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Inspection on 17/05/05 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 May 2005.

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.

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

What has improved since the last inspection?

The leadership of the staff team by the registered manager has improved as she has gained experience and confidence in the role.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxon OX28 1HY Lead Inspector Philippa MacMahon Announced 17 May 2005 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 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 H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mill House Nursing Home Address 32 Bridge Street, Witney, Oxon, OX28 1HY Telephone number Fax number Email 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 Mr Samuel David Wilson, Crown Nursing Homes 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 H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over. Date of last inspection 02 September 2005 Brief Description of the Service: Mill House is an old house in the market town of Witney, Oxfordshire. 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 home is furnished to a high standard and provides a comfortable home with a small safe garden The home is part of a group of five care homes within Oxfordshire and is managed from a corporate head office in Standlake. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and the inspector was able to meet with residents, staff, relatives and members of Crown Homes senior management team. Pre-inspection documents had been completed by the registered manager, and 11 completed residents’ comments cards, four relatives’ comment cards and one GP comment card also formed part of the inspection. Care plans were examined and the inspector was able to meet with the residents, read their care plans and see if their care needs were being met. A tour of the premises took place, and examination of records required by regulation. What the service does well: What has improved since the last inspection? The leadership of the staff team by the registered manager has improved as she has gained experience and confidence in the role. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 6 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. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Any person admitted to the home will have their needs assessed and know that these will be met. EVIDENCE: Before any person is admitted to the home the registered manager carries out a pre-admission assessment and documents this on the home’s needs assessment form. This information forms the basis for care planning and each of the residents has a pre-admission assessment document within their care plan folder. Relatives, significant carers and professionals are all involved in the process of gathering relevant information. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9. The residents’ health care needs are identified and met. The medication systems, policies and procedures are in place and in accordance with required regulations and guidelines. Residents are able to administer their own medication where appropriate and safe, and following an assessment of their suitability to do so. EVIDENCE: A sample of three care plans were examined and found to be comprehensive. They gave a clear picture of the residents’ care needs and how these will be met. Monthly reviews of the care plan are documented within the care plans, and risk assessments in relation to the prevention of falls. The inspector also met and talked to the residents whose care plans she examined and each of them reflected what was written in the care plans. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 10 Two relatives spoke very highly of the standard of care provided and held the staff in high regard. The registered nurses carry out assessments in relation to the prevention of pressure sores and are able to obtain suitable equipment to support this aspect of the care provision. Nutritional assessments are undertaken using a nationally recognised method, and examination of these showed that, where there is a small loss in weight, additional food complements as recommended in the guidelines have not been given. A good practice recommendation is that the registered nurses should follow through the guidelines for using the “MUST” method of assessment of nutritional status, to ensure the well being of the residents. One of the relatives had commented on the relatives/visitors comment card supplied by Commission for Social Care Inspection that a physiotherapist is much needed. The company employed their own physiotherapist but at the moment this post is vacant, and they are actively recruiting into it. In the interim should there be a need for immediate treatment the GP would arrange for this to take place. The residents are encouraged to walk if they are able, and the inspector observed a number of residents being assisted by the staff to walk to the dining room for lunch. Wherever possible the residents are encouraged to eat lunch in the dining rooms. The registered manager enables the residents to have access to dentist, GP, specialist nurses, pharmacy, chiropody and hearing and sight tests should it be required. The medication administration system used by the home is in the process of being changed, and the management of the changeover has been well thought through by the registered manager, to ensure a safe administration of all medicines. One of the residents wishes to self administer her own medicines, and the registered manager discussed with the inspector the process that should be in place to ensure that this is appropriate and safe. Appropriate policies and procedures for dealing with medicines are in place. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15. That the food provision is adequate to meet the nutritional needs of the residents, but is lacking in variety and quality. EVIDENCE: A number of residents were spoken to during this inspection and each of them expressed the view that the quality of the food was not up to their expectations. The comments were that there were no fresh green vegetables, only root vegetables or frozen. There is little variety on the menu, and a lack of fresh fruit. One resident said “We have nothing else to look forward to other than our meals and these are disappointing”. There were positive comments about lovely cakes and suppers; it was just the main meal of the day that was lacking. The cook confirmed that the menu had not been changed for a long time, and that she is not able to order fresh green vegetables. Fruit is in the cold store if anybody asks for it but it is not offered during the normal course of the day. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18. Residents and relatives know how to access the complaints system should they need it, and know that any concerns will be dealt with in a timely manner. Residents are able to take part in the civic process. Residents are protected from abuse. EVIDENCE: There have been no complaints since the last inspection. The home has a clear complaints system and a copy is displayed in the home and in the service users’ guide. A relative spoken to during the inspection was aware of the complaints system and how to access it. The general election had just taken place and those residents wishing to were assisted to vote using the postal vote system. Staff spoken to are aware of issues of abuse and the protection of the residents. All new staff receive training in this subject as part of their induction training. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26. The premises are attractive and well looked after, and provide a comfortable homely place for the residents to live in. The use of a male urinal to empty catheter bags for female residents is both demeaning, and a risk to health and safety as the container is only rinsed and left wet on its side. A good practice recommendation is listed in the appropriate section of this report. I EVIDENCE: The home is located in the centre of Witney town, and accessible to the shops and services. The home is very well laid out and suitable for its purpose, and the quality of the fabric and decoration of the premises is of a high standard throughout. There is an ongoing programme of routine maintenance and renewal of the fabric and decoration. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 14 The grounds are tidy, attractive and accessible to the residents. All areas of the home were found to be clean and hygienic, and one of the relatives visiting said that there were never any odours and this was why he chose the home for his mother. The laundry was clean and tidy, and there are hand washing facilities available in all areas of the home including the laundry, sluice, bathrooms and toilets. One of the shared en-suite rooms contained a male urinal and the registered manager explained that the purpose of this was to empty catheter bags when they become full. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30. The company is proactive in the provision of training and employs a senior nurse in the role of clinical practice development nurse. The staff are all trained and competent to do their jobs. Staff recruitment is carried out centrally and the inspector will visit head office to look at staff files and the systems involved in making sure that good appointments are made. EVIDENCE: Staff rosters were examined and found to have the appropriate number and skill mix required to meet the care needs of the residents. No agency staff are used at the present time as there is a full complement of staff, including domestic staff. All staff are involved in training and development and working towards NVQ Level 2 and other awards. Records of all staff training are kept in the home. The training programme is developed by the clinical practice development nurse and rolled out across the homes. Training is provided locally and is very much based on practice within the homes, which makes the learning much more relevant. All staff receive induction training before working in the home unsupervised. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37, 38 The home is well managed by the registered manager with support from her deputy and the responsible individual from head office. The only system of supervision in place is informal and there is no supporting documentation. There are safe working practices in place that are supported by good record keeping. EVIDENCE: The registered manager is undertaking her registered manager’s award and is well on the way to completing it. A new deputy is in post who is also undertaking the registered manager’s award. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 17 There are very clear lines of accountability within the home and this was apparent from talking to the staff, residents and relatives. The registered manager has the respect of the residents, staff and relatives, who all spoke highly of her approachability and openness. Staff supervision occurs informally as part of normal working, and no supporting documentation is kept of the interactions. Crown Homes is looking at different models of supervision before deciding on the best way forward for its staff. A poster was on the staff noticeboard advertising a workshop on the topic of staff supervision that is being held locally. It is hoped that a number of staff will attend and this will help to form a way forward. All records required by regulation are kept secure, up to date and in good order. All staff receive mandatory training in fire safety, moving and handling and food hygiene. There are two staff with up-to-date first aid training, and the rest of the shifts are covered by registered nurses who the company considers are competent to provide first aid. The inspector examined the service documents required to ensure the health and safety of residents and staff and found them to be up-to-date and complete. Appropriate risk assessments into safe working practices have been documented. Food storage and preparation areas are all in accordance with required environmental health directives. Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 N/A 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x x 2 x 3 Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 19 no Are there any outstanding requirements from the last inspection? 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 Regulation None 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 8 Good Practice Recommendations A good practice recommendation is that the registered nurses should follow through the guidelines for using the “MUST” method of assessment of nutritional status, to ensure the well being of the residents It is recommended that a review of the menus and food provision is made with the help of the residents and staff. It is strongly recommended that the use of male urinals for emptying catheter bags should cease, and an alternative container that is easy to sterilise be put into use for this purpose. 2. 3. 15 26 Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill House Nursing Home H57-H08 S27165 Mill House V219067 170505 Stage 4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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