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Inspection on 23/06/06 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 23rd June 2006.

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 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

The home is clean and hygienic, and provides a homely and welcoming atmosphere. The garden is well designed to meet the needs of the residents, and several were enjoying the fresh air and sunshine on the day of the inspection visit. All the relatives who responded to the CSCI survey said that they could see the residents in private. Residents said that the food is good, and the petty cash kept for residents is well managed.

What has improved since the last inspection?

Training for some staff in the protection of vulnerable adults and dementia care has taken place, and health and safety meetings have started.A new bath has been installed downstairs, and the dishwasher has been replaced.

What the care home could do better:

The care plans should be reviewed monthly with the staff who are involved in writing them, to ensure that the residents` ongoing care needs are always included in the care plans. This recommendation remains from the previous inspection report. The programme of activities needs to include the seven-days of the week. This recommendation remains from the previous inspection report, although now there is no activity programme, but an activities co-ordinator is expected to join the staff soon. All the residents need to be provided with a copy of the service user guide, so that prospective and current residents have all the information they need about the home. All the risk assessments used at the home need to be based on evidence, so that the care staff clearly understand the needs of the residents. The admission procedures for individuals admitted regularly for respite care need to be improved, so that all their needs are recognised on arrival and staff know what to do to meet those needs. Only one nutritional risk assessment tool should be used instead of the two used at present, so that staff are clear on how to care for the residents. All the medication received into the home must be recorded as received, and this has now been addressed by the home. Regular residents` meetings need to be considered, so that residents can discuss issues affecting their daily lives, and so that they can take an active part in exercising their choice about how the home should be run. The complaints procedure used in the home needs to be changed to the procedure included in the service user guide, so that residents and the public will know that they can verbally complain to senior staff and can expect their complaint to be appropriately recorded and taken seriously. The central heating needs to be repaired, and safety valves need to be fitted to all residents` hot water taps so that the risk of scalding is lessened. Care staff who do not have sufficient English language skills to converse meaningfully with the residents should be helped to improve their language skills.All the necessary information about staff must be available so that only suitable people care for the residents, and the manager has now addressed this. The manager needs to know what training the care staff need to improve the service, and needs to identifying appropriate courses and encourage staff to attend. A member of staff trained in first aid needs to be on duty at all times. The home`s induction-training programme needs to be the one recommended. Communication between the home and the organisation`s senior management needs to be improved, and giving the manager the use of a computer would improve communications for the benefit of the residents.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Kate Harrison Unannounced Inspection 23rd June 2006 09:40 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.V298450.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.V298450.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.V298450.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 24th November 2005 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 home is furnished to a high standard and provides a comfortable home for the residents. The registered manager runs the home, with a team of nurses, housekeeping and care staff. The weekly fees range from £567 to £728. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.40 hours and was in the service for 8 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, 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, and there were 34 residents in the home on the day of the inspection visit. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Several residents and relatives replied, as did some health and social care professionals. From the evidence seen by the inspector, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural backgrounds, although some training may be needed. What the service does well: What has improved since the last inspection? Training for some staff in the protection of vulnerable adults and dementia care has taken place, and health and safety meetings have started. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 6 A new bath has been installed downstairs, and the dishwasher has been replaced. What they could do better: The care plans should be reviewed monthly with the staff who are involved in writing them, to ensure that the residents’ ongoing care needs are always included in the care plans. This recommendation remains from the previous inspection report. The programme of activities needs to include the seven-days of the week. This recommendation remains from the previous inspection report, although now there is no activity programme, but an activities co-ordinator is expected to join the staff soon. All the residents need to be provided with a copy of the service user guide, so that prospective and current residents have all the information they need about the home. All the risk assessments used at the home need to be based on evidence, so that the care staff clearly understand the needs of the residents. The admission procedures for individuals admitted regularly for respite care need to be improved, so that all their needs are recognised on arrival and staff know what to do to meet those needs. Only one nutritional risk assessment tool should be used instead of the two used at present, so that staff are clear on how to care for the residents. All the medication received into the home must be recorded as received, and this has now been addressed by the home. Regular residents’ meetings need to be considered, so that residents can discuss issues affecting their daily lives, and so that they can take an active part in exercising their choice about how the home should be run. The complaints procedure used in the home needs to be changed to the procedure included in the service user guide, so that residents and the public will know that they can verbally complain to senior staff and can expect their complaint to be appropriately recorded and taken seriously. The central heating needs to be repaired, and safety valves need to be fitted to all residents’ hot water taps so that the risk of scalding is lessened. Care staff who do not have sufficient English language skills to converse meaningfully with the residents should be helped to improve their language skills. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 7 All the necessary information about staff must be available so that only suitable people care for the residents, and the manager has now addressed this. The manager needs to know what training the care staff need to improve the service, and needs to identifying appropriate courses and encourage staff to attend. A member of staff trained in first aid needs to be on duty at all times. The home’s induction-training programme needs to be the one recommended. Communication between the home and the organisation’s senior management needs to be improved, and giving the manager the use of a computer would improve communications for the benefit of the residents. 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 DS0000027165.V298450.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.V298450.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not provide intermediate care. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has introduced new pre-admission assessment paperwork since the change of ownership, and the new paperwork is now used for all new admissions. The new pre-admission assessment form contains some risk assessment formats, including the evidence based risk assessment for pressure areas. It is not clear what the evidence base for other risk assessments used by the pre-admission form are, and the registered manager should make sure that all the risk assessments used are evidence based. One resident came regularly for respite care and had been admitted two days previously, but the verbally updated information regarding the admission was not recorded, and it was not clear that all the assessment information was current as the record showed that the previous admission assessment was conducted in July 2005. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 10 It is recommended that the registered manager develop a written procedure for the pre-admission assessment of individuals admitted regularly for respite care, so that all their needs are recognised and met. Feedback from the CSCI comment cards indicate that new contracts promised have not yet been provided, and the inspector understood that the written information about the home for prospective and current residents has not yet been updated to include information about the new owners. The review of the statement of purpose and the service user guide has not yet been completed to include the new owner details, although the change of ownership took place about ten months ago. To make sure that all the necessary information about the home provided to residents is current, the updating of the statement of purpose and the service user guide must be quickly completed, and a copy of the service user guide must be provided to residents. The inspector understands that this has now been addressed. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is poor, due to the lack of care planning and provision for vulnerable residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The care planning and health and welfare arrangements were assessed for three residents. One resident had been at the home for some time, and had appropriate care plans in place. Two residents had recently been admitted and care plans were not available for them. One individual had been admitted five days previously with complex health and welfare needs, and although a draft care plan had been developed at the pre-admission assessment which did not adequately address all the care issues, no further work on the care plan was recorded. The resident’s needs included sudden acute episodes, when skilled care needed to be provided quickly, but no care plan was written to help staff manage the acute episodes. The resident reported having acute episodes when staff were not able to adequately help. Although not well, a resident was experiencing difficulty trying to resolve social issues affecting the family, and not enough information was available for staff to quickly understand and Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 12 provide for the individual’s needs. The registered manager addressed this issue on the day by appointing a keyworker and by organising a meeting to coordinate care. Another individual admitted for respite care two days previously had no recent written assessment of need and had no care plans completed, so that care staff had no written information about what the needs were, or how to meet them. Comments from relatives and residents, through the CSCI comment cards, indicate that staff do not pay sufficient attention to the health needs of the residents, and that communication with staff is sometimes difficult due to language problems. No evidence was seen to show that the recommendation about monthly reviews of the care plans made at the previous inspection had been implemented, although the keyworker system in use should be used to carry out the reviews. Care plans must be written in a timely way, so that immediate care needs are met. A recommendation to use the Malnutrition Universal Screening Tool (MUST) risk assessment was made at the last inspection, and there is evidence that the tool is being used, but at the same time as another nutrition risk assessment tool, leading to confusion. For example, in one individual’s file one tool showed that, at a score of 18 , an individual was at very high risk, whilst the same individual scoring 2 on another tool was also at very high risk. Only one nutritional risk assessment tool should be used, to avoid confusion. One of the two hoists in the home was not working, and the manager said she was ordering two other pieces of equipment so that residents could be moved safely. The manager said that she was unable to access regular dental checkups for the residents, and agreed that she will seek advice from the Primary Care Trust on how to do this, so that dental health is promoted. Medication was brought into the home during the week for two individuals and was not recorded as received in, and all medication received into the home must be recorded as received. The medication administered to residents and disposed of is appropriately recorded, although the recording of controlled drugs was not complete. The inspector understands that the recording of medication has now been improved to meet legislation. Residents said that the staff are respectful to them, and that their privacy is respected. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Planned activities are lacking and there was no plan for organised activities for the residents during the month. The registered manager said that the process for recruiting an activities organiser was in hand, and hoped that soon an organiser would be in post. Feedback from residents showed that organised trips out have not taken place this year, and one resident said that she/he has to rely on family for trips outside the home. Residents are able to see visitors in private at all reasonable times. Residents’ financial affairs are not managed by the home, and are managed by relatives or by social services when the resident is unable to do so. Residents have a choice of home cooked food including fresh vegetables, and can eat in one of the three dining rooms. Residents said that the food was good on the day of the inspection visit, and the menus are being reviewed in consultation with the residents. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: One complainant has recently contacted the Commission with information concerning the home, and the issues have been passes to the registered manager to investigate and respond to the Commission, as the complainant wishes to remain confidential. Some residents said that they knew who to complain to, but the complaints procedure that is displayed in the home states that complainants need to put their concerns in writing. The procedure should take into account that several of the residents may not be able to do this, or have relatives able to write on their behalf. The complaint procedure included in the service user guide is appropriate and should be displayed and used in the home, so that residents and the public will know that they can verbally complain to senior staff and can expect their concerns to be appropriately recorded and taken seriously. Staff members receive training on how to protect vulnerable adults from abuse, and policies and procedures referring to Oxfordshire’s multi-agency codes of practice are available to support staff. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home is comfortable and homely, and generally the décor is in good order. Staff members record the maintenance issues they discover and the maintenance manager addresses these on an ongoing basis. Rooms are usually redecorated before a new resident arrives, and this was happening on the day of the inspection visit. Regular audits are carried out on maintenance issues, such as the window restrictors and the bed rails, to ensure that they remain fit for purpose. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 16 Several comments from residents and relatives from the CSCI survey showed that it can take a long time for some maintenance issues, such as a recent problem with the front door, to be addressed. The inspector understood that the central heating on the ground floor has not worked for several months, and it is not clear what is being done to fix it. The registered manager should take action to have the central heating repaired. The inspector also understood that thermostatic valves are not fitted to residents’ private and communal hot water outlets, and that the water temperature of the boiler is adjusted when the temperature at the outlet is too high. This is not good practice, and thermostatic valves should be fitted to all residents’ hot water outlets so that the risk of scalding is lessened. Storage is a problem at the home, and this leads staff to store items such as flower vases in inappropriate areas, such as on the floor of the sluice room. The registered manager is looking for ways to improve storage space, especially for wheelchairs. There are good systems in the laundry, helping to minimize the spread of infection. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home’s staffing rota shows that a registered nurse is always on duty, and that six carers are usually on duty during the mornings, with four usually on duty in the afternoons and evenings. The majority of residents who responded to the CSCI survey said that they ‘usually’ received the care and support they needed, whilst the majority of relatives felt that there were not always sufficient staff on duty. The recruitment of an activities organiser will improve the staffing situation and will improve outcomes for residents. Comments were also made about several care staff not having sufficient English language skills to converse meaningfully with the residents, and the registered manager should take action to address this issue. The home has not yet reached the 50 level of care staff with NVQ qualifications, and is making slow progress. One member of the 17 care staff complement holds NVQ Level 2, and six other members of staff who are qualified nurses overseas are regarded by the home as equivalent to NVQ qualified, although this has not been verified. Two nurses are undertaking assessor training and four members of the care staff intend to start the NVQ training soon. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 18 The recruitment procedures show shortfalls in acquiring authentic references and appropriate checks for care staff, and this means that the home is placing vulnerable residents at risk. Two ‘To Whom It Concerns’ references and another unverified reference were seen in the staff files assessed, and one member of staff did not have an appropriate criminal record check. The registered manager must not employ a person to work at the home unless she has obtained all the necessary information about that person, and is satisfied on reasonable grounds as to the authenticity of the references. This issue has been addressed appropriately since the inspection visit. The home has an induction training programme, but it is not clear that it is in line with the Skills for Care programme, which leads on to the NVQ programme, and the registered manager should take action to make sure that it is an appropriate training. The home has a training matrix showing what training has been provided for staff. The matrix shows that most staff have attended mandatory training, although the fire lecture is overdue. The manager agreed to arrange a date for this training as soon as possible. Some members of staff have attended abuse and dementia care training, but most staff have not attended other care training such as infection control, nutrition or wound care. It is not clear that staff are encouraged to attend training, or what the staff training needs are. Residents’ comments from the CSCI survey show that members of staff do not always quickly understand their care needs, and this indicates that staff training needs to be improved. The registered manager should carry out a training needs audit for care staff, and should identifying appropriate courses and encourage staff to attend. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The registered manager achieved the Registered Manager’s Award in 2005 and has been running the home since 2003. Until the home was taken over last year, the previous management was very involved in the day-to-day running of the home. This resulted in the registered manager not being able to appropriately develop her management skills, and the new management has different expectations of the registered manager. Comments from the residents and relatives suggest that management support for the registered manager is weak, resulting in the leadership of the home suffering. Examples of poor support include the long wait for an updated service user guide and statement of purpose, long delays before key maintenance issues are addressed and new contracts promised for the residents not being delivered. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 20 The responsible individual should take action to improve the lines of communication between the home and the organisation’s senior management. The use of a computer for the registered manager would improve communications, and would enable her to easily obtain information regarding best practice for the benefit of the residents. The home’s quality assurance system is developing, and recently monthly surveys to residents have started, although results have not yet been collated. The unannounced monthly visits to the home from the organisation’s senior management have recently restarted, and this should improve the quality of life for the residents. Residents meetings are not organised, although relatives meet twice a year. The registered manager should consider organising residents’ meetings so that issues affecting their daily lives can be discussed, and so that the residents can take an active part in exercising their choice about how the home should be run. The residents’ petty cash is kept safely and is appropriately recorded. The registered manager has completed a health and safety course, and meetings are held to identify issues that need attention, although issues such as fire training are not addressed in a timely way. It is not clear that sufficient staff are trained in first aid, especially at night, to cover all shifts, and the registered manager should make sure that a staff member trained in first aid is on duty at all times. Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 3 2 X X X X X X 3 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 2 X 2 X 3 X X 2 Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP7 Regulation 5 15 Requirement A copy of the service user guide must be provided to residents. The registered manager must ensure that care plans are written, in consultation with the resident, including those admitted for respite care, in a timely way, so that all their needs are met as soon as possible after admission. Timescale for action 31/07/06 31/07/06 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 OP7 Good Practice Recommendations It is a recommendation that the care planning process should be reviewed with the staff who are involved in writing them to ensure that the residents’ ongoing care needs are always included in the care plans. It is a recommendation that the care plans should be reviewed monthly. These recommendations remain from the previous inspection report. DS0000027165.V298450.R01.S.doc Version 5.2 Page 23 Mill House Nursing Home 2. OP12 It is recommended that the registered manager should look into ways of providing activities on the four days of the week when the activities co-ordinator is not visiting the home. This recommendation remains from the previous inspection report. The registered manager should make sure that all the risk assessments used at the home are evidence based. The registered manager should develop a written procedure for the pre-admission assessment of individuals admitted regularly for respite care, so that all their needs are recognised and met. Only one nutritional risk assessment tool should be used, so that it is clear to staff how to meet the needs of the residents. The complaints procedure included in the service user guide should be displayed and used in the home. The registered manager should ensure that thermostatic valves are fitted to all residents’ hot water outlets so that the risk of scalding is lessened. The registered manager should take action to make sure that all care staff have sufficient English language skills to converse meaningfully with the residents. The registered manager should carry out a training needs audit for care staff, and should identifying appropriate courses and encourage staff to attend, so that the staff team can meet the needs of the residents. The registered manager should take action to make sure that the home’s induction training programme is to the Skills for Care specification. The responsible individual should take action to improve the lines of communication between the home and the organisation’s senior management. The responsible individual should consider providing the registered manager with the use of a computer, as this would improve communications, and benefit the residents. 3 4 OP3 OP3 5 OP8 6 7 OP16 OP25 9 OP27 10 OP30 11 OP30 12 13 OP31 OP31 Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 24 14 OP33 The registered manager should consider organising residents’ meetings so that issues affecting their daily lives can be discussed, and so that the residents take an active part in exercising their choice about how the home should be run. The registered manager should make sure that a staff member trained in first aid is on duty at all times. 15 OP38 Mill House Nursing Home DS0000027165.V298450.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, 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 DS0000027165.V298450.R01.S.doc Version 5.2 Page 26 - 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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