Inspection on 07/06/07 for Mill House

This inspection was carried out on 7th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mill House 07/06/06

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 Debra Allen Unannounced Inspection 7th June 2007 11:00 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.V343357.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.V343357.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 info@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited 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) 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.V343357.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. 7th June 2006 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.V343357.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the service users and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. Mill House received a random unannounced inspection on 1st November 2006, following which, three of the four requirements and nine of the ten previous recommendations were deemed met. A further one requirement and two recommendations were made as a result of the random inspection. This key inspection was carried out over a period of five and a quarter hours and included a tour of the premises, inspection of staff and service users’ records and the home’s records relating to health and safety. Two staff members were interviewed, a discussion took place with the manager and a number of service users were chatted with. Four service user surveys and three relative/visitor’s comment cards were completed and received prior to the inspection, all of which contained positive comments such as: “Relatives are always welcome.” “I would like to say how very helpful I find staff to my mother but also to my family. A very caring home with excellent management.” My uncle is suffering from Alzheimer’s and believes he is in a hotel. Seeing the way he is treated, it is better. Two recommendations have been made as a result of this inspection. However, following receipt of the draft copy of this report, the provider responded as follows: (1) “The practice of staff and clients enjoying meals and snacks times together is now fully restored and remains an extremely positive benefit at the home.” Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 6 (2) “All Prime Life properties undergo a thorough property audit annually, the next such audit at Mill House is scheduled for September and we will address any issues of decoration or areas of improvement that are needed.” Also, following a response from the provider, a paragraph has been removed from page eighteen which referred to shared rooms, as the inspector agreed it was deemed to be misleading. What the service does well: What has improved since the last inspection? There has been very good progress on addressing the issues raised at the previous key inspection and random inspection, which was carried out in November 2006. All requirements from these are now deemed met. The home has developed considerably since the previous inspections with regard to training in dementia care, which was clearly evidenced in the care plans and there is improved attention to the monitoring of falls and the nutritional needs of residents. Since the last key inspection, mealtimes have become more flexible and there is a good selection of ‘finger’ food available to service users at all times. These are stored in clear fronted fridges in both of the dining rooms of Mill House and Mallard. Health and safety work on radiators has been completed and fire records are kept up to date. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mill House DS0000015661.V343357.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.V343357.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is good. (Standard 6 is not currently applicable.) Prospective service users are able to make an informed choice about where to live and information is provided to assist them to do this. Each person has a contract and a copy of the statement of Purpose and Service user’s Guide. Service users have their needs assessed prior to moving in to Mill House and are confident that the home will meet these needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for three service users were examined during this inspection and the information contained in them was found to be clear and detailed. The admission details were seen to include aspects such as personal profile, history, likes, dislikes and daily living requirements. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 10 All the information collected during the assessment process was noted to be clearly recorded in service users’ files and had been used to compile effective care plans. The home has developed considerably since the previous inspections with regard to training in dementia care, which was clearly evidenced in the care plans. Each person was noted to have received a contract and a copy of the Statement of Purpose and Service User’s Guide. Mill House DS0000015661.V343357.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. Each service user has a detailed care plan which describes their health, personal and social care needs. Service users have access to healthcare professionals and they are protected by the home’s medication policies and procedures. Service users and their families are treated with respect and dignity throughout good health, illness, dying and death. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The contents of the three care plans that were inspected were clearly indexed and included admission details and life profile, general assessment details, care plan and evaluations, information relating to health support services, risk assessments, family contacts, daily reports and checklists for key-workers. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 12 All the information held on file was seen to be written in a respectful manner and was very descriptive and informative, helping to ensure the consistency and continuity of care provision. Each care plan was noted to be reviewed on a quarterly basis. The risk assessments looked at covered a number of general aspects such as hypothermia, heat-waves, access to the river bank, external areas in adverse weather conditions and smoking. Personal risk assessments were also seen for service users and all were seen as well written, reviewed regularly, up-to-date and relevant. Involvement from healthcare professionals such as District Nurse, GP, Optician, Occupational Therapist, Dietician and Chiropodist was also evident from the care plans. The manager continues to monitor falls and a number of people have been referred to the ‘Falls Team’ for further support and advice. A number of contributory factors have been noted but none have indicated inadequate care. The MUST (Malnutrition Universal Screening Tool) was seen to be used and service users’ weights continue to be monitored on weekly or monthly basis. The home has very robust policies and procedures with regard to dealing with and administering medication and the records seen on the day of inspection were clear and up to date. During the inspection observations were made of staff knocking on doors before entering and appeared to be addressing people appropriately. From this the opinion was formed that service users are treated with respect and have their privacy upheld. Discussions with the manager and two staff confirmed that they understood the home’s policies and procedures with regard to death and they described how they dealt with anticipated and unexpected deaths in such a way as to ensure the service user and their family were treated with absolute dignity and respect. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Service users have the opportunity to take part in a number of activities, hobbies and pastimes and are supported to maintain contact with family, friends and the local community, according to their wishes. Service users receive a balanced diet which is wholesome and nutritious and additional food is freely available outside normal mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A lot of work has gone in to developing the activities which are available to service users, with a particular focus for those with dementia. Very good guidance was seen with regard to understanding each stage of dementia and the activities that would be most suitable. For example, for the early stage (reflective and orientated to goals) games, sport, craft and discussions could be appropriate whereas for mid/late (concerned with sensory) these could include massage, cooking, gardening, polishing and exercising. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 14 In addition to this, the organisation (Prime Life) has produced a leaflet called ‘101 Things To Do Other Than Watching TV’. A number of photo boards and albums were seen on the day, which showed some of the recent internal and external activities and events that have taken place. Some of these included service users cooking and preparing for parties and barbecues at Mill House as well as outings to Hunstanton, Sandringham, Holt and Caister. A full programme of activities was seen, which was split into day and nighttime options. Additional daily events were also seen, with timetables of their availability – i.e. daily walk - weather permitting, mobile library – bi-monthly and communion - monthly It was evident on the day of inspection that service users are able to maintain personal and family contacts, this could be seen by notes in the comments book, observations and the responses received to the CSCI surveys. Since the last key inspection, mealtimes have been made more flexible and, as recommended previously, there is a good selection of ‘finger’ food available to service users at all times. These are stored in clear fronted fridges in both of the dining rooms of Mill House and Mallard. One of the service user’s surveys stated ‘the standard of meals is excellent’. However, a couple of recent entries in the comments book read: “It’s a shame the staff don’t eat with the residents any more – in my opinion they benefit from and prefer this.” And “We would like to see the return of staff sharing and helping residents at mealtimes,[name] found this most beneficial.” A recommendation has therefore been made to give consideration to this issue. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Service users, their families and friends know their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was seen to have a very clear and robust complaints procedure and all of the completed questionnaires received from service users and relatives/visitors stated that they knew how to make a complaint. Mill House has received six complaints since the last key inspection, three of which were upheld. Records were looked at with regard to complaints and appropriate information was seen with regard to the complaint, action taken and whether the complaint had been resolved. The two members of staff spoken to confirmed that they were aware of, and understood, the whistleblowing policy and that they had attended training for the protection of vulnerable adults. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. The home provides a clean, safe and generally well maintained environment for service users and the indoor and outdoor communal facilities are safe and comfortable. The home also has suitable and sufficient toilet and washing facilities. Service users’ bedrooms are safe and comfortable and people can have their personal possessions around them. Specialist equipment and aids are available to maximise individuals’ independence. This judgement has been made using available evidence including a visit to this service. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 17 EVIDENCE: A tour of the premises was carried out and the home was found to be clean, homely and free from offensive odours. The communal areas were warm and inviting and the standard of décor was generally good, although there are still some areas which appear a little tired. The service will therefore benefit from ongoing improvements and updating of the premises. Each service user’s bedroom was seen to be very individual and personalised, with people being encouraged to bring their own furniture and other personal belongings. Many rooms have beautiful views of the gardens and the river. All the accommodation in Mallard (the extension) is on the ground floor, with most bedrooms having en-suite facilities. Mill House has a lift to access other floors. The home also has a number of adapted baths, showers and toilet facilities. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. The home has robust recruitment policies and practices, the staff have a good mix of skills and they are trained and competent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In-depth discussions were held with two staff members and both said they felt the team worked very well together. They also spoke very highly with regard to the support and training received from the home’s management team and the organisation as a whole. Training records were looked at and evidence was seen of courses attended such as first aid, fire safety, health & safety, moving & handling, COSHH, food hygiene, protection of vulnerable adults and dementia. Three personnel files were looked at and each one contained documentation such as application form, contract, three references, identification and clear, enhanced Criminal Records Bureau (CRB) disclosures, therefore confirming that the home/organisation has robust recruitment procedures, which helps to protect the service users. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. Service users live in a home, which is run in their best interests by a competent manager and staff receive regular support and supervision. Service users’ financial interests are safeguarded and the health and welfare of service users and staff are promoted and protected by the home’s policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from observations, discussions and records that the manager has continued to make improvements to the service as a whole and clearly provides effective leadership. The manager also completed her NVQ4 Registered Manager’s Award in March of this year. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 20 Staff spoken to on the day of inspection all said they were very happy in their jobs, felt very supported by the manager and received regular supervision sessions, evidence of which was seen in the staff files. Financial records were looked at for three service users and procedures for handling their money was deemed to be safe and secure. Policies and procedures for all aspects of Mill House were seen to be very comprehensive and informative, as well as being clear and easy to read and understand. In addition, the ‘Manager’s Bible’ also contained records and information such as quality assurance/compliance review, business plan and management accounts. Audits on residents’ funds, personnel and property were also seen. All these records and information were seen to be reviewed fully on an annual basis. Detailed health and safety records and risk assessments were also seen to be up to date and relevant, thus confirming the health and welfare of service users and staff are promoted and protected. Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Mill House DS0000015661.V343357.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations It is recommended that serious consideration be given on how to address the issue raised in the comments book that the staff don’t eat with the residents any more – it was stated that they benefit from and prefer this. It is recommended that the service continues with improvements, updating and redecoration of the premises. 2. 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