessed prior to admission. The home does not cater for Intermediate care. EVIDENCE: The Inspector looked at 3 Residents files and found that they all contained a contract that included the fees and who pays. The home carries out pre admission assessments on any referral they receive to ensure that the home can meet the individuals needs. Following receipt of an enquiry and the care managers assessment, the Manager arranges to visit the proposed Resident to complete the homes assessment and to give details and discuss how Mill House runs. The Resident and family are invited to visit Mill House to ensure they are happy with the home, if everyone is happy the placement is made. The home does not admit Residents for Intermediate care. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 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) 7,8,9,10 Residents health, personal and social care needs are set out in a care plan. Residents health care needs are fully met. Residents who self medicate are protected by the homes policies and procedures. Residents feel they are treated with respect and dignity. EVIDENCE: The Inspector looked at 3 Residents file and found that individual care plans were in place. Residents and members of their family are fully involved in the making of the care plan, their views and wishes are listened to and included wherever possible. The care plans contained details of the individuals needs and how they would be cared for following consultation with the Resident, their family and the care manager. The care plans seen had been evaluated at monthly intervals and had been signed by the Resident or a member of the family. There is only one Resident in the home who self medicates and has an inhaler and paracetamol on an as and when required. There is a risk assessment in the Residents care plan and the medication is kept in a locked cupboard in the residents room. The Inspector spoke to 7 Residents and they were all very complimentary about the care they received and how it was delivered with respect and dignity, one Resident said ‘the staff are very respectful’ the staff do not put us in embarrassing situations’.
Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents lifestyles matches their expectations and preferences. Residents maintain contact with family and friends. Residents are encouraged to exercise choice and control over their lives. Residents receive a wholesome and nutritious diet. EVIDENCE: The Inspector spoke to 7 Residents and all were very positive about their care and lifestyles, comments from the residents included ‘ I can come and go as I please but I let staff know where I’m going and roughly what time I’m returning’; ‘I can get up and go to bed when I like’; ‘the food is superb’. Some Residents attend the local church when they want and Holy Communion is available if anyone requests it. Friends and families are able to visit at any time, a Residents brother visits daily and brings in a newspaper for them and another Resident has a friend who visits daily and stays for tea, there are no restrictions made on visiting times. Staff assist some of the Residents to maintain contact with relatives living out of the area by writing letters with them. The home offers choices to the Residents regarding activities and outings, recently the home tried to arrange for a trip to the theatre but all of the Residents declined the offer, the Manager is going to try to arrange other outings in the near future. The home provides a healthy and nutritious diet that both Residents and staff agreed was ‘excellent’ ‘it’s hot and there’s plenty of it’
Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 12 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) 16,18 Residents are confident their complaints will be listened to and taken seriously. Residents are protected at all times. EVIDENCE: The Inspector received 12 comment cards back from Residents and all indicated that they ‘felt safe’ in the home, of the 16 relative/visitors comment cards received 7 said they were not aware of the complaints procedure but all 16 stated that they have never needed to make a complaint. The Inspector recommends that the Manager inform all the Residents families of the complaints procedure and when visitors come to the home to point out the complaints procedure on the notice board in the entry hall. Residents spoken to indicated that they knew that if they had a complaint or were unhappy at any time the staff and manager would listen to them. Staff had attended an Adult Protection training course on the 15th September, staff spoken to were aware of the procedures to follow should they witness or hear of any abuse. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 13 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) 19,20,21,22,23,24,25,26 Residents live in a safe well maintained environment and have access to comfortable indoor and outdoor communal facilities. Residents have access to suitable lavatories and washing facilities and have access to specialist equipment to maximise their independent living. Residents own rooms suit their needs, they are safe and comfortable and are partly furnished with personal belongings. The home is clean and from the rooms viewed free from offensive odours. EVIDENCE: The home is well maintained and employs a handy person to carry out any repairs or redecoration quickly. The handy person carries out a monthly check on all potentially hazardous areas to ensure that Residents are protected and the chance of accidents minimised as much as possible. Since the completion of the extension the residents now have access to 3 lounge areas and a dining room as well as a covered outdoor area and a patio with table and chairs. The majority of rooms have en-suite facilities and there are enough communal bathing and toilets to meet the needs of the Residents. The home has specialist equipment to increase Residents independence including a hoist and
Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 14 standing hoist, wheelchairs and walking frames. The Inspector did not look into all of the individuals rooms, but those seen looked safe, comfortable and well furnished and decorated, the rooms met the needs of the individual, and Residents personal possessions were displayed. The home was clean and there were no offensive odours in any of the rooms looked at. The home had a relaxed and homely feel to it, some Residents were participating in ‘hoopla’ others were having an after dinner sleep, reading the paper, knitting or sitting outside talking and having a cigarette. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27,29,30 Residents needs are met by staff. Residents are supported and protected by the homes recruitment policy. Staff are trained and competent to do their jobs. EVIDENCE: The home has recently increased the number of staff within the home, the hours have increased to make sure that there are a minimum of 3 staff on shift throughout the whole day, 7am to 8pm, a discussion about the staffing took place between the Inspector, Manager and Provider regarding the number of staff covering overnight, the Manager and Provider felt that the main issue was between 8pm and 9pm when the majority of Residence were requiring personal care before retiring for bed, the Manager and Provider agreed that an extra member of staff would be put on the rota to cover this. The Inspector looked at 4 staff files and found that they all contained Application form, references, police checks, job description, identification and contract. Staff training in the last month has included; Medication administration, Fire, Manual Handling, Health and Safety, Basic Food Hygiene, COSSH, Challenging Behaviour and ongoing NVQ’s. The Manager is completing her NVQ4 and at present there is 1 staff member with an NVQ level 3 and 1 staff member with an NVQ level 2. There are 6 staff completing level 2 and 4 more are booked to start it in the next 4/6 weeks. Staff who spoke with the Inspector said that the support from the home Manager was ‘excellent and she was always available’, the Inspector was also told that the Providers mobile and home telephone numbers were available to staff. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 16 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) 31,33,35,36,37,38 The home is managed by a person able to discharge their duties fully. The home is run in the best interests of the residents. Residents finances are safeguarded. Staff are appropriately supervised. Residents rights are safeguarded by the homes record keeping. Residents health, safety and welfare are protected. EVIDENCE: The Manager has been in post for almost 5 years and has run the home in the best interests of the Residents. The recording and filing systems have improved and they are continuing to look at ways to further improve this area. None of the Residents finances are dealt with by the home, responsibility for this is carried out by Residents family, or next of kin, if anything is purchased for Residents by the home families are sent a monthly invoice with an attached receipt. The health, safety and welfare of Residents and staff are protected. Residents comments included, ‘I know the manager listens to me’ ‘the Manager is excellent’ ‘we can speak with Mr Francis if we want to’ ‘the Manager takes
Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 17 her job seriously and is attentive’. The manager is aware of some areas they want to address in their personal development that have been highlighted in their NVQ training. The Inspector left with no concerns with the management of the home or the safety of the Residents. Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 18 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 3 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 3 3 3 Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 19 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 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 12 Good Practice Recommendations That all activities offered are recorded, regardless of whether they take place or not. The manager to consider the most effective place to store the records, i.e on individuals care plan. That all Residents and family have access to the complaints policy and procedure including timescales and CSCI telephone number and address. That the Manager monitors the number of staff on duty during the day and night shifts to ensure that Residents needs are fully met at all times and within an acceptable timescale. 2. 3. 16 27 Mill House H56-H05 S23494 Mill House V241695 270905 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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