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Inspection on 29/01/08 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 29th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

At the last inspection we found that the garden was well designed to meet the needs of residents, residents said the food was good, residents communication books were well used where residents and relatives could record issues needing attention from staff and recruitment practice was good

What has improved since the last inspection?

Since the last inspection the home took appropriate action to respond to the statutory requirement notice. As the home is not operational and there are no residents living in the home we unable to say what else has improved since the last inspection.

What the care home could do better:

At the last inspection we found that the home needed to improve in the following areas; the routines and practices need to be considered to make sure that residents have as much control and choice over their daily lives as possible, the weekly activity schedule needs to include a range of activities suitable for both male and female residents, and should be provided over the whole week, residents` wishes regarding bathing or showering should be discussed at the pre-admission assessment, so that the home can be sure that residents can bathe and shower as they wish and medicine must always be stored at the appropriate temperature, so that the home can be sure that the medication prescribed for residents remains effective. A reliable system of recording and addressing complaints should be in place, so that residents can be sure that their complaints are recorded and addressed within appropriate timescales. We also found that the sash window in the assisted bathroom needed to be repaired and regular window cleaning needed to be organised, the home needs to make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff and to seek advice about the best way of cleaning the commodes on the top floor. The home needed to make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents with dignity and respect. The training on safeguarding vulnerable people needed to be offered to all care staff members. The quality assurance system should be assessed for effectiveness, as it may be more effective to quantify results through annual or twice annually comprehensive surveys.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Catherine Kane Unannounced Inspection 29th January 2008 11:15 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.V356064.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.V356064.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.V356064.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 12th July 2007 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. Mill House and other properties in the vicinity suffered severe flooding during extreme weather experienced at he end of July 2008. Mill House residents were evacuated to other care homes in the area. The home is currently closed while major repair and building work is being undertaken. The provider organisation expects building works to be complete and the home open for business by April 2008. The weekly fees ranged from £567 to £900.48 at the time of the last inspection, 11th April 2007. Mill House Nursing Home DS0000027165.V356064.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and carried out by one inspector. The visit to the home took less than one hour as we, the commission for social care inspection, found the home was closed for business while major repair and building work was being carried out. We spoke with the registered person responsible for this home by telephone on 31st January 2008, who provided updated information about the planned reopening of the home. This report takes into consideration information we have gathered since the last key inspection of 11th April 2007 and includes information that the provider organisation has given us and what we found when we made a follow up visit to the home on 12th July 2007. At the last inspection we found that the people who lived in this home experienced poor quality outcomes overall. We took enforcement action and a statutory requirement notice was made for the home to make improvements. An improvement plan was also requested and this was completed and returned to us by the organisation. As the home was not operational and had no residents living in the service we have not been able to fully test key national minimum standards or to find evidence that requirements and recommendations have been met and other improvement have been made. Therefore, requirements and recommendations made in this report are as outlined in the report dated 11th April 2007. Timescales for the service to make improvements to meet requirements made at the last inspection, where we have been unable to find sufficient evidence that they have been met, have been extended accordingly. It is recommended that the last inspection report be read in conjunction to this report. What the service does well: What has improved since the last inspection? Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 6 Since the last inspection the home took appropriate action to respond to the statutory requirement notice. As the home is not operational and there are no residents living in the home we unable to say what else has improved since the last inspection. 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.V356064.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.V356064.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 adequate. This judgement has been made using available evidence including a visit to this service. Some improvements were found to have been made to how the home carries out pre-admission assessment of health and welfare needs for people admitted to the home. These standards could not be fully tested as the home was not open for business and no residents were living in the home. Standard 6 would not be assessed as this home as this home does not provide intermediate care. EVIDENCE: Following the last key inspection a statutory requirement was made for the home to make improvement to how the home carries out pre-admission assessments. In the improvement plan the provider organisation stated that all potential residents will have a completed, comprehensive pre-admission assessment and a letter to confirm that the home can meet the individuals care needs prior to admission to the home. They also stated that the operations manager will audit this at least monthly. At the follow up visit Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 9 carried out on 12th July 2007 we saw the pre- admission needs assessments for two people admitted to the home. From this evidence we were satisfied that the requirement was met. Mill House Nursing Home DS0000027165.V356064.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 adequate. This judgement has been made using available evidence including a visit to this service. Some improvements were seen to have been made to the care planning system used in the home. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: Following the last key inspection a statutory requirement was made for the home to make improvements to how the home develops care plans and risk assessments in order to ensure that individual care needs are met. In the improvement plan the provider organisation stated that this would be done and random plans would be audited by the home manager and operations manager monthly as part of ongoing quality assurance programme. At the follow up visit carried out on 12th July 2007 we saw the care plans for two people living in the home. From this evidence we were satisfied that the requirement was met. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 11 As the home was not operational we have not been able to see evidence that further requirements in relation to the skills and competence of staff who carry out assessments of healthcare needs and how residents medicines are stored made at the last key inspection have been met. We have not been able to see evidence that good practice recommendations made in relation to the skills and competence of staff who undertake nutritional assessments for residents, how residents wishes for their personal care preferences are met and how the home carries out checks for the temperature record in the medicines storage area have been considered. Therefore, these requirements and recommendations have been carried forward to this report with timescales, where set, amended accordingly. Mill House Nursing Home DS0000027165.V356064.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 adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection while we found that the home provided good food and a variety of activities, the residents have limited control over routines in the home, and therefore little control over their daily lives. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: As the home was not operational we have not been able to see evidence that good practice recommendations made in relation to the weekly activity schedule including a range of activities suitable for both male and female residents and that the routines and practices in the home give residents as much control and choice over their daily lives as possible have been considered. Therefore, these recommendations have been carried forward to this report. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection we found that residents could not be sure that their complaints would be addressed appropriately. We also found that insufficient numbers of staff had been trained in safeguarding vulnerable adults for the home to be certain that residents would be safe. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: As the home was not operational we have not been able to see evidence that requirements in relation to the system for recording and considering complaints made are addressed and that all care staff have received training in safeguarding vulnerable adults made at the last key inspection have been met. Therefore, these requirements have been carried forward to this report with timescales amended accordingly. The commission has received no complaints about this service since the last inspection. The commission has been made aware of one issue that the home has been referred appropriately though the local multi agency safeguarding adults procedures since the last inspection. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection we found that improvements had been made to the home’s environment but poor practice in the home puts residents at risk due to poor recognition of fire and safety risks. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: As the home was not operational we have not been able to see evidence that requirements in relation to the audit to assess the safety of the sash windows and repairs or replacements carried out to minimise the safety risks to residents and staff and if advice had been sought about the cleaning of commodes on the top floor and the risk of spreading infection minimised made at the last key inspection have been met. We have not been able to see Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 15 evidence that good practice recommendations made in relation to the proper cleaning on a regular basis of windows and that items were stored appropriately and do not increase fire risks to residents, visitors and staff have been considered. Therefore, these requirements and recommendations have been carried forward to this report with timescales, where set, amended accordingly. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 16 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): 17, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection we found that while the home’s recruitment procedure was good, there were not enough staff with the skills and knowledge necessary to properly care for the residents. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: As the home was not operational we have not been able to see evidence that good practice recommendation made in relation to the home having enough staff members with the skills and knowledge to care for the health, welfare and safety of the residents has been considered. Therefore, this recommendation has been carried forward to this report. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection we found that the home lacks leadership and residents health and safety are at risk as a result. There was not enough evidence to be confident that the home was being run in the best interests of the residents. These standards could not be fully tested as the home was not open for business and no residents were living in the home. EVIDENCE: As the home was not operational we have not been able to see evidence that good practice recommendation made in relation to the quality assurance Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 18 system being effective has been considered. Therefore, this recommendation has been carried forward to this report. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 19 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 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 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 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1b) Requirement Appropriate staff members must be trained in carrying out the assessment of health and welfare needs for residents, so that the residents are properly cared for. This requirement remains outstanding from the previous timescale of 31/05/07. Medicine must always be stored at the appropriate temperature, so that the home can be sure that the medication prescribed for residents remains effective. This requirement remains outstanding from the previous timescale of 13/12/06 and 31/05/07. The temperature at which the medicines are stored within the office must be recorded daily, so that evidence is available that the medicines are stored at an appropriate temperature. This requirement remains outstanding from the previous timescale of 15/06/07. Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 21 Timescale for action 30/04/08 2. OP9 13 (2) 30/04/08 3. OP16 22 4. OP18 13 (6) 5. OP19 23 (2b) 6. OP19 13 (3) A reliable system of recording and considering complaints must be in place, so that residents and relatives can be sure that their complaints will be properly addressed. This requirement remains outstanding from the previous timescale of 31/05/07. Training for all care staff in the safeguarding of vulnerable people must be provided. This requirement remains outstanding from the previous timescale of 31/05/07. An audit must be carried out to assess the safety of the sash windows, and repairs or replacements carried out to minimise the safety risks to residents and staff. This requirement remains outstanding from the previous timescale of 31/05/07. The home must seek advice about the cleaning of commodes located on the top floor, so that the risk of spreading infection is minimised. This requirement remains outstanding from the previous timescale of 30/04/07. 30/04/08 30/04/08 30/04/08 30/04/08 Mill House Nursing Home DS0000027165.V356064.R01.S.doc Version 5.2 Page 22 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 OP8 Good Practice Recommendations It is a good practice recommendation that all staff involved in carrying out nutritional assessments should have further training on how to use the tool in place. This recommendation remains from the previous inspection report. Residents’ wishes regarding bathing or showering should be ascertained at the pre-admission assessment, so that the home can be sure of meeting their personal care needs. This recommendation remains from the previous inspection report. The weekly activity schedule should include a range of activities suitable for both male and female residents, and should be provided over the whole week. This recommendation remains from the previous inspection report. All the routines and practices of the home should be scrutinised by an appropriate person, and changes made to make sure that residents have as much control and choice over their daily lives as possible. This recommendation remains from the previous inspection report. The home should have a system in place so that all the windows in the home are properly cleaned on a regular basis. This recommendation remains from the previous inspection report. The home should make sure that items are stored appropriately and do not increase fire risks to residents, visitors and staff. This recommendation remains from the previous inspection report. The home should make sure that enough staff members have the skills and knowledge to care for the health, welfare and safety of the residents as soon as possible. This recommendation remains from the previous inspection report. DS0000027165.V356064.R01.S.doc Version 5.2 Page 23 2. OP7 3. OP12 4. OP12 5. OP19 6. OP19 7. OP30 Mill House Nursing Home 8. OP33 9. OP9 The quality assurance system should be assessed for effectiveness, as it may be more effective to quantify results through annual or twice annual comprehensive surveys. This recommendation remains from the previous inspection report. The temperature in the medicine storage area should be recorded around midday daily, so that an average temperature record will be available. This recommendation remains from the previous inspection report. Mill House Nursing Home DS0000027165.V356064.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.V356064.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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