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Inspection on 24/07/08 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 24th July 2008.

CSCI found this care home to be providing an Good 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 told us that the best thing about the home was the staff, as they were very helpful and caring. People said that the food was good, and they liked seeing the chef to discuss meals. They liked the improved garden. The regular newsletter helps keep people in touch with what is happening in the home. The good working relationships between the home and the primary care team in the intermediate care unit help people regain independence and return home as soon as possible. People said they could approach the manager to discuss any issues if they wanted to, and believed they would be listened to.

What has improved since the last inspection?

Major improvements have been made to the environment of the home while the home was closed. All areas of the home have been newly decorated; new curtains and new furniture installed both to the communal areas and bedrooms, and new carpets have been provided. New adjustable beds have also been provided. A new kitchen with new equipment has been installed, and new laundry equipment provided. A new nurses` office has been created, and the medication has been relocated to the new office. A new fire alarm and nurse call system has been installed. There is a new computer and telephone system, and an administrator is employed. The garden and patio area has been enlarged and also provides improved access for people using wheelchairs. A new manager has been recruited, and more staff members are being recruited. A new activities coordinator is employed and there is a programme of monthly activities developed with people living in the home. Regular meetings are held to make sure that people living in the home have their say about how the home is run.

What the care home could do better:

The new manager is aware of the need to improve care planning, so that people are cared for as they want to be cared for.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Kate Harrison Unannounced Inspection 24th July 2008 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mill House Nursing Home DS0000027165.V365452.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.V365452.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) Vacant 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.V365452.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 29th January 2008 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 garden. Mill House and other properties in the vicinity suffered severe flooding during extreme weather experienced at the end of July 2007. Mill House residents and staff were evacuated to other care homes in the area, and in May 2008 the home was reopened after major refurbishment. The fees range from £547 to £800 per week. Mill House Nursing Home DS0000027165.V365452.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 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’, and took place over 6.5 hours on one day. 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 judgments about the outcomes for the people living in the home. It took into account detailed information provided by the home through the Annual Quality Assurance Assessment, (AQAA) and any information that we received about the home since the last inspection. We saw those areas of the home used by people living there and looked at records and documents relating to their care, including staff members training records and management of medication. We asked the views of people living in the home about the quality of the service through surveys we sent to the home. As the home was newly reopened at the time, and people had not been living there long, the manager decided not to distribute the surveys to them. We therefore spoke to several people living in the home to get their views about the quality of the care provided, and their views are reflected in this report. We spoke to other people including the new manager, care staff, the chef, and with people visiting the home on the day. We spent time observing care practice and the routines of the home to see what life is like for the people living there. What the service does well: What has improved since the last inspection? Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 6 Major improvements have been made to the environment of the home while the home was closed. All areas of the home have been newly decorated; new curtains and new furniture installed both to the communal areas and bedrooms, and new carpets have been provided. New adjustable beds have also been provided. A new kitchen with new equipment has been installed, and new laundry equipment provided. A new nurses’ office has been created, and the medication has been relocated to the new office. A new fire alarm and nurse call system has been installed. There is a new computer and telephone system, and an administrator is employed. The garden and patio area has been enlarged and also provides improved access for people using wheelchairs. A new manager has been recruited, and more staff members are being recruited. A new activities coordinator is employed and there is a programme of monthly activities developed with people living in the home. Regular meetings are held to make sure that people living in the home have their say about how the home is run. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are assessed before they move into the home, and measures are in place to help people admitted for intermediate care to become more independent and return home. EVIDENCE: The manager carries out a pre-admission assessment for people who contact the home about moving in permanently. We saw the pre-admission assessments for two people recently admitted. One person had returned to the home after evacuation during the floods, and the manager had carried out a review of needs following the re-admission. The manager had visited the other individual before admission and had carried out a pre-admission assessment to see if the home could meet the care needs, using the Southern Cross organisation’s documentation. A member of the intermediate care team, a senior physiotherapist or occupational therapist, liaises closely with the manager of the home to make sure that the home can meet the needs of the people who are admitted to the Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 9 intermediate care unit. The manager assesses the available information and makes a decision to admit or not to admit. The intermediate care team provides the therapy routines to enable people to return home as soon as possible. We discussed the process with a person admitted to the intermediate care unit, and saw the mutually agreed goals designed to enable the individual to return home. The Southern Cross organisation has specific documentation: ‘Short Stay Care File’, for recording the care information for people admitted to the intermediate care unit, and the NHS also provides information about their service within the home. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living in the home are met, though personal preferences are not always documented. EVIDENCE: The home uses the named nurse and key worker system so that individuals know who is responsible for their care. Everyone living at the home is registered with a general practitioner. We saw care plans for three people, supported by risk assessments, showing what action is to be taken to minimise the risks to individuals’ health. Examples of risk assessments we saw were about falling, nutrition and pressure wounds, and some gave detailed information for the carers so that the risks to health were minimised. People told us that the staff are ‘wonderful and caring’, and that the best thing about the home is the staff. A healthcare professional dealing with the intermediate care unit commented that the ‘nursing care cannot be faulted’. The home uses the prepared Southern Cross documentation to record care plans and risk assessments, and there is limited scope for personalising the Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 11 care plans. The documentation asks for personal preferences for some activities, for example about where to eat, but not about bathing or showering preferences. The care plan information for care staff about one individual’s personal care directed them to offer the individual a bath or shower once a week, and a wash daily. There was no information about the individual’s preference for weekly bathing, and this issue needs to be addressed, so that the personal care preferences of people living at the home are known and respected. The manager said she was addressing the outdated care practices of some staff with supervision and training, and the AQAA shows that care planning training in the ‘person-centred’ approach is planned. The medication has been moved to a different room, and the temperature is monitored to make sure that it is stored appropriately. New equipment including cupboards, a medicines fridge and medicine trolleys have been provided. The receipt of medication is recorded, and a contract is in place for the appropriate disposal of medication. Medication is delivered monthly from a high street pharmacy, and the home is able to seek advice and clarification about particular medication from the pharmacy whenever necessary. We looked at the arrangements for managing medication for three people, and saw that the medication administration records were fully completed and that the controlled drugs were managed well. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have a say about how the home is run, and have opportunities to take part in activities within the home. EVIDENCE: The home employs an activities coordinator, who was attending a course about activities on the day of our visit. She asks the views of people living in the home about their preferences, and also encourages men to put forward suggestions for activities to suit them, as the majority of people living in the home are female. Activities are planned regularly and events for July included cream tea in the garden, bingo twice during the month, a film afternoon, a curry night and craft sessions. The hairdresser visits regularly, and people living in the home have an opportunity to attend a Christian religious service monthly. The home has the use of a minibus for trips out, but needs an appropriate person qualified to drive it, so it is not used. The AQAA shows that this is part of the improvement planned for the coming months. Meetings are held regularly so the people living in the home can have their say about matters affecting them, and can contribute to the regular newsletter. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 13 A group of people in the dining room agreed that daily life was ‘ok’, and said that they liked the improved garden. The organisation has designed a menu system so that meals at the home are nutritionally well balanced. People can choose their meals from a menu and there is also a monthly opportunity to design a menu for the day. They have a choice about where to eat, and the dining room is well presented with several tables seating four people. The majority of people who commented about the quality of the food said it was good, and some said it was very good. Visitors are welcome at the home, and several were at the home during our visit. Mill House Nursing Home DS0000027165.V365452.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home know how to complain if they need to, and they are protected from harm through the home’s safeguarding systems. EVIDENCE: The home’s complaints procedure is available in the entrance hall, and a record of complaints is kept. People said they knew what to do if they were unhappy with the service at the home, and the manager is available regularly to discuss issues arising. We received information about one complaint recently, and this has been recorded and addressed in a timely way. A requirement was made at the 2007 inspection that training be provided for staff about safeguarding people from harm. When the home closed in July 2007 the staff team were dispersed to other homes within the group. Some staff have not returned and others have been recently recruited. Of the 26 people now employed at the home six have attended training on the protection of vulnerable people in the past year, apart from introductory training, and a training date is organised soon to make sure that all the staff members have appropriate training. The manager has recently attended safeguarding training. The manager is aware of the local codes of practice when responding to allegations or suspicions of abuse, and introductory training for new staff about safeguarding vulnerable people and how to respond is provided. . Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 15 Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is newly decorated and refurbished, clean and well maintained, and provides a comfortable homely place for the people who live there. EVIDENCE: People we spoke to who live in the home said the home was comfortable and homely. Signage has improved and it is easier for people to know where they are in the home as areas are clearly named. The home has been renovated and refurbished during the past year, including new carpets throughout the home. The bathrooms have been upgraded, though one is not functioning properly. New equipment has been provided in the bathrooms, including a bath with integral hoist on the ground floor. The sash windows have been upgraded and are fitted with locks. The intermediate care unit has separate accommodation and communal areas, including an area where people can prepare drinks to prepare for independence. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 17 The garden has been extended and now provides improved access, more space for people living in the home and raised flower beds. There is a full time person responsible for maintenance, and there is a good system in place to make sure that repairs are carried out in a timely way. The home’s laundry is managed in the home’s laundry room, by a dedicated person. Gloves, aprons and hand gel are provided to minimise the risk of infection. Several staff members have attended infection control training, and it is planned for all the staff team to have the training. The AQAA shows that the home intends to install mechanical sluices over the next 12 months to minimise the risk of spreading infection. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team is being carefully formed to make sure that the needs of people living in the home are met. EVIDENCE: People told us that the best thing about the home was the staff team, who were ‘very helpful and caring’. There is a staff rota showing that there is a mix of skilled staff available over the 24 hours. Some people commented that the staff were very busy and worked very hard, but that there were not enough employed at the home. The manager explained that not all the staff returned to the home after reopening, and that there had been difficulties with recent recruiting. She said that four new people were currently going through the recruitment process, and that they would join the team as soon as the recruitment process was completed. There is an understanding that it is important to recruit suitable people for the home, and this may take some time. The organisation encourages staff to enrol on National Vocational Qualification (NVQ) training in care, and has an NVQ coordinator to manage training across the organisation. At present, apart from the nurses, three people working at the home have NVQ Level 2 in Care and one more is enrolled on the course. Some care staff members are not eligible to enrol on the training. The home’s induction programme is to the appropriate standard, and new staff complete workbooks to demonstrate their understanding of the subject. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 19 The home has a training programme and is making progress in providing all the necessary training for the new team. The manager works from a matrix, and is aware of what training the team needs. We looked at three recruitment files to check the home’s recruitment procedure. The administration of the recruitment process is carried out by a department of the organisation, and an arrangement is in place to keep information about staff Criminal Record Bureau (CRB) certificates at the department’s office. The manager is able to access information about CRB clearance through the organisation’s system. All of the files had proof of identity, photographs and date of clearance regarding the POVA list (the list of people banned from working with vulnerable people). The manager has made clear in the AQAA that the aim for the future months is to continue with staff training and to integrate new staff into the team through staff training and supervision. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people living there. EVIDENCE: There is currently no registered manager for the service but the manager was appointed recently and is currently going through the process of becoming the registered manager with the Commission. She has managed other care homes in the past and holds the Registered Manager’s Award. A deputy manager has also been appointed to help manage the home with an emphasis on improving clinical practice. Since reopening in May 2008 the manager has started some monthly audits to assess the quality of the service, and a senior manager from the organisation visits unannounced every month to carry out a quality review exercise Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 21 including the views of some people living in the home. This month the annual quality review, including surveys to people living in the home and their relatives, was carried out and results are coming in to be collated. It is intended to publish the results in the home’s newsletter. The organisation has introduced an improved way of managing petty cash kept for people living in the home, and now this is kept in separate bank accounts by a high street bank. The home’s fire risk assessment was carried out by the Facilities Department of the organisation before the reopening of the home, and the manager said that evacuation plans are in place. More evacuation equipment is being purchased. A new fire safety system has been installed and contracts are in place to make sure that maintenance is carried out regularly. We saw the recent records about fire safety including the emergency lighting system and these were satisfactory. The AQAA states that it is the intention of the manager to maintain and improve standards in the home over the next 12 months. Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 22 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X 3 X X 3 Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill House Nursing Home DS0000027165.V365452.R01.S.doc Version 5.2 Page 25 - 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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