Inspection on 04/06/10 for Mill House

This inspection was carried out on 4th June 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mill House 11/08/08

Mill House 13/08/07

Mill House 31/08/06

Mill House 29/11/05

Mill House 21/04/05

Mill House 26/11/04

Mill House 07/07/04

Mill House 29/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Mill House 51 Mount Pleasant Bilston Wolverhampton West Midlands WV14 7LS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Adams     Date: 0 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 45 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 45 Information about the care home Name of care home: Address: Mill House 51 Mount Pleasant Bilston Wolverhampton West Midlands WV14 7LS 01902493436 01902493436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ragavendrawo Ramdoo,Mrs Bernadette Ameranmerion Ramdoo Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 24 Dementia ( DE) 24 Date of last inspection Brief description of the care home Mill House care home is providing personal care and accommodation for 24 older people who have some form of mental illness, but who are not in need of nursing care. Care Homes for Older People Page 4 of 45 Over 65 0 0 24 24 Brief description of the care home The home is located on a main road with ease of access to the Bilston high street and all of its amenities.The home is a large detached two-storey building that was adapted as a residential care home in 2002. The accommodation consists of 24 single occupancy rooms with en suite and shower facilities with the exception of one bedroom without a shower facility. Communal facilities of sitting and dining areas are located on each floor. There is a quiet room for people who use the service and a meeting room for visitors on the first floor. There are adequate communal toilets and assisted bathrooms facilities on each floor. There are gardens and a patio area at the rear of the building. There is ample car parking space at the rear of the building. The Registered Providers Mr Ragavendrawo Ramdoo and Mrs Bernadette Ramdoo have been operating this service since March 2002. They make the services of Mill House known to people thinking about living at the home in The Statement of Purpose and Service Users Guide. The Inspection Report is mentioned in the Statement of Purpose and how a copy can be obtained. The care home rates are reviewed annually and service users are notified one month in advance. The only additional charges to service users are for hairdressing and chiropody. The reader is advised to contact the service to clarify their current rates. Care Homes for Older People Page 5 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. This inspection was carried out over three days. The home did know we were going to visit on the first day, although they were aware of our intentions to return on the subsequent days. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the Care Homes for Older People Page 6 of 45 home. These are reports about things that have happened in the home that they have to let us know about by law, and an improvement plan we requested after the last inspection. The service have also sent us additional information the Registered Providers Mr and Mrs Ramdoo have documented as part of their weekly and monthly monitoring of the service since the Registered Managers post recently became vacant. Four people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, viewing their private bedroom accommodation, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were also looked at. Where people who use the service were able to comment on the care they receive, their views have been included in this report. We sent 10 of our Have your Say surveys to people who use the service, 10 to their relatives and people who are close to them, 10 to staff members, and 4 to health and social care professionals who visit Mill House regularly. We received 4 replies from people who live there, 4 responses from people who were close to them and three completed surveys from staff members. One health professional also responded. Their views have been included in this report. Feedback about the conclusions of the inspection was given to management team members at the end of the inspection. Care Homes for Older People Page 7 of 45 What the care home does well: What has improved since the last inspection? What they could do better: Our findings as a result of this inspection meant that we issued a total of three Immediate Requirements for issues which needed urgent remedial action to improve the hot water supply to the home and to ensure fire safety standards were satisfactory. We also issued a further 11 statutory requirements where we feel the home needs to make permanent improvements to the service it provides, and a total of 14 good practice recommendations for the service to consider to make the lifestyle for people at Mill House better. Care Homes for Older People Page 8 of 45 The information Mill House collects about an individual as part of their decision-making to see if they can meet their needs is in need of further expansion to make sure it contains enough information about the mental health needs of the person who is thinking of living at the home. This will make sure the home are fully aware of the psychological needs of the individual so they know how to look after the person properly. Care plan paperwork is also in need of further expansion so it contains all of the details to make sure staff have written guidance how to look after people who have not got the capacity to let them know their needs and preferences. This must be kept up to date to reflect the current needs of people especially when health needs change,as a result of being in hospital or following an accident. Day-to-day working systems at the home are in need of improvement to make sure staff can monitor what people have to eat and drink to keep them well. Safety assessments to minimise the risk of people of potential hazards are in need of further review. This is to make sure they give a clear account of measures staff are advised to take to promote the safety comfort and well-being of people living at the home. Medication management systems are in need of further development to make sure any medications received into the home are fully accounted for and kept safe until people need them. Staff working practices at Mill House require further consideration to make sure the privacy and dignity needs of people are prioritised as part of their daily needs, especially with regards to involving people about their dress preferences and use of their personal accommodation. People reported they felt that the cleanliness of the home had improved, however some of the bedrooms we visited had an unpleasant odour indicating carpets were in need of cleaning. Infection control practices are in need of improvement in line with our findings and those reported by the community infection control nurse who visited the service recently. This will make sure people living, visiting and working at Mill House have clean and hygienic surroundings. The home management systems to ensure Mill House is kept maintained to a standard that promotes the safety, well-being and comfort are in need of further development to make sure people are living in surroundings that are in a good state of repair and can meet their needs. Staff recruitment processes require further development to make sure any new team members are thoroughly checked out to be competent and safe to work with vulnerable adults. Management systems are in need of further development to ensure staff implement the knowledge and understanding they attain from training into their daily working Care Homes for Older People Page 9 of 45 practices in order to improve standards of care and support at Mill House. The service is recommended to facilitate the prompt recruitment of a suitable individual to manage the day-to-day running of the service in order to provide stability, direction, monitoring and motivation of the care team to improve the standards of care and support they provide. As a result of this inspection, with the consent of the home management team, we obtained for photocopies of some of the paperwork about how Mill House meet peoples needs. This information will be used to consider further action we need to take in order to make sure the home complies with our regulations to meet National Minimum Standards for Care Homes for Older People, and ensure the health and well-being of people who live at the home is promoted at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 45 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 45 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking about living at Mill House receive most of the required information about the service to help them make an informed choice about what the agency can offer. People do not have all of their needs fully assessed prior to moving into the home which means they cannot be fully confident they will receive the care they need. Evidence: Mill House management has produced the information they are required by law to provide, in the form of a Statement of Purpose and Service User Guide. February 2010 copies of this information were given to us to review as part of the inspection process. The information is presented in two separate, easy to read, colourful brochures with realistic photographs to inform people what the home looks like. The statement of purpose also has an admission agreement incorporated into the paperwork. Although Care Homes for Older People Page 12 of 45 Evidence: information is well laid out, some of its contents required amending or expanding. The information did not tell the reader what is the current management arrangements were for the home, as since our last inspection the registered manager position has become vacant. The information provided about the way the Mill House manages any comments concerns and complaints would benefit further detail about how long the service will take to investigate such matters. In addition, the information both of the documents contained about the Care Quality Commission appeared confusing to any reader. The brochures referred to us as the Quality Care Commission, and the National Care Standards Commission. Discussions with the acting manager confirmed this document is not yet available in other formats, such pictorial, audio, Braille or different languages. The acting manager told us people have a needs assessment before they move into the home. We were also informed that Mrs Ramdoo the registered provider for the service had been assisting in assessing any potential residents since the departure of the home manager. We looked at the care records for people who live in the home, which included people who have been admitted since our last key inspection in January 2010. Overall we found variations in how people have their needs assessed and the level of detail obtained. It is important that enough information is obtained at the time an individual moves into the home so that staff know how people want and should have their care needs met. Review of the care records for a person who was admitted for care and support to manage mental health needs established they contained a document intended to assist staff in assessing peoples needs before and on admission to the home. This showed that a staff representative had been to see the person in hospital before they were admitted to Mill House. The document was not fully completed and where information had been written it was not sufficient to show the care which would be needed. The pre-admission assessment information also lacked details to confirm people and their supporters were in agreement that the details the service had recorded about them was accurate and appropriate to the care and support package they required. The recordkeeping could not demonstrate that the persons capacity and best interests were being accounted for, protected and promoted.Observation of this individual during the inspection confirmed ways to effectively manage his behavioural and mental health needs had not been identified. This matter was discussed with the management team as part of as part of the Care Homes for Older People Page 13 of 45 Evidence: inspection. As the home is specifically registered with us to accommodate people with mental health needs, including dementia related conditions, the admission process needs to ensure it fully accounts for these matters as part of the assessment of a person. Any Interested parties can then be assured that this important aspect of care has been fully considered before they are offered a place at the home. Care Homes for Older People Page 14 of 45 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because staff are not effective in ensuring care is provided according to the needs of the person or when risks to the health and welfare of that person are identified. Poor medication practices mean that people cannot be confident that they are receiving the medication they need. Evidence: We received varying feedback about how people and their representatives view their needs are met at Mill House. Four people visiting the home that responded to our survey told us they were satisfied with the care their relatives receive. Four people who live at home also told us they are happy and satisfied with their care. As many people who live at Mill House are unable to feedback their views, and are reliant on staff being aware of their needs and how to meet them it is important that care records are accurate and contain sufficient information so that staff have guidance to follow on how to meet individual needs and that any risks to the individual Care Homes for Older People Page 15 of 45 Evidence: are clearly identified. In order to establish whether the records of people living in the home reflected their needs, we spent several hours observing individuals and staff in communal areas. We also discussed peoples needs with the staff team. Following this, an in depth examination of care records of four people who live at Mill House confirmed that the home is not adhering to legislation or good practice guidance in how it assesses, plans and reviews peoples care. We found that some people were lacking care plans and that assessments of possible risks to their health, safety and welfare are either not sufficient or have not been undertaken. These were issues we identified at our last key inspection in January 2010 when we made six statutory requirements for the home to demonstrate they had made permanent improvements to the way they care and support for people at Mill House. Although some improvements to the care paperwork are evident, our findings could not offer us assurance people are receiving all of the care they require. Our findings confirmed that further improvements are needed before four out of the six requirements we made can be fully complied with. Records failed to inform us that a full long term ongoing assessment of peoples needs had been carried out and kept up-to-date. This has had an impact on the care people have received and our findings indicate people did not receive the care and support they required to keep them safe and well.The circumstances leading to an individual being transferred to a nursing home indicated that their wound care and physical needs had not been regularly reviewed or acted upon to establish the person was receiving all the expected care and support in the timely manner normally expected. When care matters were explored further, other care plan records showed that key information about individuals health needs had been omitted. Records to account for the daily care and support people were offered and received were not maintained accurately. The daily records for one person had not been fully completed on four occasions over the space of a fortnight. This suggests Mill House cannot confirm they have a realistic record of the day-to-day care and support they carry out for the people living there. Care plans do not offer enough details to show how they meet peoples basic hygiene needs in a way they prefer. For example, the records of one person did not confirm the support and assistance an individual needed for hair washing and shaving. Similar findings in care plan records do not offer us assurance that people with more complex physical and mental health needs are being met. One person who came to live at the the home from hospital had information to tell Mill House that they were at risk of falls. This was not fully accounted for in the home care Care Homes for Older People Page 16 of 45 Evidence: records and meant staff were not fully aware of this safety issue. Recordkeeping contained inaccurate information about the use of appropriate equipment to keep the person safe, and a medical condition that posed a risk to the same individuals safety was not accounted for. Observation of the person confirmed they were at risk of injury due to lack of safety measures being carried out by their staff to safely manage their physical and mental health needs. The recordkeeping of another person who had an accident as a result of a fall did not clearly account for the first aid measures taken by the home to manage the injury sustained until it was seen by a community nurse the following day. Safety assessments carried out by the home to minimise the risk of people being harmed lacked detail to guide staff how to keep individuals safe. When people were identified at high risk of falls in manual handling assessments, there was no care plan guidance for staff to follow to advise them what to do in the event of the person falling, even though the home risk assessment paperwork advised staff to devise such plans. Our findings indicated that safety assessments had not been updated when peoples needs changed. The records of one person advised staff to monitor one person with mobility and balance challenges on an hourly basis, whereas our observation of the individual confirmed they were in need of constant monitoring as they attempted to repeatedly mobilise in an unsafe manner. It is positive the home are now involving people and their representatives in the care planning process, and some records are starting to reflect this. We also found improved recording of information in care records for people requiring monitoring of their food intake and weight management. However records could not account for the type and amount of drinks people are offered. The records of one person who was frail and underweight could not show that staff were following advice of the community dietician to offer the person more nourishing drinks as an alternative to tea. We obtained copies of this information. Food and drink issues were explored further when the records of an individual with known health challenges had been admitted to hospital on four occasions since our last inspection with recurrent problems relating to urine infections and dehydration. Examination of this persons records confirmed their assessment of need had not been reviewed as part of the preparation for the persons return to the home, and as a result the home had not devised any changes to care for the person such as monitoring the individuals fluid intake and urine output. This means the home do not demonstrate they are aware of professional good practice guidance to follow for a person with such specific needs.This doe not assure us Mill House are promoting the Care Homes for Older People Page 17 of 45 Evidence: well being of this person to prevent further hospital admissions for this condition. As a result of the above findings we requested photocopies of some of this information as evidence to consider taking further action to improve this aspect of the service. We looked at systems and practices that promote peoples right to privacy and dignity. We saw that bedroom doors are fitted with a privacy lock. We observed staff knocking before they entered peoples bedrooms, and overheard people being addressed respectfully. On all three inspection days we observed several people congregated in the ground floor and first floor lounges in their bare or stocking feet. This practice does not offer people protection from injury when mobilising nor does it confirm they are supported to be groomed and dressed in the way they prefer. Spot checks of care plans confirmed footwear preferences of the individuals concerned were not accounted for. We overheard one person repeatedly asking for their shoes. When we looked at minutes of a staff meeting held five months ago, this dignity and safety issue had been raised as a concern to be addressed. During the tour of the home we saw that the communal hoist was being kept in a persons bedroom rather than in a communal storage area. Discussion of the matter with management confirmed that the person who occupied the bedroom had not been consulted regarding this practice and the impact this would have on their privacy. The above issues were discussed with the management at the time of the inspection. We looked at the homes systems and procedures for the management of peoples medicines. Although some improvements had been made to demonstrate that two of the three statutory requirements we made about medication matters had been complied with, current practices in place are still not robust enough to ensure people receive their medicines safely. It is positive the acting manager has a good working knowledge of the safe management of medications although our findings confirmed practices by the senior team members responsible for medication management did not demonstrate that they were putting the recent training they had received for this matter into practice. Our findings confirmed that storage of Controlled Drugs needed to be improved to ensure the cupboard dedicated for this purpose was not used to store miscellaneous items such as jewellery and dressing equipment. The home did not have a system to make sure the drug fridge was defrosted regularly, and examination of its contents confirmed that staff have not been writing opening dates of liquid and topical medications in use. Spot checks of medications received as a result of people being discharged from hospital confirmed Mill House do not have a satisfactory method to confirm the safe receipt of medications. Some Controlled Drugs issued by a hospital Care Homes for Older People Page 18 of 45 Evidence: for one person had the individuals name spelt incorrectly. This had not been acted upon by the home staff. Analysis of medication administration records of one person discharged from hospital did not accurately tally with the stock level of medication kept for this person. As a result of these findings the acting manager carried out an immediate investigation into the matter. It is positive arrangements had been made for the local pharmacist to visit the service shortly after our inspection to offer advice and support. During the inspection we provided the management with some of our good practice guidance about medication management. We will also be liaising with our own specialist pharmacy inspectors about what further support the home would benefit from in order to improve its practices. Care Homes for Older People Page 19 of 45 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people are provided with good opportunities to have their social needs met and they receive meals which are based on their likes and dislikes. Other people are not provided with enough opportunities to enhance their wellbeing and there is a lack of evidence to show that their likes, dislikes and preferences are taken into consideration when meeting their daily needs. Evidence: All of the relatives who responded to our survey told us the home usually helped their relatives and friends to keep in touch with them,which means people can maintain relationships which are important to them. Since our last inspection the service invited relatives to a meeting to share their plans to improve the daily lifestyle of their family members living at Mill House. The meeting was well attended, and the home management team were appreciative of the positive suggestions made by family members. Everyone we spoke to was of the opinion that this aspect of the service provided by Mill House has started to improve. The home now produces a weekly activity programme, and we saw copies of the programme in different areas of the home. Discussion with a senior staff member confirmed that an activities coordinator works Care Homes for Older People Page 20 of 45 Evidence: at the home twice a week to encourage people to join in communal activities such as music, singing and craft work. On all three Inspection days communal activities were seen being held in both lounges in the afternoon. People were heard to be invited to join in group pastimes such as armchair exercises. It was confirmed that the staff team are also expected to make sure people are involved in at least one activity per shift. Although staff record these events in a folder, there is very little information held on individuals records to confirm they are based on peoples interests as yet, although there are plans in the pipeline for visitors to be involved in creating life books for the people they visit at the home saw these can be used as a reference for staff to engage people in relevant pastimes suited to their hobbies and interests. Although we never had the opportunity to meet any visitors at the home, four did respond to our survey and they told us they are welcomed by staff and are able to visit when they want to, which means people can maintain relationships which are important to them. People who were able to give us their views, confirmed their satisfaction with the meals at the home, telling us they are provided with choices for each meal and that there are alternatives if they dont like what is on the menu. As a prompt for people with memory problems, the home menu seen on display in the reception area also had pictures of the meals of the day. Discussion with the senior cook confirmed a four-week menu has been devised to account for peoples dietary needs, preferences, likes and dislikes. This information is contained in the nutritional management folder the home have introduced since our last key inspection. Review of this folder confirms that further guidance and information about the importance of adequate fluid intake is required to prompt staff to support individuals with this particular need. We also saw that a satisfaction survey about the meals in February confirmed people were happy with their meals. 95 of residents indicated no changes were necessary to the home menu and 95 offered no complaints about the meals. Our own survey reflected similar findings. At our last inspection we raised concerns about the way the service meets the dietary needs of people living at the home. The management team sent us an improvement plan and told us that food and drink intake will be monitored daily. Although Mill House records could account for food intake, there was little evidence to show how they monitored the drink intake of people to make sure they were effectively hydrated. It is positive the service has been in touch with a community dietician who has provided good information to raise staff awareness about this responsibility. This is in the process of being cascaded to staff, and we were not able to establish which Care Homes for Older People Page 21 of 45 Evidence: team members had accessed this information. On the first day of our inspection we saw that some staff were providing and assisting people with drinks in their bedroom standing over them rather than sitting with them to engage individuals to drink in a relaxing manner. One to one discussions with staff confirmed that this was due to lack of chair provision in bedrooms. As a delivery of bedroom armchairs was received during the time of the inspection it is anticipated this will alleviate this issue. This matter was discussed with management. During the first two days of our inspection we observed the lunchtime meal and saw that meals were served by the cook and people were offered choice of meals as well as portion size as part of this process. However, foods prepared for people with swallowing or chewing difficulties, had been pureed together, which is not considered to be good practice as it does not promote the sensory experience of tasting different foods and textures. This matter was discussed with the cook and by the third day of our inspection we saw that improvements had been made and that food had been pureed separately. This standard needs to be maintained to ensure everyone has the same choices and opportunities to enjoy their food at mealtimes. The local Environmental Health department visited the home in February 2010 and regarded there was a good level of compliance with food hygiene and a four-star award was made. The cook and acting manager informed that action was taken after the visit to rectify the minor deficits identified. Care Homes for Older People Page 22 of 45 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure so that people and their representatives know how to raise concerns and complaints. People are not protected from the risk of harm and abuse because processes such as recruitment, care planning, assessment of risk and administration of medication are not robust. Evidence: Due to the nature of their underlying medical conditions, people we met at the home were not able to tell us whether they had made a complaint or knew what to do if there were unhappy with the service. It was therefore positive to receive feedback from relatives carers and advocates to confirm they all knew how to complain and that Mill House have responded appropriately when they have raised concerns. The complaints procedure is clearly displayed on a notice board in the reception and as recorded earlier is also available within the service user guide. Copies of this information were also seen in the care plan records we examined. Although the home procedure provides people with clear information on the process to follow and who to contact if people want to complain, it does not tell people of the timescales they should expect their concern to be investigated by. We looked at the method used by the home to record and respond to complaints, and this shows recordkeeping process is in need of development, as there is no central record of the Care Homes for Older People Page 23 of 45 Evidence: total number of concerns and complaints this service may have received during the past 12 months. As a result the complaints management system could not be fully audited as it would have entailed scrutiny of all of the records kept for all of the people who have lived and worked in the home during this time. However we were able to see recordkeeping to account for one complaint that the service has received since our last inspection in January 2010. The action taken had been recorded. The information also told us that the acting manager responded to the complaint sensitively and promptly. Staff we spoke with could confirm their role in safeguarding adults who live at Mill House from the risk of harm or abuse and examination of records told us they had all received training in abuse awareness since our last inspection.Staff told us they would not hesitate to report poor practice.Staff records also confirmed that some of them have received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, and further training was to take place later this month, which is positive as the acting manager has not attended this training yet. The Act oversees decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. We saw that the home has obtained documentation to assist staff to determine whether a person has the capacity to make decisions.However, we never saw evidence of this information in any of the care files we examined.This issue is of major importance for a care home registered with us to care for people with mental health challenges. The wellbeing of residents cannot be fully safeguarded until all staff are fully trained and operating within policies that ensure the home is complying with our regulations. Although aspects of staff training have improved in the past 6 months further work is needed so the additional training has been put into practice to make sure that people receive a consistent, satisfactory service and the home meets National Minimum Care Standards for Older People. Since our last inspection the service have been involved in three safe guarding adult investgations with the local authority. These are currently in the progress. We will be monitoring the outcomes of these sensitive issues and findings will be included in the next key inspection report. Care Homes for Older People Page 24 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of maintenance means Mill House does not offer all the facilities we expect to make sure people live in safe and comfortable surroundings to enable all their needs to be met. People are being placed at risk of infection because infection control practices throughout the home are inconsistent with good practice guidance. Evidence: The two storey property provides 24 single bedrooms located on both floors. En suite facilities are provided in all but one bedroom. It is positive some pictorial signs are located around the home to offer people with memory problems prompts to find their bedrooms, communal toilets and bathrooms. Bathrooms and toilets are situated near to bedrooms and communal areas. Equipment and adaptations are in place to assist people with reduced mobility. These include a passenger lift, grab rails and assisted baths. Analysis of the accident book confirmed one person had fallen in their shower recently.This led us to review the facilities people have available to enable them to shower and bathe safely, and our findings indicated that this need was being compromised due to lack of suitable equipment being in good working order. At the start of our inspection both communal bathrooms were unsafe to use, and the only way people could have a shower was if they were well enough to stand or of they could manage to sit on small fold down seats attached Care Homes for Older People Page 25 of 45 Evidence: to the wall of their en suite shower. Prompt remedial action taken by the home management team made sure bathing facilities were safe and fully operational by the end of our inspection, and two shower chairs had been ordered to replace the broken one we saw. Random checks of hot water temperatures in areas accessible to people living at the home confirmed they were in need of readjusting, and the process the home had to check on the hot water supply was in need of further development to demonstrate the service was doing all it could to keep people safe from scald and Legionella Risk. Remedial action was taken at the time of the inspection for this matter after we issued an Immediate Requirement notice to address this situation. We also observed several minor repairs to fixtures and fittings such as toilet roll holders in need of attention as we walked round the home and these had not been accounted for in the home maintenance book. We looked at a number of bedrooms and saw that lighting had been improved to enable people with the opportunity to read in their room if they so wished. Although the communal areas of the home were clean, some of the bedrooms we visited had an unpleasant smell of stale urine. Some stained bedroom carpets were also seen to be in need of thorough cleaning. These conditions do not offer people pleasant, private personal spaces to relax and rest. One bedroom was also being used as a storage area for a hoist used by staff to move and handle people. As reported earlier, this does not promote privacy arrangements for this individual. Another bedroom was seen to contain a portable electric heater. Discussion of this matter confirmed that a risk assessment had not been devised to ensure this equipment is used safely. We saw people who were in receipt of wound care for leg ulcers and individuals with swollen feet who would have benefited from the use of foot stools to promote their comfort. Discussion with the staff team confirmed that they were not available. Lounges provided on the ground and first floor were seen to be equipped with basic furnishings, although some of these items especially the side tables were showing signs of wear and tear. We were informed that new several armchairs had been delivered to replace those taken out of use following a visit from the community infection control nurse. New reminiscence boards, with Down Memory Lane themes and sepia photographs seen on display in these areas made the place more homely. During our tour of the home we observed that some practices did not promote good fire safety. A fire exit route from the first floor and ground floor was congested with Care Homes for Older People Page 26 of 45 Evidence: numerous combustible items, including mattresses, large rolls of paper towels, and garden furniture. In addition, fire extinguishers were locked in cupboards and not accessible in an emergency situation. This puts people living visiting and working at the home at risk in the event of a fire. These issues triggered us to check the maintenance of the fire safety system, and we found that recommended remedial works had not been carried out as expected when the equipment was serviced recently. When we were not able to review an up to date fire risk assessment for Mill House we could not confirm what routine fire safety checks were being carried out by the management team. As a result we contacted the Wolverhampton Fire Safety Department in order to inform them of our findings and request appropriate support for the management team to prioritise remedial actions. We also issued Immediate Requirement notices in order for the home to take urgent action to put these issues right. Upon visiting the laundry on the ground floor we saw that the washing machine was out of order and had created a backlog of laundry to be carried out. On the first inspection day this had been dealt with effectively, however upon visiting this area on the third inspection day we saw soiled clothing piled up adjacent to where a workman was repairing the machine. This does not reflect good infection control practice. These findings also indicate systems to manage this short term issue had not been effective. When we looked at the clinical waste storage area, although it was seen to be secure, used gloves discarded in this area indicated staff were not following appropriate procedures for this matter. Upon review of the report following the visit by the community infection control nurse in March 2010, similar failures we identified during the inspection visits were reflected, and a total of 18 key action points were identified to improve infection control standards in the home. Although discussions with management indicate some improvements have been made, the service needs to prioritise these actions especially with regards to day-to-day working practices of staff in order to make sure they consistently follow infection control procedures. Externally, access to grounds at the front of the home is restricted by keypad locks as Mill House faces onto to a busy road. Alternatively people have access to a garden at the rear of the property. It has a large gazebo providing a pleasant shady area, although there are no handrails to promote peoples mobility to enjoy a walk outdoors. The above findings indicate that the service needs to develop an auditing system to make sure they can demonstrate they keep living conditions for people at Mill House as safe as possible, and that they have all the adaptations and equipment necessary Care Homes for Older People Page 27 of 45 Evidence: to meet peoples needs. These issues were discussed with management at the time of the inspection. Care Homes for Older People Page 28 of 45 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not safeguarded from the risk of harm and abuse because the homes recruitment process is not robust. Staff are not transferring their skills they have acquired in recent training into their day-to-day practices to ensure all care and support needs of people living at a Mill House are met. Evidence: The staff we spoke with said they enjoy working with the people who live at Mill House and view that people receive good care. One member of staff we spoke with viewed that improvements could be made with the provision of better person focused activities and more staff could help to achieve that, another described staffing levels as just about right. Relatives who responded expressed their appreciation of the staff who worked in the home.This was positive information as we had received comments since our last inspection that the home was short of staff. We looked at the personnel files of two new staff members to look at how the home recruits its team. We found the home has not ensured these staff had all the necessary pre-employment checks undertaken to ensure they are suitable to work with vulnerable people. One member of staff recently started working at the home Care Homes for Older People Page 29 of 45 Evidence: after only one reference had been obtained. The reference did not provide any contact details of the referee except for a mobile telephone number. Likewise, the references provided for the second person were not robust, they were photocopies which had not been validated as authentic, and they could only confirm knowing the person for a total of nine months. Photocopies of proof of identity information also lacked back up details to confirm they had been validated as authentic. It is also a concern that both sets of records did not contain necessary up-to-date contact details for both individuals. They had relocated to this area after being offered their jobs,and records did not account for their new addresses indicating the home would have difficulty locating them if they failed to attend to work at the home without giving notice. This practice does not safeguard the well-being of people living at Mill House. Although staff who responded to our survey viewed the induction they had when they first started working at the home as good, the records we examined for two new starters did not confirm this. Information lacked details to demonstrate the new employees had been introduced to working at Mill House appropriately and could not tell us what support and supervision they had received during this time. It is positive that the service have provided the mandatory training the team needed to keep up to date with current practice since our last inspection, including manual handling training. Examination of staff records confirmed information they shared with us about attending medication administration, safeguarding adults and dementia training. The business development plan provided by the management also described action being taken to ensure ongoing training for the team members with targets set for 75 of the team to attain necessary care qualifications by next year. It is disappointing that our inspection observations have confirmed that staff are not putting the outcomes of their training into practice. Although the whole care team have received refresher fire training since the last inspection, no- one had raised their concerns about the fire safety breaches we identified. Likewise although staff have recently had health and safety training, chemical bottles seen in use at home for housekeeping duties did not comply with its associated legislation. We raised concerns about this issue at our last inspection. Similar issues recorded earlier in this report about medication management also demonstrates permanent changes to improve standards had not been achieved even though medication training had been undertaken by senior staff members delegated this responsibility. These are issues the managementt team will need to focus on to ensure that processes which impact on outcomes for people are looked at in depth. Care Homes for Older People Page 30 of 45 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that the home will be run in a way that ensures their needs will be met properly. Evidence: A senior member of staff, who has worked at the home for some time, has recently taken on the role of acting manager on an interim basis, since the recent departure of the registered manager. The acting manager was present throughout all three days of our inspection and they offered their assistance and co-operation for the inspection. We saw they have a good rapport with people who live at the home, visitors and staff and we received many comments giving very positive feedback about this person. One visiting professional to the home was very specific in their view that the management of the home had improved with the new acting manager. We saw written records which show that Mr and Mrs Ramdoo have been regularly visiting and working at the home since our last inspection. They have been conducting weekly and monthly checks of the home management systems and have been having Care Homes for Older People Page 31 of 45 Evidence: weekly meetings with the acting manager. Reports of these meetings have been sent to us so we could monitor the progress Mill House has been making to improve standards. Our inspection findings confirm these systems would benefit from being improved as it does not suggest that processes which impact on outcomes for people are looked at in depth. Robust monitoring should be able to identify when improvements need to be made and our observations made at this inspection and evidenced throughout this report indicate the home has not been managed or monitored effectively for some time. For example there was no evidence that care plans are audited for their integrity or that care records are checked to ensure that people are receiving the care they need. It is positive that the management team have conducted several meetings with people, their visitors and the staff team to give them the opportunity to put forward ideas to improve the service. Although these meetings document the need for changes to improve the lifestyles for people living at the home, our findings confirm they have not been carried out. For example staff meeting records for January raised staff awareness about the importance of people wearing footwear,but this practice has not been maintained. When we looked at how the home manages the finances of some of the people they care for, we saw documentation for seven people which included records and receipts of their spending. Spot check of the records for one person established that the system would benefit being improved by making sure two people sign paperwork to confirm the amount of money received and handled on a persons behalf. We also confirmed that there has been no audit of these systems since the last manager left. We saw from looking at staff files that the home has a staff supervision process in place, although the staff files we saw showed this has not happened as often as it should do, this is now improving. All were seen to have received supervision sessions since our last inspection, although records for a management team member lacked details to confirm support and development arrangements since the departure of the Registered Manager for the home. These matters were discussed with the management team during the inspection. We looked at a selection of documentation to confirm checks of services and equipment, to ensure Mill House is well maintained. Several of these records we looked at established that this aspect of the home management had not been effectively acted upon. As recorded earlier, the home fire safety management processes have not been carried out as well as they should have been. An in-depth look at the hot water management system told us that the necessary systems to make Care Homes for Older People Page 32 of 45 Evidence: sure the water supply in the home is kept safe from Legionella risk was in need of review, alongside the need for written records to show it is regularly tested to ensure it is not too hot. Essential servicing to hoisting equipment was also three months overdue. It was therefore positive to meet the engineer at the home to carry out this duty by the end of the inspection. As a result of our inspection in January 2010, we requested an improvement plan from the Mill House management team to give us details of their plans to make permanent improvements of this service. As part of this inspection process we analysed the activity this service pledged to carry out to change the home for the better. Our findings confirmed that several actions had not been carried out to the necessary extent and detail to make sure the well-being of individuals was being promoted at all times, and that people had a safe place to live, visit and work.Our findings from this inspection show that prompt action on the part of the company is needed to ensure management systems and processes are effective so that outcomes for people are improved and the risk of harm reduced. As a result of our findings we will be considering further action we deem to be necessary in order to make sure permanent improvements are made and maintained at Mill House. Photocopies of documentation were obtained throughout this inspection to use as part of our decision making process for this matter. The company must also ensure that a suitable, competent person is appointed to provide leadership and direction at Mill House to improve the outcomes for the people who live thereand an application must be made to register that individual with CQC. This is to comply with our regulations and to ensure people will have the confidence in the home because it is led and managed effectively. Care Homes for Older People Page 33 of 45 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Measures must be taken to ensure care plans provide sufficient information. This should ensure staff know who to meet peoples needs properly. 22/03/2010 2 8 12 Action must be taken to ensure risk assessments provide sufficient information. This should ensure all staff know how to assist people safely. 22/03/2010 3 8 12 Appropriate action must be 01/03/2010 taken to address peoples dietary needs, where records show they are underweight or have special nutritional needs to keep them healthy and well. This should promote peoples health. 4 9 13 Measures must be taken to ensure the Medication Administration Records are signed when medicines are given out. This should ensure people receive their medicines regularly and provide an audit trail. 01/03/2010 Care Homes for Older People Page 34 of 45 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 5 15 12 Action must be taken to ensure people are provided with the relevant support to eat and drink. This should promote their health. 01/03/2010 6 26 16 Action must be taken to 01/03/2010 review the cleaning regime in the home. This should promote peoples health and comfort. 7 38 13 Action must be taken to 01/03/2010 ensure all Control of Substance Hazardous to Health (COSHH) are securely stored. This should ensure people are not placed at risk of harm. Care Homes for Older People Page 35 of 45 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 23 Fire safety arrangements at Mill House must make sure all fire exit routes and surrounding areas are kept clear of obstruction at all times. The home must raise staff awareness of this matter to ensure fire safety routes and exit areas are sterile of obstruction. This will offer assurance to people living visiting and working at the home that the management are promoting the safety of individuals at all times in order to deal with any emergency evacuation situation. 04/06/2010 2 19 23 Within 5 days remedial 11/06/2010 action must be taken to confirm all hot water supplied to areas where people use the service is safe and maintained around 43 Degrees Centigrade. This action will ensure people using the service have access to a safe hot water supply. 3 19 23 Storage areas for fire 04/06/2010 extinguishers must be unlocked with appropriate signage to inform people not to lock them again. This will ensure people have Care Homes for Older People Page 36 of 45 Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action access to emergency fire fighting equipment in the event of an emergency and promote the well being of individuals at Mill House. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 When anyone thinking of moving into Mill House is being considered, a full physical and psychological assessment of needs must be carried out as part of the preadmission process, involving all significant parties and representatives of the individual to ensure the best interests of the person are fully accounted for. 11/08/2010 These actions will demonstrate the home will make sure they only admit people once all parties involved are satisfied the home can meet the mental health needs and physical needs of the person concerned. Care Homes for Older People Page 37 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 9 13 The home management systems for the receipt of medication needs to demonstrate there is a clear audit trail of any medication received into the home. This should accurately account for any medications administered to a person and offer the individual assurance they will safely receive any medication prescribed for them by their doctor at the appropriate times. 11/08/2010 3 9 13 The records of the administration of all medicines for the people who use the service including dressings must be robust and accurate. This is to demonstrate that all medication is administered as prescribed. Controlled Drug storage must not be used for anything other than prescribed controlled drugs. This will make sure people are confident the medication prescribed for them will be kept secure until it is required. 11/08/2010 4 9 13 11/08/2010 Care Homes for Older People Page 38 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 10 12 Mill House management must review care practices of individuals to make sure they address their needs which maximises the unique individuality of people to ensure their needs and preferences are not challenged by compromises to their dignity privacy and wellbeing This will offer assurance to people that live at Mill House that they are supported to meet their needs in a way that promotes their esteem pride and self respect. 11/08/2010 6 18 12 The needs assessment process for people living at Mill House who have mental health challenges must be developed to account for peoples decision making abilities to ensure there is confirmation of their capacity to be involved in options about their daily lifestyle and well-being. This will confirm the service have taken the decision making needs of people into account in lines with Mental Capacity Act legislation as part of the service effort to promote the safety and well- 24/09/2010 Care Homes for Older People Page 39 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action being of individuals living in the home. 7 19 16 The home must devise an auditing and monitoring system to ensure the environment is maintained to a satisfactory standard. This will offer assurance that the management systems make sure people have a safe place to live with all equipment necessary to promote their well being in good working order. 8 26 13 The home must develop and 17/09/2010 put in place effective infection prevention and control processes based on evidence based research and relevant guidance. This is to ensure people are provided with an environment and equipment which is clean and free from odour. 9 29 19 Staff recruited by the home 27/08/2010 must have all required pre employment checks undertaken including appropriate reference clearance and authentication of documents used as proof of identity before they commence employment. 16/09/2010 Care Homes for Older People Page 40 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 10 30 18 Management systems must 27/08/2010 be developed to ensure staff apply their learning outcomes from recent training into their day-today practice of working at Mill House to improve standards of care and support. This will offer assurance to the people that they are being cared and supported by people who are competent in their roles in line with up to date practice. 11 38 13 The service must provide 27/08/2010 evidence that a full up to date Legionella risk assessment has been carried out, and any remedial actions have been carried out promptly to resolve any issues identified. This will offer assurance to people living visiting and working at the home that the management team is taking all necessary Care Homes for Older People Page 41 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action precautions to provide safe premises. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is recommended that the information the service provides for people thinking of moving into Mill House is fully updated to account for the current management status of the home.Complaints information would benefit details of timescales people should have responses to any comments they make, alongside relevant up to date regulatory information about the Care Quality Commission. This will make sure people are in receipt of all the relevant information they require about the services provided in this home It is recommended that the information the service provides for people thinking of moving into Mill House is available in other formats, so everyone has the opportunity to be enabled to understand what services Mill House provides. The home must provide suitable storage facilities for controlled drugs kept in their safekeeping. This will make sure people are confident the medication prescribed for them will be kept secure until it is required. Appropriate action must be taken to ensure all people are given the necessary support to pursue their specific individualised social interests.This should enable them to live a fulfilling and stimulating lifestyle. The service must provide evidence that staff fully understand the need to demonstrate good fluid intake as part of the nutritional management for people who live in the home, especially those with medical conditions which require adequate fluid intake. Details of any daily fluid targets and actual intake and output must be recorded in line with good practice guidelines for their medical conditions. 2 1 3 9 4 12 5 15 Care Homes for Older People Page 42 of 45 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 15 It is advised that the service develop a system to ensure they can demonstrate staff awareness about the importance of nutrition has been cascaded and understood saw that it can be put into day-to-day practice as part of meeting the nutritional needs of people who live at Mill House. It is advised that the service develop a system to ensure people who require soft and pureed food are offered the same choices and variety of foods which are presented in a way to promote sensory stimulation so they have the benefit of enjoying different flavours and tastes of the meal they are offered. It is advised the service develop a system to make sure they can provide us upon our request a summary of complaints made about the service during the preceding 12 months which describes what action was taken in response. It is recommended this service develop their complaints procedure further to make sure people are fully aware of the timescales that Mill House will respond to any concerns they receive. Induction records for new starters would benefit evidence to demonstrate they have been introduced to working at home in line with expected Common Induction Standards. It is advised that the home management team develop a robust system to confirm two signatures are obtained when money is all received and used on behalf of the person using the service. Anyone in receipt of this support from the home must have this information clearly identified on their care plan. The service is advised to actively recruit an individual with appropriate management skills and experience to facilitate the day-to-day running of the service in line with essential standards necessary to be registered as a care home for individuals with mental health needs. Management sysytems at Mill House require expansion to demonstrate all staff are fully trained and operating within Page 43 of 45 7 15 8 16 9 16 10 30 11 35 12 38 13 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations policies that ensure the home is complying with our regulations. Further work is needed so the additional training has been put into practice and people receive a consistent service which meeets their needs. 14 38 It is advised that the home management team make sure the COSHH folder contains all the relevant data sheets for all chemicals used in the home, with evidence that staff have read and understand and aware of them so they know how to safely use and store them. Care Homes for Older People Page 44 of 45 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 45 of 45 - 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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