Inspection on 07/06/06 for Mill House

This inspection was carried out on 7th June 2006.

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

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

Other inspections for this house

Mill House 07/06/07

Mill House 08/11/05

Mill House 25/05/05

Mill House 04/10/04

Mill House 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Mill House 15 Mill Road Gt. Ryburgh Fakenham Norfolk NR21 0ED Lead Inspector Jenny Rose Unannounced Inspection 7th June 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House Address 15 Mill Road Gt. Ryburgh Fakenham Norfolk NR21 0ED 01328 829323 01328 829554 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Prime Life Limited Mrs Thandiwe Ziro Care Home 44 Category(ies) of Dementia - over 65 years of age (44), Old age, registration, with number not falling within any other category (44) of places Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No Service Users who need to use a wheelchair are to be accommodated in rooms 22, 23, 24 and 25. 8th November 2005 Date of last inspection Brief Description of the Service: Mill House accommodates 44 service users in a large extended country house. The main house is on two floors, with a single storey extension. Nine terraced bungalows also provide semi independent accommodation comprising, bedroom, sitting room and kitchen and a bathroom. The Home provides personal care to older people who are mentally frail except for those service users admitted to the bungalows. A new manager was recruited in April 2005.The Home is situated in a rural position at the end of a country lane in the village of Gt Ryburgh and overlooking the river. Most of the rooms are single and several have lovely views. The Home has a large garden and patio which has recently been redesigned and made safe. There is a bus service to Fakenham from the village. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection lasting eight and half-hours. Discussions were held with the manager about the progress of the Home and how the requirements and recommendations of the last inspections had been met. Policies and records were examined. Ms Hilary Shephard, Regulatory Inspector CSCI, with a special interest in Dementia Care, attended for part of the day and her recommendations are included in this Report. Preparation had taken place in the CSCI office beforehand and a pre-inspection form, together with survey forms to be distributed by the Home to the service users and their relatives. However the pre-inspection questionnaire had not been returned from the head office of the organisation, although twenty-one service users and four relatives’ surveys had been returned and their views have been taken into account in this report. The GP and Community Nurses attending the Home were also surveyed for their views. On the day, a tour of some of the premises was undertaken, there were thirty three residents in the home, five of these are living in the nine bungalows, although one resident was in hospital. A group of residents were out on a bus trip. Five members of staff were spoken to in private; six residents were spoken to in private and several others chatted with, together with two relatives visiting the Home. What the service does well: * Good progress has been made by the manager in her first year in making positive changes to the service offered. She is giving clear leadership to the staff team, which is recognised not only by the staff, but also other healthcare professionals, relatives and visitors. She recognises there are still improvements to be made, but is accepting this challenge. * Staff feel well supported by the manager and the framework of staff meetings and on the handover of shifts helps them in their work. The residents feel they are treated well by the staff. * There is good record keeping ensuring staff and residents are protected, as far as possible. Medication is dealt with appropriately and safely, as well as other issues regarding the health and safety of residents and staff. * The food is good, varied and appetising and enjoyed by the residents. There is also 24 hour access to drinks and snacks, but there are some issues regarding meal times and suggestions for the nutritional needs for those residents with dementia Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 6 * The views over the river with its wildlife and the secure outside communal courtyard areas make for a very pleasant setting for the Home. The new ‘bungalows’ are built to a high standard for the semi-independent living for those residents. What has improved since the last inspection? What they could do better: * Care plans for those residents with dementia need to be expanded. Attention has been given to the details of the personal care, particularly of male residents, but this needs constant review and updating, with residents and their relatives where possible, as well as attention to life histories, concentration on residents’ strengths and abilities in meaningful activities, particularly associated with daily living and developing communication with frail residents. * Staffing levels should be calculated on the dependency needs of the residents. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 7 * Detailed, practical dementia care training needs to be further developed. together with the keyworking system. * Some areas of the older part of the home could be improved, particularly for more frail residents in terms of lighting and colours for those with poor sight, as well as the comfort of some communal areas and some bedrooms, particularly for those with dementia. 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 DS0000015661.V299488.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Mill House DS0000015661.V299488.R01.S.doc Version 5.2 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 the following standard(s): 3,6 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a needs assessment carried out for all prospective residents to ensure as far as possible that their needs can be met in the Home. However, a more detailed assessment of their dementia care needs, would more fully ensure that they can be properly looked after. The Home does not provide intermediate care. EVIDENCE: Four care plans were examined and found to contain a detailed assessment document outlining the needs and abilities of the residents. Aspects of health and social care were covered and, where possible, with the help of relatives or information from social services and other healthcare agencies. This is reviewed after a month and also includes how the resident fits in with the existing resident group. One visitor spoken to said that her relative had been admitted to the home as an emergency placement with the help of social services, although members of Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 10 the family had visited the home prior to the admission and they were able to arrange the room with some personal furniture and belongings and felt able to visit their relative at any time. Her admission had necessitated a change of GP and Community Psychiatric Nurse. She was, however, receiving many visitors. The manager also explained that a meeting was soon to be held with the family and other healthcare agencies involved to review her situation. For those with dementia, details of life history and significant events and more detailed assessment of care needs with regard to pressure areas, nutrition, falls, means of communication and meaningful activities, would more fully ensure that they can be properly looked after. This is referred to elsewhere in the Report. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 7,8,9,10 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans for the more able residents give staff the information they need to care for them, but for those residents with dementia, these need to be expanded with more detail to reach good practice in person centred care. There are systems in place for ensuring that the residents’ healthcare needs are monitored and met, but liaison with the community healthcare professionals should be continually reviewed. Policies and procedures are in place to ensure that medication is appropriately administered. Residents and their relatives feel that they are treated well by staff, but there are still improvements to be made in how personal care is delivered, particularly to male residents and to all residents with dementia. EVIDENCE: Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 12 The examination of care plans, on this occasion, focused especially on those residents with some form of dementia, which at the last inspection was all the, then 35, residents. Four care plans were examined in detail, the residents spoken to, as well as their relatives, where possible. For the less dependent residents there was good guidance on such issues, for example, as mobility and breathlessness and risk assessments for falls, which minimise such risks, and the manager said that these are reviewed regularly, with the resident and/or their relatives, if appropriate. The format for the plans has been praised by the Commission in the past, however, there need to be improvements in the care plans for dementia care needs. Some plans do not include details of residents’ social and emotional needs, nor staff guidelines of how to communicate with the resident, nor how the resident communicates, e.g. non-verbal cues. The manager reported that following a recommendation in a letter from the Commission of 16 December 2005, the refusal of personal care is documented and there was evidence from one plan that there was guidance in how to approach one particular resident. There are some details of life history in one plan, but specific, very significant issues of one resident’s childhood do not appear to be followed through in the plan. The daily record for another resident, stating that a resident likes “milk and cake” does not appear to be followed through in the care plan. In this same plan, where there are issues of weight loss. There is nothing about offering food little and often, or supplementing diet on days when the resident does not eat much. There is little information for staff guidance for meaningful activity, or deflecting aggressive behaviour, or, particularly, that one resident has poor sight. There is therefore a requirement that care plans for those residents with dementia should be expanded in line with good practice in such areas as social and emotional needs, nutrition, person centred care, communication, the significance of some personal possessions, particularly photographs, to name a few, and risk assessments. Meaningful activities are dealt with elsewhere in this report. There had been three comment cards returned from healthcare professionals, all with positive comments, including the GP and Community Nurses. There were positive views as to the changes the manager had managed to institute and the minutes of a meeting with the Community Nurses, which had taken place on 26 January 2006, were seen. The Manager had asked for the Community Nurses assistance with in-house training in epilepsy. She, however, was aware that there was still a need to continue to foster close liaison. There was evidence from files that residents’ healthcare needs are met. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 13 The medication round was observed and this was seen to be appropriately administered. The records contained the resident’s photograph and were completed correctly. The member of staff had received appropriate training and had recently received an updating. There is a medical room where the medication trolleys and the controlled drugs cabinet are kept. There was no one in the home at the time who was on controlled drugs or who was self medicating. Twenty two resident survey forms had been completed and twenty one surveys reported that the residents liked living in the home and felt well cared for. Two residents spoken to also spoke positively about the care they received from the staff. One relatives’ survey commented positively on the care of his relative in a terminal illness. Observation of some members of staff showed a caring, patient manner with some residents, but in general there was not much personal interaction seen during the morning, except when staff were attending to care tasks, drinks and food. Two relatives’ surveys indicated that there had been problems with the manner in which the laundry was organised, and insufficient care being taken with more delicate washing. Nevertheless, there was no criticism of the staff in general and in speaking with the relatives concerned, it appeared that they had found the manager very approachable and she had now appointed to dedicated laundry staff, which had solved these problems. The previous difficulties regarding the unkempt appearance of some residents, particularly male residents, was being addressed, although on the day there was one female resident whose appearance needed attention. The manager said that a male care assistant was about to be appointed and it would be his particular role to see to the shaving of the male residents. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12,13,14,15 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the residents were happy with the way the home is run and they felt their preferences were taken into account, however, although more meaningful activities for those with dementia would enhance the quality of life for residents. Residents are able to maintain contact with family, friends and the local community if they wished. Residents are supported to stay in control of their own affairs, but often need the assistance of their relatives or the Home. The food is varied and good and there were few complaints. However, there are some suggestions regarding the nutritional needs of those with dementia, which would improve the quality of dementia care. EVIDENCE: Nineteen resident surveys said they were happy living in the home; three were ambivalent, although the residents spoken to had no complaints. Nine resident surveys expressed the opinion that the Home did not provide suitable activities. This was also the opinion in one relative’s survey. The Manager reported that the Home has recently appointed a designated member of staff Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 15 responsible for activities and from previous inspections, there is evidence to suggest that activities have greatly improved. There were comments in the compliments book about the Christmas arrangements involving residents’ relatives, at which the residents and visitors had enjoyed music and dancing. A summer barbecue was in the planning. In addition, the organisation have produced an activities booklet which some ideas for activities, which was seen in the home. Relatives, staff and residents all reported on the pleasure the wildlife on the river gives them all and feeding the ducks in the wellmaintained garden is a popular activity. However, for those with dementia there was little evidence from the care plans that life histories and previous occupations have been followed through in providing meaningful activities, such as housekeeping tasks, cookery, laundry or gardening for individual residents. There is therefore a repeated recommendation that this work should continue to be developed. Two visitors to the home were spoken to and the relatives’ surveys confirmed that they were welcome to visit the home at any time. One resident spoken to also confirmed that her daughter who makes several visits a week had just visited her to do her hair and the compliments book contained positive remarks from relatives. One visitor says she spends a great deal of time with her relative in the home and residents can choose to entertain visitors in their own rooms, the communal or garden areas. Residents are encouraged to stay in charge of their affairs. One resident spoken to reported that the staff at the Home enable her to maintain contact with her solicitor. In the main the majority of residents need the help of relatives or solicitors to manage their affairs and the home’s policies and procedures ensure that residents are protected from financial abuse. The menus were available and these confirmed that the food was varied and residents were offered a choice. Twenty residents’ surveys said they liked the food, two said they did ‘sometimes’. Lunch, which appeared fresh, hot and appetising, was seen to be eaten in various areas of the Home, including being served in residents’ rooms, if they so wished, as well as the main Dining Room where the tables were pleasantly laid with napkins and choice of juice. The cook said she knew the residents’ preferences and tried to vary the menu accordingly, as well as to the seasons. She also produced all the food for special occasions, such as Christmas and a proposed barbecue this summer. On the day of the inspection, a number of residents had gone on an outing in the bus owned by the home and had taken a picnic. On their return, one resident was seen to be able to ask for a drink and something to eat ‘outside’ the regular mealtimes. There is a glass fronted fridge available in the dining room, which is good practice, with soft drinks and snacks and staff reported that they sometimes put sandwiches in there so that there is something available 24 hours. There is a recommendation that more finger foods, Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 16 according to individual preferences to be available in the fridge, especially for those residents who do not eat at the regular meal times and that a notice is placed on the fridge inviting residents to help themselves. This is also referred to elsewhere in this report. The temperature on the day of the inspection was very warm and ice lollies were given to residents who wanted them during the afternoon, which is good practice. There had been an issue from the previous inspection regarding the early timing of the lunch for those residents who needed help with feeding. The manager explained that she had managed to delay the timing until 11.45, as she felt that it was unfair that the residents who needed help should have to wait until the majority of residents had finished their lunch, including the service of lunch to those in the bungalows, which could be much later. This is still very early and the recommendation from the previous inspection is therefore repeated. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 16, 18 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and a less formal complaints book is now in place and action taken to address them is also recorded, giving residents, relatives and friends confidence that concerns will be listened to and acted upon. There are policies and procedures in place and staff are aware of the issues surrounding the protection of vulnerable adults. EVIDENCE: The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users’ guide contains the complaints procedure and is also posted in the Home. There is a file of formal complaints with details of the actions taken. The recommendation from a previous inspection had been implemented and a residents’ complaints book was seen with details of actions taken to remedy the concerns. The last being on 2 April 2006. Two residents spoken to were aware of the complaints procedure and said they would know to whom to complain should they need to. There is a Whistle Blowing Policy and two members of staff spoken to were aware of the issues surrounding the protection of vulnerable adults and had undergone training. The manager had attended a seminar on the subject run Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 18 by Norfolk Police and there was a Protection of Vulnerable Adults procedure in the home with specifically local information and the staff have now completed training in the protection of vulnerable adults and one member of staff spoken to gave a good account of her knowledge of this issue. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 19, 20,24,25,26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is situated in a beautiful location, but there continue to be discrepancies in the décor and furnishings of the older building, which need to be addressed, especially in regard to the dementia care needs of many of the residents. Safe access is available to outdoor communal facilities, but improvements are still needed in the comfort of the indoor communal areas. Much individual accommodation is of a high standard and personalised, but some bedrooms are very bare and some still lack locks and lockable facilities within the rooms. The lighting in some corridors was not satisfactory for those with poor sight and radiators covers are still required to keep residents safe. There was carpet cleaning in progress at the time of the inspection, but there was an odour in the front entrance and some furniture was stained and dirty. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Home is set in a beautiful, rural location with views of the river and its wildlife. There is a pleasant internal courtyard/sitting area with raised flower bed and small water feature, accessible, but secure, as well as a well-laid out garden with further sitting area. The Home is connected to the village by a country lane, but is not very accessible for residents, as there is no path. The geography of the Home is in three parts with a main, older house and extension and a separate set of terraced bungalows, not joined internally to the main house. The bungalows are new and are built and decorated to a high standard. They have their own kitchens and shower facilities and residents can be private and self-contained. However, current residents need some assistance from staff and also come to the main building for their meals and entertainment, or have their meals taken to the bungalows. This issue is dealt with elsewhere in this report. If residents prefer a bath to a shower they need to go to the main building. This does mean that in cold or rainy weather, residents and staff are unprotected when moving between the two buildings. The extension is single storey and has lovely, single, mainly en-suite rooms, many of which are personalised and are of a good size and many enjoy attractive views. Apart from the bungalows, most bedrooms do not have locks, nor lockable facilities for their valuables or money. The manager said that she expected this work to be carried out in the near future, but there is a repeated recommendation for this work to be completed. The main part is older and on two floors connected by a shaft lift. However, although there have been improvements, according to comments in previous inspections, some areas, for example the landing outside the lift, could be further improved with thought given to more comfortable seating, more ‘interesting’ items of décor and a more homely atmosphere where residents/and or their visitors could sit and chat. The paintwork is poor in places and some carpets are too brightly patterned, which can be confusing to people with poor sight/dementia and different coloured carpets along corridors may cause residents, with poor sight and dementia, to fall. There is therefore a repeated recommendation for some redecoration, especially in the dining room, where there is wallpaper missing in some places, although the manager reported that she was expecting redecoration and recarpeting work to be carried out in the next few weeks and the schedule for this was seen. Also there is a recommendation that some thought be given to the colour of carpets in communal areas, especially corridors to aid recognition of areas and locations by colour. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 21 There are varied communal spaces for sitting. There are three sitting rooms, one with a dining area, a separate dining room in the main house, which seats 16 and a conservatory used by people who smoke. The bungalows each have their own sitting areas with attractive views, but these residents also come into the main house to sit. The sitting room in the main house continues to look bare with no carpet on the floor. Some of the furniture seen was stained and dirty and was not suitable for one or two of the residents. During the inspection one resident slipped off a sofa, together with the cushion. There is therefore a recommendation that consideration be given to replacing some of the furniture in the communal areas with more suitable seating. Most bedrooms seen were a good size, although in the main house there are two very awkward rooms, two with an interconnecting door, which is a Fire Exit, although the smaller room was unoccupied at present. On the first floor there was another awkwardly shaped room, with the window facing a blank wall, which, together with two other rooms seen, were very bare and unpersonalised, or personal items crowded on to narrow furniture and or photographs placed where residents could not see them. In one of the rooms the bed was missing a headboard. This and the other related issues are dealt with elsewhere in the report. Radiators are still unprotected and need to be covered to prevent residents falling against them and burning themselves. The manager again reported that the materials for completion of this work had been received by the maintenance person, but there remains a repeated requirement for this work to be carried out, as in the winter months uncovered radiators could be unsafe for residents. The lighting in some corridors in the old building on the day was too dark and not safe for residents with poor sight/dementia and there was insufficient handrail leading to one toilet. There is therefore a recommendation for this to be attended to. There is a loud and intrusive telephone bell, which can be heard upstairs and there is therefore a recommendation for this to be modified, as this could disturb and agitate frail residents. All areas of the home seen were clean. However, on the day of the inspection, although carpet cleaning was in progress, there was an odour of stale urine in the front entrance hall. This odour had also been commented on in a relatives’ survey. There is therefore a recommendation that if this odour cannot be eradicated by carpet cleaning, that consideration be given to replacing the carpet. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and visitors commented favourably on the attitude of the staff, but it was not clear that the ratio of care staff to residents is being determined according to the assessed needs of the residents and the quality of care for those residents with dementia is therefore being affected. There are better training opportunities, but these still need to be developed in conjunction with the needs of the residents to foster better practice, especially in dementia care. Recruitment procedures are robust and thus protect residents as far as possible. New staff receive induction training which equips them to understand the assessed needs of the residents, but the needs of residents with dementia requires more rigorous attention to good practice. EVIDENCE: “The staff are fine”, remarked one visitor. “The girls are all kind”, remarked a visitor with many years’ connection with the home, as a member of staff and as a visitor to a resident, also one resident spoken to commented that the …“girls are thoughtful”. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 23 The manager reported that there had been a recruitment drive in the wider organisation, from which the home was benefiting and the rota was seen, which showed that, according to the numbers of residents, there was an adequate number of staff. However, the information requested in the PreInspection Questionnaire had not been received in the CSCI office from the head office of the organisation and therefore there was no written evidence that staffing numbers were based on the needs of the residents. However, there was evidence from two relatives’ surveys that they felt there were insufficient numbers of staff on duty, particularly at weekends, and that it was not always clear who was in charge in the manager’s absence, which is dealt with elsewhere in the report. Also dealt with elsewhere in the report, is the fact that some frailer residents are having their midday meal at 11.45am, slightly later than at the last inspection, so as not to have to wait until other residents had finished theirs. It was also still the case that the residents in the bungalows could only be attended to after everyone else was seen to in the main house, as it would mean remaining staff being put under strain if one member of staff left the building to go to the bungalows. As stated elsewhere, the geography of the Home also makes demands on staff, as it is spread out, and attending to residents in the bungalows necessitates staff moving out of doors. These factors all appear to indicate that staffing is still not being determined according to the assessed needs of the residents, although the manager reported that in the near future they were expecting to employ a male member of staff whose designated role would be to assist male residents with their personal care and also that the Home had newly appointed a designated activities organiser whose hours were 1.00pm until 11.00pm to assist over the twilight shift. However, the continuing requirement that the numbers of staff on duty adequately meet the individual needs of service users, still remains. Staff spoken to confirmed that received regular supervision sessions with the manager, or a senior staff member and were able to discuss issues of practice and their training needs. Supervision records seen also confirmed this. All members of staff spoken to confirmed that they found the manager supportive and approachable. There were regular staff meetings and staff felt able to speak and they felt they worked well as a team, this was also confirmed by two other members of staff spoken to. One member of staff, who was most enthusiastic about her work, had just finished a course on Equal Value, Equal Care and in Dementia. She described her role as keyworker to three people, in which she would check individual resident’s clothes and for any personal toiletries they might need. She also described efforts which had been made in putting a resident in touch with his family with the help of another agency and keeping in touch with residents’ families, if their relative were ill. Staff files confirmed training is taking place and for the Home to fund outside training, such as NVQ, staff sign a contract with them for a year. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In her first year, the manager has made good progress in making positive changes to the home for the benefit of the residents and she manages her duties well. There is a quality assurance system in place and a new procedure for dealing with residents’ concerns ensures, as far as possible that the home listens to the voice of the residents. Residents’ money and the recording is looked after safely. The health and safety procedures, and records together with training are good, however the Accident Book revealed a high number of falls in one particular month. EVIDENCE: Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 25 A survey from a healthcare professional commented that the manager is “very pro-active and a great advocate for the clients. Many changes have been made, which, we as a team, feel are very positive.” As seen from two previous reports, the manager took over the home at a difficult time, when there were inherited staffing difficulties and complaints about practices. She has worked very hard to give leadership to the staff team and staff and visitors spoken to, as well as comments from healthcare professionals acknowledge this. The manager is a qualified nurse with management experience and in caring for older people. She is anxious to develop her own skills, as well as those of the staff, in order to provide a better standard of care for the residents. Although she already had training in dementia care, she has recently completed an updating course, together with members of staff, and wishes to develop this further. Her attitude is very much resident focused. She has the support and guidance from managers at the head office of the organisation, two of whom had recently made routine visits to the home, one on 6 June 2006 to check on the bungalows and another auditing residents’ cash on 7 June 2006 (seen in Diary). As can be seen from sections of this report, there are still improvements to be made, particularly in the care of residents with dementia and the further development of the keyworker system to implement this, but the manager has a very positive attitude to facing this challenge. She is setting up a system whereby the keyworkers have a check list which they will sign for completing specific tasks with residents in conjunction with specific issues in their care plan and also checking housekeeping issues in their rooms, such as missing headboards, dealt with elsewhere in this report. There is a quality assurance system in place, which was seen, dated August 2005. The manager has also introduced a new procedure for the recording of residents’ complaints and concerns, in addition to the more formal complaints procedure, referred to elsewhere in this report, which helps to ensure that residents and their relatives feel their complaints are listened to and acted upon. However, there were some remarks received from residents’ relatives that they were unsure to whom they should address concerns in the manager’s absence. One commented that she felt the manager should have a deputy, or at least, in her absence, it should be made clear to visitors, who is in charge. There is therefore a recommendation that in addition to the notices in different areas of the home regarding residents’ keyworkers, it should be clear who is in overall charge at that time, should it not be the manager. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 26 The only money kept in the home is that from relatives or solicitors to buy personal items for residents. Three records for the safekeeping of residents’ money were checked at random with the cash held and receipts, these were found to be correct. A copy of the Regulation 26 visit of 6 May 2006 was received in the CSCI office on 9 June 2006 which mentions the stocking of the fridge in the dining room, which is the subject of a recommendation elsewhere in this report. As reported in previous inspections, there were good records and training of staff in terms of fire, moving and handling, first aid and food handling; as well as for control of infection and COSHH. Electrical and gas systems are serviced regularly and records of water temperatures were seen to be controlled to prevent scalding. The lift service certificate was seen to be up to date. Fire drills are held regularly and the fire alarm tests were seen to be carried out regularly, the last being on 31 May 2006. Accidents are well recorded and the manager says she audits and analyses these regularly, particularly in relation to falls, of which there had been 17 during the month of May. An analysis of these falls was received in the CSCI office on 9 June 2006, but there is a requirement that risk assessments for falls are carried out, particularly during periods of residents’ illness. Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1) Requirement The registered person shall prepare a written plan with the service user, or a representative as to how the service users needs in respect of his health and welfare are to be met. In this case, particularly the dementia care needs. The registered person must continue to make arrangements to ensure that the dignity of the service users is respected. The risks from hot unguarded radiators must be identified and eliminated so far as possible. Repeated requirement The registered must ensure that risk assessments are carried out. In this instance particularly for falls in periods of illness. Timescale for action 31/08/06 2. OP10 12(4) 31/07/06 3. OP25 13(4)(c) 31/07/06 4. OP38 13(4)(c) 31/07/06 Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP12 Good Practice Recommendations It is recommended that care plans for those residents with dementia should be expanded in line with good practice in dementia care. It is recommended that that those service users who require assistance from staff are catered for at the normal mealtimes. This is a repeated recommendation It is recommended that the pursuit of more stimulation and meaningful activities for the service users should carry on. It is recommended that more finger foods are available in the fridge in the dining room in line with good practice in dementia care It is recommended that redecoration and carpeting is considered, particularly in corridors and communal areas in line with good practice in dementia care. Repeated recommendation It is recommended that a loud telephone bell, which can be heard on the first floor landing, be modified. It is recommended that consideration be given to replacing some of the furniture, especially in communal areas It is recommended that lighting and the handrail in one particular corridor is improved. Consideration should be given to the provision of locked facilities and locks on doors in service users’ bedrooms. Repeated recommendation It is recommended that together with the notices regarding residents’ keyworkers, it is made clear to visitors to whom they should refer, in the manager’s absence. 3. OP12 4. 4. OP15 OP19 5 6. 7. 8. 10. OP19 OP20 OP20 OP24 OP31 Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill House DS0000015661.V299488.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!