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Inspection on 24/11/05 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 24th November 2005.

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

What has improved since the last inspection?

A group of residents said that the food was excellent, and the cakes were out of this world.

What the care home could do better:

The whole care planning process needs to be reviewed to ensure that all of the residents` care needs are met, especially as changes occur. Risk assessments need to be carried out on a systematic basis for all residents. The programme of activities needs to include a seven-day diary, rather than the three days provided at the moment.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Philippa MacMahon Unannounced Inspection 09:40 24 November 2005 th 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.V260569.R01.S.doc Version 5.0 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.V260569.R01.S.doc Version 5.0 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 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.V260569.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. Date of last inspection 17th May 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. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the second to take place in the inspection year. The inspector spent a good deal of the time talking to staff, residents and visitors to ascertain their views on the service provided. Care plans were examined and the inspector met with the residents to ensure that the care plans matched the individual’s care needs, and that these are being met. What the service does well: What has improved since the last inspection? What they could do better: The whole care planning process needs to be reviewed to ensure that all of the residents’ care needs are met, especially as changes occur. Risk assessments need to be carried out on a systematic basis for all residents. The programme of activities needs to include a seven-day diary, rather than the three days provided at the moment. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 6 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.V260569.R01.S.doc Version 5.0 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.V260569.R01.S.doc Version 5.0 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 the following standard(s): None of these outcomes were examined on this occasion as they had been addressed at the previous inspection in this inspection cycle. EVIDENCE: Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 10 Every resident has a care plan in which their assessed needs are identified and the action required to meet those needs. The care planning system is not complete and needs to be reviewed. Risk assessments are not being carried out in a systematic way. The residents are treated with dignity and respect. EVIDENCE: A sample of care plans was examined and, on the whole, the assessed care needs are identified and the action required to meet those needs. However, when there were any changes in the residents’ care needs these were found in the daily record and not uplifted onto a care plan. This could lead to appropriate care not being given. 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. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 10 A short stay residents’ care plan was incomplete in that there was no risk assessment for moving and handling, or the prevention of pressure wounds when the person was assessed as being at risk. One of the care plans examined had not been updated since July 2005. This is not good practice and it is a recommendation that the care plans should be reviewed monthly. The inspector observed staff assisting the residents during the course of the inspection. On each occasion the member of staff showed that they understood privacy and dignity issues by the way they talked to the residents, and by always knocking on the door before entering a room. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14. The activities provided are limited, and need to be addressed. There is good contact with family and friends. EVIDENCE: There is an activities co-ordinator who visits the home three days a week. On these occasions those residents wishing to can take part in various activities such as making Christmas crackers and gifts. A number of residents spoken to said that this was enjoyable but that the rest of the week was very dull and boring with nothing to do. When asked, one resident expressed a wish to go into town in a wheelchair to get some fresh air. It is recommended that the registered manager should look into ways of providing activities on the other four days of the week when the activities co-ordinator is not visiting the home. Family and friends were visiting the home at the time of the inspection and, without exception, they said that they always felt very welcome and enjoyed their visits. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 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 the following standard(s): None of these outcomes were assessed on this occasion. EVIDENCE: Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 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 the following standard(s): None of these outcomes were assessed on this occasion. EVIDENCE: Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 14 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): 29 The home’s policies and procedures for staff recruitment are in place. EVIDENCE: The inspector examined the home’s recruitment policies and procedures at the previous head office earlier in the inspection year, and found them to be up to date and complete. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 15 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, 35 The registered manager is qualified to run the home. Individual resident’s financial interests are safeguarded. EVIDENCE: The registered manager has recently achieved the NVQ Managers award, and is to be congratulated on this achievement. The resident’s individual money is kept in plastic wallets in the home’s safe, and receipts and records are kept of all transactions made. Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 16 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 17 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. 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. 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. • Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 18 2 OP8 3 OP12 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 all the residents. • It is further recommended that all residents admitted to the home, either on a long or short stay basis, should have risk assessments carried out for moving and handling, prevention of pressure wounds and nutrition. 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. • Mill House Nursing Home DS0000027165.V260569.R01.S.doc Version 5.0 Page 19 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.V260569.R01.S.doc Version 5.0 Page 20 - 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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