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Inspection on 17/07/09 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 17th July 2009.

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

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.

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

People are only admitted to the home following a pre-admission assessment, as this makes sure that the home has the capacity to meet their needs. People admitted for intermediate care are helped to regain their independence as far as possible and to return home. We saw staff members treat people in a caring and respectful way and people told us that the staff team ‘work extremely hard’. The majority of people told us through our survey that there are activities available they can take part in. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 People told us that they like the food at the home, and we saw that the dining rooms are well presented and that lunch time was relaxed and leisurely. The home’s environment is friendly and is well maintained.

What has improved since the last inspection?

At our last inspection the home had reopened after major refurbishment and people were settling into the clean and refurbished home.

What the care home could do better:

Improve the way it looks after people, to make sure that people’s personal care needs are met in the way they want. Get healthcare advice about nutrition when needed so that people’s needs are met. Provide staff training about nutrition so that the staff members know what to do to improve the nutritional status of people living there. Make sure that professional advice is implemented about cleaning individual commodes. Make sure that the equipment necessary to meet people’s needs such as hoists and showers are available. Keep people’s private information confidential. Find better ways of gaining the views of people living in the home. Make it easier for people who do not have a private phone line to have easy phone contact with their friends and family. Identify the frequency of people’s personal care needs about bathing or showering. Make sure that there are enough staff members available at the times suitable for people in the home so that they can shower or bathe according to their choice. Make sure all the staff recruitment information is kept for regulation purposes. Improve the auditing procedures so that the home is proactive about noticing shortfalls. .

Key inspection report CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Kate Harrison Key Unannounced Inspection 17th July 2009 09:30 DS0000027165.V376534.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Mill House Nursing Home DS0000027165.V376534.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 Ltd (part of the Southern Cross Healthcare Group) Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 43. Date of last inspection 24th July 2008 Brief Description of the Service: Mill House Nursing Home is an old house in the market town of Witney, Oxfordshire, owned by the Southern Cross Healthcare Group since 2005. It was renovated and extended in 1996 and has accommodation for 43 residents. The rooms are single and double, with en-suite facilities of toilet and hand wash-basin. 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, communal bathrooms and a garden room overlooking a landscaped courtyard garden. Mill House was closed following severe flooding during extreme weather in July 2007, and the home was reopened after major refurbishment in May 2008. The fees range from £443.20 to £822 per week. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 9.30 am and 5pm during one day. The inspector was accompanied by an ‘expert by experience’, who spent 3 hours in the home on the same day from 11am to 2pm, talking to people living in the home and observing what life is like for them. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment, (the AQAA) and any other information we received about the home since the last inspection in July 2008. The AQAA was signed by the previous registered manager who left her post in May 2009 and we found that some of the information provided did not match the findings at our inspection visit. We saw the communal areas of the home and some private rooms used by people living there. We looked at records and documents relating to the care of the people living there. We saw recruitment and staff training information and looked at how peoples medication was managed. We asked the views of the people who live in the home, through questionnaires we had sent out. We spoke to several individuals about their lives in the home during our visit, and we spoke to several staff members. Altogether we received 14 completed surveys from the staff team, one healthcare professional and from people living in the home and their views are reflected in this report. We spoke to the acting manager, some staff members, and a senior manager from the company, and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. We found that the home was not meeting all the needs of people living in the home and made several requirements so that life can improve for people. What the service does well: People are only admitted to the home following a pre-admission assessment, as this makes sure that the home has the capacity to meet their needs. People admitted for intermediate care are helped to regain their independence as far as possible and to return home. We saw staff members treat people in a caring and respectful way and people told us that the staff team ‘work extremely hard’. The majority of people told us through our survey that there are activities available they can take part in. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 6 People told us that they like the food at the home, and we saw that the dining rooms are well presented and that lunch time was relaxed and leisurely. The home’s environment is friendly and is well maintained. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 7 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Mill House Nursing Home DS0000027165.V376534.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.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted to the home following a preadmission assessment to make sure the home can meet their needs. People admitted for intermediate care are helped to regain their independence as far as possible and to return home. EVIDENCE: We looked at the individual care records for three people recently admitted to the home, including one person staying in the intermediate care unit. We saw that a pre-admission assessment had taken place for each individual. We discussed with the acting manager how people are admitted to the intermediate care unit of the home. She said that the pre-admission assessments are conducted by staff from the National Health Service, such as a registered nurse or physiotherapist, and the information is faxed to the home, so that a decision can be made about the home’s ability to meet the Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 10 individual’s needs. We saw from the records of the files seen that this was the case and that all the information was available. We met the individual and discussed how the home was meeting her/his needs, and s/he told us about the progress made during the stay at the home, and about the expectation that s/he would be returning home. We noted from the other files that a qualified person, usually a registered nurse from the home, visits the individual to carry out the pre-admission assessment and to make sure that the home can meet their needs. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home treats some people living in the home in a way which does not respect their dignity and does not always meet their health and personal care needs. EVIDENCE: We looked at three individuals’ care records to check how personal and health care was managed. We saw that staff members try to personalise the care plans, for example in a care plan for an individual in the intermediate care unit about managing one individual’s anxiety the instructions to staff included: ‘ensure you leave X feeling safe and comfortable’. One healthcare professional told us about the intermediate care unit that people’s health and social care needs are always monitored, reviewed and met, and that the home acts, with regard to the intermediate care unit, to seek advice and act on the advice about improving people’s well-being. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 12 Risk assessments are carried out for key topics, and the records we saw contained appropriate assessments. We saw risk assessments for people in the nursing home about an individual’s nutritional state, but there were no records to show that the individual was referred to a dietician if the results of the assessment are outside normal range. We noted that there are no records of staff members attending training about nutrition. The lack of a referral means that some people in the home may not receive the appropriate advice they need. We discussed this with the acting manager, and she acknowledged that referrals had not been made for people with a high body mass index. The home confirmed following the inspection that three individuals have now been referred for healthcare advice. One file showed that an individual who was usually weighed monthly had not been weighed from March 2009, as the hoist needed to assist staff was broken, so there was no record to show if the individual was losing or putting on weight. We asked the acting manager about this, and she said that the home had reported the fault to the organisation’s service department but it had not been repaired. A sister home nearby had borrowed another hoist, so the home had two hoists less than was appropriate to meet the needs of the people living in the home. Following our inspection visit the acting manager informed us that one hoist had been returned to the home. We saw notices on two individuals’ bedroom doors in a public corridor, giving details meant for staff members about their personal care needs, and noted that the home was not respecting their privacy and dignity. This is not in keeping with the home’s statement of purpose about maintaining confidentiality. In our inspection report of 24th July 08 we commented on the practice in the home to offer weekly baths or showers and we were assured that the practice would be addressed through staff supervision and training. The home’s AQAA says that people ‘are offered a choice of washing and bathing arrangements and their rights to make that decision are respected’. The home’s statement of purpose says that people have choice over their daily lives including ‘the number of showers/baths they have’. People told us that they are offered a shower once a week, and on the morning of our inspection visit we noted that none of the 19 people on one floor had a bath or shower. One shower was not in use and awaiting repair. We asked a member of staff about this, and we were told that people do not bathe or shower in the mornings, and that people are offered showers in the afternoons. We saw that one care plan said ‘make sure X has a bath or shower at least once a week. Offer a good wash daily’. One person told us ‘I would like a shower more often than once a week but I don’t want to get anyone into trouble’. One person replied to our survey that more showers and baths should be offered, preferably more than once a week. Another person told us ‘I think the bath is not in use’, and another said about showering: ‘well, it is very difficult for the staff and in a perfect world we would get one everyday’. Others told us that when they were offered a shower in the afternoons it was not always convenient for them, one saying that she had just been to the hairdresser and another saying that it was too cold at that time for a shower. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 13 The home is not meeting its statement of purpose, in that it does not always treat people living in the home ‘with care, dignity, respect and sensitivity’, as people’s personal care needs are not met in the way they want. We looked at how the home manages medication, and saw that the medication is stored securely. All the medication is recorded when received and administered and there is a system in place to manage discontinued medication. We noted that the medication records we checked were properly completed, including controlled drugs. We noted that medication with a ‘use by’ date kept in the fridge after opening is usually dated on opening, though we found one opened with a dispensing date of May 09 that had not been dated on opening. This was discussed with the registered nurse and the medication was disposed of. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have some opportunities to live as they want to, but the home needs to improve this outcome area to make sure it meets its own goals about individual choice. EVIDENCE: The home has an activity coordinator who works 20 hours a week over 4 days, and we noted that there is a schedule of activities in place for the home. Activities include weekly bingo, gardening club, regular visits from a ‘Pets as Therapy’ dog and the mobile library and themed special events. The majority of people told us through our survey that there are activities available they can take part in, though some individuals told us that there were no activities they had any interest in. Four individuals said that they thought that singing would be a good idea, and to have the training and use of a computer for people to use the worldwide web and remain in contact with their friends and family. The home organises some trips out for small groups of people, and others are taken out by family and friends. There is a small mobile shop now in use to help those people who have no access to the shops. Some people have limited Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 15 access to the outdoors, and one person with a countryside background told us ‘I just sit, I love to be outside but I just sit here’. Some people pay to have private phones, but one individual who did not told us that she wished she was able to use a phone to call her children, and another said that the home did the phoning for them and left messages, but that they did not actually use the phone. The home needs to address this issue, so that people who do not have a private phone line can have easy contact with their friends and family. Although we understand from the AQAA that regular meetings are arranged by the activity coordinator, people did not understand that this was an opportunity for them to have their say about life in the home and about what activities they might like, and the home needs to find make sure that they are meeting their statement of purpose about meeting ‘individuals’ specific wishes and choices’. There are opportunities for people to practice their religious beliefs, through visits from ministers of religion and attendance at local church services. People told us that they liked the food at the home, and that they were offered snacks throughout the day. The food we saw at lunch time was of good quality and well presented. Because not all the people who would benefit from dietary advice had been referred to a dietician it is doubtful that the food provided was meeting the dietary needs of all the people in the home. We noted that the staff team helped people who needed help to eat with respect and lunch was unhurried and relaxed. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives know the procedure to follow if they need to make complaints and the staff team are trained in protecting people from abuse. EVIDENCE: Everyone living at the home who responded to our survey said they knew how to make a complaint. The staff members who responded also said that they knew what to do if someone has concerns, and the acting manager said that she has an ‘open door’ policy about seeing people. She also has a designated evening when people know she is available if they want to talk to her about any concerns arising. The home’s complaints procedure is displayed in the hall, and contains information for people wishing to make a complaint to the home. Our details were included, but had an incorrect phone number and this was corrected during our visit. We saw the complaints record showing complaints received since our last visit, and noted that five complaints were recorded. Four had been responded to within the timescales of the complaints procedure, and one is ongoing. The AQAA information shows that the home intends to use learning from the complaints made to improve the home. The home has a safeguarding procedure and a whistle blower policy to enable staff to report any allegations or suspicions of abuse. Staff training about Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 17 keeping people safe from harm is included in induction training and further training is provided. The majority of staff received update training in the last year and more training is planned. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home lacks good infection control procedures and this could put people living in the home at risk. EVIDENCE: The home’s environment was upgraded last year and the home employs a person responsible for maintenance. There is a system in place to address repairs on a daily basis, so people living in the home can have maintenance issues attended to quickly. Regular maintenance checks are recorded, such as water temperature checks and fire safety checks. We saw signs on two toilets saying ‘Disabled WC’ and we asked the acting manager to consider what this meant for people in the home who used wheelchairs. She told us following the inspection that the signs had been removed, so that now all the people living the home know that the toilet is suitable for them. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 19 We saw that the shower in one bathroom was not usable and that several commodes were stored there, in an unhygienic condition. The bins in the bathrooms containing soiled pads had swing tops and one remained stuck open. Another commode in a bathroom in use was also in an unhygienic state. It was clear from our conversation with members of care staff and cleaning staff that staff members do not know whose role it is to clean the commodes, as each said it was the other’s job. We discussed these issues with the acting manager who took action to dispose of the unused commodes and following the inspection said that hygienic pedal operated bins had been ordered to replace the swing top bins. She told us that commodes were cleaned in individual’s rooms using special wipes by the care staff, and this is not in keeping with good practice. Last year’s AQAA showed that the home intended to install mechanical sluices but there is no functioning sluice in the home. The home must make arrangements to implement the Department of Health’s advice about the cleaning of commodes in the publication ‘Infection control guidance for care homes’ to make sure that people in the home are protected from harm. Following this advice will mean that the appropriate staff members get training in the proper cleaning of the commodes and will know where to clean them. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers and training need to be improved, so that the needs of all the people in the home are met. EVIDENCE: The home has a staffing rota showing that there is a registered nurse available over the 24 hours, two usually during the day and seven carers for the two units. People living in the home told us through our survey that staff members are available when they were needed and that they listened and acted on what people said. However when we asked them about personal hygiene people told us that they usually were offered a bath or shower once a week. As the culture in the home does not encourage people to bath or shower daily, the home must review the staffing arrangements to make sure that there are enough staff members available at the times suitable for people in the home to exercise their choice about personal care. The home is not yet meeting the national minimum standard of 50 staff trained to National Vocational Qualification Level 2 in Care (NVQ2), as only 6 of the 22 carers have the qualification, and this needs to be corrected in the home’s statement of purpose. The home has an induction programme for new staff and a programme of further training. We saw the staff training matrix showing the name and Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 21 frequency of the training courses but it included only four nurses whereas the staff duty rota showed 11. Some of the nurses work part time and are not included on the training matrix, so we are unable to say that all the nurses had received appropriate training. According to the matrix 9 of the care staff have not had their safeguarding training and the status of the 7 nurses not included on the matrix is unknown. Only two nurses have had infection control training along with less than 40 of care staff, and nobody has received training about nutrition. The home must review staff training to make sure that all the care staff team receive safeguarding training quickly and that the provision for training for nurses and carers is appropriate to meet the needs of the people in the home. We looked at three staff recruitment records to see how the home conducted the recruitment process. We found that all the necessary information was available, except that the company does not keep the Criminal Record Bureau (CRB) certificates for us to inspect. Information from the CRBs is kept on a computer system. The certificates are kept at the company’s headquarters and can be made available for us to see, but the policy is to destroy them after six months. We discussed this with the senior manager and she understood that the home needs to keep the CRBs until after our next inspection and she undertook to discuss this with the company. Mill House Nursing Home DS0000027165.V376534.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not operate in the best interests of the people living there and is not meeting its statement of purpose. EVIDENCE: The home does not have a registered manager in charge, as the registered manager left the home in May 09 and the home has been run since then by the acting manager, supported by a senior manager from the company. The acting manager is leaving the home soon and a new manager has been recruited to manage the home, with the expectation that the individual will become the home’s registered manager. Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 23 The home manages small amounts of petty cash for individuals, withdrawn from the individual’s account in the aggregate account for the home. Individuals request cash amounts and spend this as they wish, and sign a record saying they have received an amount from the home. Records are kept of the transaction and the home is considering how best to improve record keeping so that staff are protected from any accusations. The home monitors health and safety in the home and the home’s health and safety committee meets to discuss issues arising. The home has a fire safety risk assessment in place and staff members receive training about fire safety. The home has a quality assurance programme that involves surveys to people living in the home and their supporters, and regular audits on care and housekeeping topics by the senior managers. We are concerned that the regular audits did not highlight the issues we are making requirements about in this report, and about comments from people living in the home such as ‘I just accept that this is how it is’ and ‘I don’t want to get anyone into trouble’, as they show some of the powerlessness felt by individuals. We found that the service delivered in the intermediate care unit is monitored by healthcare professionals from the National Health Service, and we found no evidence that people there are unhappy with the service provided. The home’s AQAA did not present an accurate picture of life in the home, as it made several statements about care such as the home providing ‘exceptional nursing care’ and people being offered ‘a choice of washing and bathing arrangements and their rights to make that decision are respected’. In our inspection report of April 2007 we highlighted several issues of concern including the need to seek advice about the cleaning of commodes and about the routines and practices in the home, to make sure that people in the home have as much control and choice over their daily lives as possible. This inspection has found that these issues have not been properly addressed and that the home is not properly meeting individuals’ health and personal care needs. The home’s statement of purpose states that ‘we offer care that is of the highest standard that is tailored to meet individuals’ specific wishes and choices’ and we found evidence to show that this is not the case. Mill House Nursing Home DS0000027165.V376534.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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 1 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 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 3 Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP8 OP7 Regulation 12 Requirement That people living in the home have their health and personal care needs recognised and met by: 1. Monitoring weight and referral to healthcare professionals for advice when weight is outside recommended levels. 2. Identifying the frequency of people’s personal care needs about bathing or showering and taking steps to meet the needs. 3. Having appropriate facilities and aids available to make sure people’s health and personal care needs are met. That the home makes arrangements to implement the Department of Health’s advice about the cleaning of commodes to make sure that people in the home are protected from infection. That the home reviews the staffing arrangements to make sure that there are enough staff members available at the times suitable for people in the home DS0000027165.V376534.R01.S.doc Timescale for action 31/07/09 2 OP26 13 (3) 30/09/09 3 OP27 18(1)(a) 30/09/09 Mill House Nursing Home Version 5.2 Page 26 4 OP30 18(1)(C) to exercise their choice about personal care. That the home provides training for staff members about infection control, about safeguarding and about meeting the nutritional requirements of people living in the home. 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mill House Nursing Home DS0000027165.V376534.R01.S.doc Version 5.2 Page 27 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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