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Inspection on 11/04/07 for Mill House Nursing Home

Also see our care home review for Mill House Nursing Home for more information

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The garden is well designed to meet the needs of the residents, and several enjoyed the fresh air and sunshine on the day of the inspection visit. Residents said that the food is good. Each resident has a communication book, and residents and relatives can record issues needing attention from the staff.Recruitment practice is good, and the home manages small amounts of petty cash for residents very well. The Southern Cross Healthcare Group provides good support to the registered manager through regular meetings and visits from the operations manager. .

What has improved since the last inspection?

A deputy manager has been appointed to work part time, and staff and residents find that her arrival at the home has improved life for the residents. Training for staff members has improved. The refurbishment of the communal and private areas of the home is continuing, and residents like the brighter colours now used.

What the care home could do better:

All the routines and practices of the home should be scrutinised by an appropriate person, and changes made to make sure that residents have as much control and choice over their daily lives as possible. The personal and health care needs of residents, before and after admission, should be better recognised and managed. The information for staff about how to look after the residents should be better documented. Residents` wishes regarding bathing or showering should be discussed at the pre-admission assessment, so that the home can be sure that residents can bathe and shower as they wish. Medicine must always be stored at the appropriate temperature, so that the home can be sure that the medication prescribed for residents remains effective. The sash window in the assisted bathroom needs to be repaired. Regular window cleaning needs to be organised. The weekly activity schedule needs to include a range of activities suitable for both male and female residents, and should be provided over the whole week. A reliable system of recording and addressing complaints should be in place, so that residents can be sure that their complaints are recorded and addressed within appropriate timescales.The home needs to make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff. The manager needs to seek advice about the best way of cleaning the commodes on the top floor. The home needs to make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents with dignity and respect. The training on safeguarding vulnerable people needs to be offered to all care staff members. The quality assurance system should be assessed for effectiveness, as it may be more effective to quantify results through annual or twice annually comprehensive surveys.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Kate Harrison Unannounced Inspection 11th April 2007 09:30 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 Nursing Home DS0000027165.V330595.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 Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House Nursing Home Address 32 Bridge Street Witney Oxfordshire OX28 1HY 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) 01993 775907 01993 776388 millhouse@schealthcare.co.uk Chiltern Care Homes Limited (part of the Southern Cross Healthcare Group) Karen Rouse Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. Date of last inspection 2nd November 2006 Brief Description of the Service: Mill House is an old house in the market town of Witney, Oxfordshire, owned by the Southern Cross Healthcare Group since 2005. It was totally renovated and extended in 1996 and has accommodation for 43 residents. The rooms are single or double, all with en-suite facilities. It is situated close to the town centre and within easy reach of all local amenities. There are three dining rooms and two sitting rooms, together with a garden room overlooking a landscaped courtyard. The registered manager runs the home, with a team of nurses, housekeeping and care staff. The weekly fees range from £567 to £900.48. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was an unannounced key inspection, and was a thorough look at how well the service is doing. The inspector arrived at the service at 09.30 and was in the home for 7.5 hours. The inspection took into account detailed information provided by the manager of the home, and any information that the CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at records and documents relating to the care of the residents, including the management of medication. The inspector asked the views of the residents and relatives about the home through questionnaires that the Commission had sent out through the home. No replies were received, so the inspector spent as much time as possible talking to residents on the day. Two relatives had short discussions with the inspector. The inspector spoke to care staff, the chef and some of the home’s housekeeping staff, and spent time observing care practice and the routines of the home to see what life is like for the residents living there. The inspector also met the the operations manager and discussed the inspection visit findings with her and with the registered manager. At two previous inspection visits, the poor assessment before admission to the home and the lack of care plans for residents were highlighted, as failings in these areas meant that the health and welfare needs of the residents were at risk. Requirements and recommendations were made at previous inspection visits regarding assessments and care plans. At this inspection visit the same failings were again identified, and an immediate requirement was made regarding care planning for one individual. Due to the limited understanding of needs assessment, poor attention to individual’s choice and the low number of staff members trained to National Vocational Qualification Level 2 in Care, it is not clear that the needs of individuals regarding equality and diversity would be met at the home. What the service does well: The garden is well designed to meet the needs of the residents, and several enjoyed the fresh air and sunshine on the day of the inspection visit. Residents said that the food is good. Each resident has a communication book, and residents and relatives can record issues needing attention from the staff. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 6 Recruitment practice is good, and the home manages small amounts of petty cash for residents very well. The Southern Cross Healthcare Group provides good support to the registered manager through regular meetings and visits from the operations manager. . What has improved since the last inspection? What they could do better: All the routines and practices of the home should be scrutinised by an appropriate person, and changes made to make sure that residents have as much control and choice over their daily lives as possible. The personal and health care needs of residents, before and after admission, should be better recognised and managed. The information for staff about how to look after the residents should be better documented. Residents’ wishes regarding bathing or showering should be discussed at the pre-admission assessment, so that the home can be sure that residents can bathe and shower as they wish. Medicine must always be stored at the appropriate temperature, so that the home can be sure that the medication prescribed for residents remains effective. The sash window in the assisted bathroom needs to be repaired. Regular window cleaning needs to be organised. The weekly activity schedule needs to include a range of activities suitable for both male and female residents, and should be provided over the whole week. A reliable system of recording and addressing complaints should be in place, so that residents can be sure that their complaints are recorded and addressed within appropriate timescales. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 7 The home needs to make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff. The manager needs to seek advice about the best way of cleaning the commodes on the top floor. The home needs to make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents with dignity and respect. The training on safeguarding vulnerable people needs to be offered to all care staff members. The quality assurance system should be assessed for effectiveness, as it may be more effective to quantify results through annual or twice annually comprehensive surveys. 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 Nursing Home DS0000027165.V330595.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 Nursing Home DS0000027165.V330595.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): 3. The home does not provide intermediate care. Quality in this outcome area is poor. There is no reliable system in place to carry out pre-admission assessment of health and welfare needs for individuals admitted for short stays at the home. This failure puts individuals at risk, as changing needs may not be recognised and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home uses the company’s documentation to carry out pre-admission assessments, and the inspector saw the documentation for one individual admitted some months ago. All the information from the individual’s stay in hospital was available and the pre-admission assessment contained all the necessary information to make a decision about admitting the individual to the home. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 10 There was no evidence that a recent assessment had taken place to understand the needs of one individual admitted the previous day. The individual came to stay at the home for a short period, and had regularly stayed for short periods, last time in February 2007. No information was available about the current needs of the individual, and staff members had no updated information about how to care for the individual’s needs. This puts the individual at risk and is unacceptable practice. The same failing had been identified at previous inspections and, following the inspection visit of 23/06/06, a recommendation was made to develop a written procedure about the admission of short stay residents. A requirement was made following the 02/11/06 inspection visit, that all pre-admission assessments must be completed prior to admission, with a timescale for implementation by 23/11/06. There is a continuing failure to develop a system to manage the admission of individuals coming for short stays at the home, and individuals are therefore put at risk. An effective system must be in place so that the needs of all those admitted to the home are known and recorded before admission. Mill House Nursing Home DS0000027165.V330595.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 and 10. Quality in this outcome area is poor. This is the third inspection visit when the standard of care has not improved. Residents are put at risk because of the limited understanding of health needs assessment, poor or no care planning and the failure to store medication at the appropriate temperature. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector checked three individuals’ care files to see how care was planned and delivered. An individual admitted the previous day had no care plans developed and an immediate requirement was made to develop the care plans within 12 hours, so that the individual’s needs could be identified and met. The manager confirmed that the care plans were developed for the individual within the timescale. The registered nurses carry out risk assessments on health issues to determine what care is needed by the individual. One individual was assessed as at ‘high’ risk of falling, but the care plans in place only dealt with managing the risk of falling out of bed, and not other risks present during the day. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 12 The manager confirmed that she has arranged to meet with the Falls Service to discuss the training needs of the home, so that the residents’ needs are met. The home continues to use two types of nutritional risk assessment, and this practice poses difficulties for staff. Both risk assessments were carried out for one individual and, in one example, the risk showed ‘very high risk’ from one assessment, and at ‘no risk’ from the other. No care plan was developed, so there was no information available for staff members to apply the information from the two risk assessments to the needs of the resident. The continence assessments used by staff members are not completed properly, as no summaries are completed and therefore staff members do not easily understand what the outcome of the assessment was. Staff must be properly trained in carrying out assessment of health and welfare needs, so that all the residents’ needs are known. One individual had a choking episode the previous day when the emergency services had to be called, but there was no care plan developed to instruct staff members in managing another episode in the event of a recurrence. The care plans about personal hygiene advise staff to offer a bath or shower once a week to individuals, and there is no evidence that residents can choose when to bath or shower. Residents may wish to bath or shower more regularly, and the pre-admission assessment should take this fact into account so that the home has the resources available for the needs of the residents. Residents’ wishes regarding bathing or showering should be ascertained at the pre-admission assessment, so that the home can be sure of meeting their needs. Residents said that staff treat them well, are caring and respectful, and give them privacy. The administration of medication is properly recorded, though most of the medication remains stored in an area of the office where the temperature during the inspector’s visit was recorded at 25 degrees Centigrade. A requirement was made at the last inspection to address the suitability of the office as a place to store medication because of the high temperatures. A fan had been purchased, but the temperature remains too high for the majority of medication stored. The manager explained her unsuccessful efforts to acquire an air conditioning unit for the room, but it is not clear that this measure will address the issue. As a consequence it is not known if the medications retain their effectiveness, and so may continue to pose a risk to residents. A further requirement and recommendation is made in this report. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 13 Following a recommendation at the last inspection visit, the registered manager confirmed that the wishes of residents regarding arrangements at the time of death are now discussed during reviews of care. Mill House Nursing Home DS0000027165.V330595.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. Although the home provides good food and a variety of activities, the residents have limited control over the routines of the home, and therefore have little choice over their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although individual members of staff show respect for the residents, the routines of the home are in some instances institutionalised. Residents were brought to the dining room more than half an hour before lunch was served to them, and they had no choice but to wait at the table. When the inspector asked why this happened, one resident said ‘This is what they do’ and another said ‘We’re used to it now’. Care plans show that residents do not have choice over bathing or showering arrangements, and it is not clear if this is because of lack of staff members, ineffective deployment of staff members, longstanding practice in the home or for the convenience of staff. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 15 One resident said that waiting for staff to come was the worst thing about life in the home, and during the inspection visit bells rang continuously until early afternoon. The registered manager accepted that this was a usual occurrence due to the system in place. All the routines and practices of the home should be scrutinised by an appropriate person, and changes made to make sure that residents have as much control and choice over their daily lives as possible. Several residents said that they enjoyed the activities provided, and the activities organiser gets the views of the residents regarding preferred activities. Individual and group activities are organised, and outings are planned for the near future. As the activities organiser works over four days, it is not clear what activities are provided during the remaining three days. The activities schedule for the week of April 2nd showed activities mainly suitable for women, with two activities suitable for both men and women. The weekly activity schedule should include a range of activities suitable for both male and female residents, and should be provided over the whole week. Visitors are able to come to the home at all reasonable times, and are welcomed by staff. Residents enjoy the food, and several said that lunch on the day of the inspection visit was ‘excellent’. The chef has been at the home for over three years and has good communication with residents, and the activity co-ordinator tells him about residents’ food preferences. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is poor. Residents cannot be sure that the manager, because of her unreliable practice, will address their complaints appropriately. Insufficient numbers of staff are trained in safeguarding vulnerable adults for the home to be certain that residents will be safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is displayed in the hall, and included an incorrect telephone number for the Commission. The operations manager corrected the error and all the information was correct before the end of the day. Two residents said they knew how to make a complaint, and one resident said that s/he had made a concern known to a senior member of staff who addressed the issue quickly. As no residents or relatives gave their views through the Commission’s comment cards, it was not possible to know the views of other residents and relatives. A complaints book has only recently been available at the home, and the manager is responsible for the recording of complaints. Complaints are not always recorded promptly, and three known complaints were not recorded until during the inspection visit. This practice can jeopardise the home’s need to respond to complainants within appropriate timescales, and a reliable system of recording and addressing complaints must be in place. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 17 The Commission received information from the local adult services department about a care issue at the home. The issue had been investigated by the home, but the relative remains unsatisfied with the way the manager addressed the issues. From records seen, less than fifty percent of staff members have attended training on safeguarding vulnerable people, and a requirement is made in this report to increase the numbers. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is poor. Although the provider has made improvements to the home’s environment, poor practice in the home puts residents at risk due to poor recognition of fire and safety risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several improvements have been made recently, including the installation of a new central heating system in the newer part of the house. Most communal areas of the house have been newly painted, as have several bedrooms. All of the sash windows need cleaning, and some are badly stained with grime. The home should have a system in place so that all the windows in the home are properly cleaned on a regular basis. Some windows do not fit properly and have large gaps, especially the sash window in the assisted bathroom discussed with the manager. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 19 An audit must be carried out to assess the safety of the sash windows, and repairs or replacements carried out to minimise the safety risks to residents and staff. Three mattresses were stored under the wooded stairs, along with the hairdresser’s plastic storage unit and other items, and these pose a fire safety risk for residents and staff members. The maintenance member of staff agreed to remove the items and store them elsewhere, and the home should make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff. The sluice on the top floor does not work, has not worked for a long time and is awaiting removal. The registered manager confirmed that, because of this, staff members clean commodes in the en-suite facilities of the residents. The registered manager must seek advice about the cleaning of commodes located on the top floor, so that the risk of spreading infection is minimised. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is poor. Although the home’s recruitment procedures are good, there are not enough staff members with the skills and knowledge necessary to properly care for the individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the home has no carer vacancies and a staff rota is in place, it is not clear that there are sufficient staff members on duty to meet the needs of the residents. Call bells continually sound during the day, and residents say that waiting for care staff is a problem. An issue from a complaint concerned staff not being available to help a resident get up before 11.30am, and issues about personal choice regarding bathing and residents being brought to the table half an hour before mealtimes may involve the lack of staff. There is little evidence that enough staff members are available to deliver person-centred support. An appropriate person should undertake a review of the staffing needs of the home, based on the needs of the residents, so that sufficient and skilled staff members are available for the residents. There are very few carers trained to NVQ Level 2 in Care, though the home has made an effort to increase the numbers registered on a course. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 21 A check of the recruitment files of three staff members shows that the recruitment practice is good, and that all the necessary information was available. The home’s induction procedures are documented on the staff induction records for new staff, and the registered manager said that the format meets the Skills for Care standards. From the training records seen, it is not clear that enough staff have attended moving and handling training, safeguarding vulnerable adults, infection control or health and safety training during the past year. More training is planned, but as the level of NVQ Level 2 training is very low, the home should make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents as soon as possible. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 22 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, 33, 35 and 38. Quality in this outcome area is poor. The home lacks leadership and residents’ health and safety are at risk as a result. There is not enough evidence to be confident that the home is run in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been at the home for several years, is qualified and has been supported in her role by the company’s regional operations manager following the change in ownership in 2005. Issues arising from this inspection visit and from previous reports show that important issues within the scope of the manager’s duty are not addressed appropriately, such as the pre-admission assessment of prospective residents, care planning, and risk assessments on health and welfare issues. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 23 Practice in the home concerning key issues of respect and dignity, infection control and health and safety are poor. Formal supervision of staff has recently started, but an effective system is not yet operating. The quality assurance system includes sending questionnaires to three relatives every month, though there was no record that an analysis was carried out to assess the results, or any plan made to act on suggestions. This system should be assessed for effectiveness, as it may be more effective to quantify results through annual or more regular comprehensive surveys. Small amounts of petty cash are kept safely for some residents, and accurate accounts and records are kept of transactions. The home has carried out a fire risk assessment, and although the equipment has been ordered, it is not yet available at the home and so it is not clear that all the residents’ best interests are protected in the event of a fire. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 24 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 Requirement It is a requirement that all pre-admission assessments must be completed in full and a letter confirming that the home can meet the care needs is sent prior to admission to the home. This requirement remains outstanding from the previous inspection, and has a revised timescale from 23/11/06. It is a requirement that all residents in the home, whether for short or long stay, must have an up to date care plan in place that takes into account all of their care needs. This requirement remains outstanding from the previous inspection, and has a revised timescale from 02/11/06. At this inspection an immediate requirement was made regarding one individual with a timescale of 12 hours, and that requirement was met. Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 26 Timescale for action 30/04/07 2 OP7 15 30/04/07 3 OP8 12 (1b) 4 OP9 13 (2) Appropriate staff members must be trained in carrying out the assessment of health and welfare needs for residents, so that the residents are properly cared for. Medicine must always be stored at the appropriate temperature, so that the home can be sure that the medication prescribed for residents remains effective. This requirement remains outstanding from the previous inspection, with a revised timescale from 13/12/06. The temperature at which the medicines are stored within the office must be recorded daily, so that evidence is available that the medicines are stored at an appropriate temperature. A reliable system of recording and considering complaints must be in place, so that residents and relatives can be sure that their complaints will be properly addressed. Training for all care staff in the safeguarding of vulnerable people must be provided. An audit must be carried out to assess the safety of the sash windows, and repairs or replacements carried out to minimise the safety risks to residents and staff. The registered manager must seek advice about the cleaning of commodes located on the top floor, so that the risk of spreading infection is minimised. 31/05/07 31/05/07 15/06/07 5 OP16 22 31/05/07 6 7 OP18 OP19 13 (6) 23 (2b) 31/05/07 31/05/07 8 OP19 13 (3) 30/04/07 Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations It is a good practice recommendation that all staff involved in carrying out nutritional assessments should have further training on how to use the tool in place. This recommendation remains from the previous inspection report. Residents’ wishes regarding bathing or showering should be ascertained at the pre-admission assessment, so that the home can be sure of meeting their personal care needs. The weekly activity schedule should include a range of activities suitable for both male and female residents, and should be provided over the whole week. All the routines and practices of the home should be scrutinised by an appropriate person, and changes made to make sure that residents have as much control and choice over their daily lives as possible. The home should have a system in place so that all the windows in the home are properly cleaned on a regular basis. The home should make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff. The home should make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents as soon as possible. The quality assurance system should be assessed for effectiveness, as it may be more effective to quantify results through annual or twice annual comprehensive surveys. The temperature in the medicine storage area should be recorded around midday daily, so that an average temperature record will be available. 2 OP7 3 4 OP12 OP12 5 6 7 8 OP19 OP19 OP30 OP33 9 OP9 Mill House Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing Home DS0000027165.V330595.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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