Inspection on 04/12/06 for Mill House, The

This inspection was carried out on 4th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mill House, The 24/11/05

Mill House, The 09/08/05

Mill House, The 15/02/05

Mill House, The 16/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mill House, The Kington Flyford Flavell Worcestershire WR7 4DG Lead Inspector Nic Andrews Unannounced Inspection 09:15 4 and 6 December 2006 th 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, The DS0000018688.V317801.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, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House, The Address Kington Flyford Flavell Worcestershire WR7 4DG 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) 01386 793110 01386 793259 Mrs Joanne Carroll Mr Anthony William Carroll Mrs Sandra Ann Wills Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also accommodate people over 65 years of age who have an additional physical disability. 24 November 2005 Date of last inspection Brief Description of the Service: The Mill House is a large, purpose built property situated in a rural area in the village of Kington. The premises are registered as a residential care home for a maximum of 30 older people with a dementia illness. The service users may also have a physical disability. The service users are accommodated in single bedrooms on two floors. All of the bedrooms have en suite facilities. The home has a passenger lift to enable the service users who are accommodated on the first floor to access their bedrooms more easily. There are four lounges, a dining room and a conservatory. The home provides communal bathroom and toilet facilities. The garden includes two safe enclosed areas and there is adequate car parking space near the front of the building. The fees are £2,300.00 per month. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards with the help of the registered manager and, for part of the time, the registered provider. The home’s response to the two requirements that were made as a result of the previous inspection was also assessed. Various records and a number of policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were held with service users, members of staff and the relative of one service user. As part of the inspection ‘Comment Cards’ were issued to the relatives/visitors of the service users and to visiting professionals. Three Comment Cards, two from relatives/visitors and one from a visiting professional, were completed and returned. The responses to all the questions that were asked were positive. The comments contained in the Comment Cards are reflected in this report. What the service does well: The home had a warm, friendly and welcoming atmosphere. The home also had a satisfactory admission procedure that enabled prospective service users and/or their relatives to visit the home prior to admission. There was evidence to show that the service users’ healthcare needs were being met and that they were treated with dignity and respect. The service users were provided with a range of social and leisure activities appropriate to their needs. The service users were enabled to maintain contact with their relatives and other visitors and to exercise choice and control over their lives within their own individual capabilities. A wholesome and varied diet was provided. The home had a satisfactory complaints procedure. The service users lived in a clean, comfortable and well-maintained environment. The registered manager had the required qualifications and experience and was highly competent to manage the home and meet its stated aims and objectives. The staffing levels and the arrangements for the deployment of staff were satisfactory. The staff displayed a caring and sensitive attitude and carried out their work in an efficient manner. The staff received relevant training that was targeted on improving outcomes for service users. The registered manager stated that the home provided good training for all the staff not simply to meet the required standard but to enhance the quality of the service users’ care. The registered manager also felt that the range of social activities provided was to a high standard. The registered provider maintained a positive and active interest in the home and offered constructive involvement and support that was beneficial to both the staff and to the wellbeing of the service users. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 6 What 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, The DS0000018688.V317801.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, The DS0000018688.V317801.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): 1, 2, 3 and 5. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Prospective service users and/or their representatives had the opportunity to visit the home prior to admission and contracts were provided. The forms that were used to assess prospective service users covered all of the relevant aspects of care. However, the statement of purpose and service users’ guide needed to include all of the information required for prospective service users and/or their representatives to make a fully informed choice about the home. EVIDENCE: The home had an attractive brochure that contained information about the service. It was stated that a copy of the brochure was issued to all prospective service users and/or their representatives. The information in the brochure included a statement of purpose, a copy of which was made available for inspection. However, the statement of purpose did not contain all of the information required by Regulation 4, Schedule 1 and Standard 1 of the National Minimum Standards (NMS). The registered manager stated that a new service users’ guide was being developed. The home must provide a Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 9 statement of purpose and a service users’ guide that include all of the relevant information. The registered manager stated that a copy of the service users’ guide had been issued to all of the service users and/or their representatives. Evidence should be retained on the service users’ individual files to show that this action has been taken. It was confirmed that all of the service users except those that did not have a next of kin had been issued with a statement of their terms and conditions of residence (contract). The contract that was made available for inspection contained inappropriate references to ‘patient’, ‘nurse’ and ‘nurse in charge’. The contract was, therefore, amended during the inspection. A copy of the amended contract was subsequently made available for inspection. The contents of the amended version of the contract were satisfactory. The service user files that were inspected included a copy of the contract. The registered manager and/or the registered provider carried out the preadmission assessments either at the prospective service users’ homes or at hospital, depending on the person’s individual circumstances. Information about the needs of prospective service users was obtained from relatives, social workers and hospital staff, as appropriate. A copy of the forms that were used to assess the care needs of prospective service users were made available for inspection. The forms included an assessment form, a medical profile: resident assessment form and a handling assessment. The forms covered all of the aspects of care referred to in Standard 3.3 of the National Minimum Standards. Prospective service users and/or their relatives were given the opportunity to visit the home prior to admission. The registered manager stated that the home did not admit new service users in an emergency. The relative of one service user felt that his mother’s admission to the home was handled very well. Mill House, The DS0000018688.V317801.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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. There was evidence to show that the service users’ healthcare needs were being met and that they were treated with dignity and respect. The home provided a care plan for each service user and the care plans were reviewed at the required intervals. However, the information in the care plans was not sufficiently specific to ensure that all of the service users’ care needs were met. The staff had also not undertaken accredited training in the administration of medication. EVIDENCE: It was confirmed that all the service users had a care plan that was based on an assessment of their care needs. A copy of the care plan form was made available for inspection. The care plan was comprehensive in its scope and covered all of the aspects of care referred to in Standard 3.3 of the National Minimum Standards. However, the care plans did not always record the specific action to be taken by the staff to ensure that all of the service users’ care needs were met. The amount of space in the care plans for recording information appeared to be limited. The registered manager stated that all of the relevant information regarding the service users’ care was recorded in the Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 11 daily records and was discussed in detail during shift handovers. The care plans were reviewed at least once a month but there was no evidence to show that all the aspects of care covered by the care plan had been reviewed. The registered manager said that she would give further consideration to the format of the care plans. The Comment Card completed by one relative/visitor stated, ‘I find the standard of care to be excellent as do my relatives and would unreservedly recommend it to anyone seeking a care home. It was confirmed that all of the service users were registered with the local GP surgery. None of the service users had any pressure sores. The home provided its own pressure relieving mattresses and cushions. The district nurse was involved in the care of two service users. Any palliative care equipment that was required was obtained from the district nurse, as and when necessary. It was confirmed that risk assessments had been carried out and recorded on falls in respect of all service users and, where necessary, epileptic seizures. Thirteen service users were under the care of the psychologist. It was confirmed that none of the service users required the formal involvement of a physiotherapist. However, the service users were encouraged to engage in organised physical exercises every two weeks. All of the service users were mobile. Fluid and diet charts were maintained. The service users’ weight was recorded every month. The home had encountered problems in obtaining the services of an NHS dentist. The home was supported by other visiting professionals e.g. the chiropodist every six weeks, the continence adviser every six months and the optician annually or more frequently, if required. The Comment Card completed by a visiting professional stated, ‘The care provided at the Mill House is excellent’. The arrangements made for the safe storage of medication were satisfactory. Medication was kept in lockable trolleys in a lockable store. Access to the medication was limited to the senior staff. A list of the signatures of staff authorised to administer medication was maintained. There was a controlled drug cupboard that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. Medication requiring cold storage was appropriately stored in a dedicated fridge. Dates of opening were recorded on the outside of containers. It was confirmed that the home had a copy of the guidance on the administration of medicines published by the Royal Pharmaceutical Society of Great Britain. It was noted that, when medication had been prescribed for a variable dose i.e. ‘one or two tablets’, the staff were not recording the actual amount administered. During the inspection, the registered manager discussed this issue with the GP and the matter was resolved in accordance with the GPs’ instructions. It was also noted that, where medication was hand written on to the Medication Administration Records (MAR) charts, there were no staff signatures to confirm the accuracy of the information recorded. The registered manager subsequently confirmed that all of the senior staff undertake thorough induction training over a six month period before they are permitted to administer medication. As part of this training the staff are instructed to obtain two signatures. It was evident that the staff had received Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 12 training in the administration of medication but not to the required standard. The policy and procedure for the administration of medication needed to be amended. The reference to the National Care Standards Commission should be deleted and replaced by a reference to the Commission for Social Care Inspection. The policy should also state that any errors in the administration of medication must be reported to the CSCI without delay. The relative of one service user said that he was satisfied with the medical care that his mother received and that he was kept informed by the home of any changes in her medication. The members of staff with whom discussions were held had a sound understanding of the importance of maintaining the service users’ privacy and dignity. The answers they gave to the questions that were asked reflected the principles of good practice outlined in Standard 10 of the National Minimum Standards. The home had a cordless phone to enable those service users that were capable to make and receive calls in private. It was confirmed that the service users’ clothing was named in order to ensure that the service users wore their own clothes at all times. The staff induction programme included guidance on how to treat service users with respect. The service users’ privacy was enhanced by the provision of all single bedroom accommodation. One of the service users with whom a discussion was held stated felt that she was treated with dignity and respect and that her privacy was maintained. The relative of one service user also felt that his mother was treated with dignity and respect and that the staff always spoke to her politely. Mill House, The DS0000018688.V317801.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users were provided with a range of social and leisure activities appropriate to their needs and were able to maintain their links with relatives and other visitors with whom contact was encouraged. The service users were helped to exercise choice and control over their lives and were provided with a varied and wholesome diet. EVIDENCE: The home had its own car for taking the service users on outings both individually and in small groups of two or three people. The outings were mainly to local venues for shopping or coffee e.g. garden centres and a nearby farm. The car was also used to transport service users to hospital appointments. In addition, the home normally provided one main outing each year in which the majority of service users participated. This year the service users had been taken on an outing in May to Weston-Super-Mare. The service users had also attended a Harvest Festival in October. A range of internal social and leisure activities were provided. These included musical exercises twice a month, a visiting singer once a month and a visitor who attended every week to arrange individual and group activities and to help the service users to maintain contact with their relatives. A member of staff was employed to Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 14 spend three afternoons each week organising activities. The home had a proactive approach to leisure activities in order to promote social interaction and to help the service users to overcome the introversion that often accompanies a dementia illness. One service user with whom discussions were held confirmed that she was able to get up and go to bed when she wished. The arrangements for mealtimes were flexible. Although the service users could eat their meals in their bedrooms they were encouraged to eat their meals in the dining room. The local minister of religion visited the home every month and held a Communion service. A Roman Catholic priest also visited the home regularly. Arrangements were in hand to enable the service users to enjoy Christmas celebrations. The staff recognised the importance of helping the service users to maintain contact with their relatives and friends by sending written messages and cards. There were no unnecessary visiting restrictions. Visitors were asked to avoid meal times. One service user and the relative of another service user confirmed that visitors were made welcome and offered a drink. It was also confirmed that the service users and their visitors had the opportunity to meet in private. The home maintained links with the local ‘Over 60’s club’. Arrangements had been made for a drama group to visit the home early in the new-year. All of the service users lacked the capacity to manage their own financial affairs. The relatives took responsibility for this aspect of the service users’ care through the power of attorney. However, the service users were encouraged to make choices as far as they were able to do so, for example, in regard to food, social activities and the clothes they wore. The home had a policy on ‘self advocacy’. The home also held information leaflets on various organisations that offered relevant advice and support e.g. the Citizens’ Advice Bureau, the Alzheimer’s Disease Society, Help the Aged and Social Services. Details regarding these services, the addresses and telephone numbers, and information about the local advocacy service should be included in the service users’ guide. It was confirmed that service users were entitled to bring personal possessions with them when they were admitted to the home and the bedrooms contained evidence to show that this practice was observed. The statement of purpose that was included as part of the brochure that was made available to prospective service users stated, ‘Rooms are fully furnished but personal items are very welcome’. The relative of one service user stated that he was made aware that his mother could bring personal possessions with her. However, he was not aware of the service users’ right to see the records held about them by the home. The registered manager stated that relatives who attended the reviews of the service users’ care were able to access this information. The home operated a four-week menu. The record of the food provided was balanced and varied. The food that was observed being served during the inspection was wholesome and attractively presented. Mealtimes were evenly Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 15 spaced throughout the day. Drinks and snacks were available between mealtimes and in the evening. The staff recognised the social importance of mealtimes and the need to allow the service users adequate time to eat. Staff were observed giving assistance to service users who required help with feeding in a discreet and sensitive manner. One service user described the food as ‘good’. One service user who was said to be ‘prone to choking’ had her food cut into small pieces. It was confirmed that a risk assessment had been carried out in regard to this issue and that staff were always present at mealtimes. None of the service users required the use of special cutlery or other eating aids but the registered manager confirmed that appropriate items were available if necessary. Details of the service users’ food preferences were maintained. A choice of food was offered at breakfast and teatime. One main meal was offered at lunchtime with a choice of dessert. The service users who did not like the food that was on offer were provided with an alternative meal. Details of the daily menu were written on a notice board at the entrance to the dining room. The registered manager and cook had attended the ‘Better food, safer food’ training. The kitchen was clean and well equipped with freestanding stainless steel items. It was confirmed that all of the equipment was in good working order. A record of food temperatures and fridge and freezer temperatures was maintained. Food stores were satisfactory and food items were clearly labelled and dated. The kitchen had a fire blanket and a fire extinguisher. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 16 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints procedure. However, the home’s policy and procedure on the protection of vulnerable adults from abuse did not fully ensure the safety of the service users. EVIDENCE: The home had a satisfactory complaints procedure. A notice was displayed in the main reception area informing visitors to contact the registered manager if they had any concerns. A complaints procedure formed part of the information that was issued to prospective service users and/or their relatives. A record of complaints was maintained by the home. There had been no complaints since the previous inspection. One of the service users and also the relative of one service user stated that they felt confident about making a complaint, if necessary, and that any complaint would be taken seriously and responded to quickly. They both felt that the registered manager was approachable. The home had a policy and procedure for the protection of vulnerable adults from abuse called ‘Policy on Abuse’. Part of the home’s Policy on Abuse called ‘Investigation Process’ was unsatisfactory and should be amended. Any incidents of suspected or alleged abuse must be referred to the Adult Protection Coordinator and/or the CSCI and the Police before the commencement of any investigation by the home. Abuse is a criminal offence and the Police must always be given the first opportunity to investigate any possible abuse before the home commences its own enquiry. The home also Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 17 had a ‘whistle blowing’ policy that was included in the ‘Employee Handbook’. The registered manager confirmed that no incidents of alleged or suspected incidents of abuse had occurred or had otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had had no reason to refer any member of staff for consideration for inclusion on the POVA register. The home had a copy of ‘No Secrets’. The registered manager confirmed that both she and all the staff had undertaken training in the protection of vulnerable adults from abuse. The home also had a policy and procedure for responding to service users who displayed aggressive behaviour towards other service users or staff. The registered manager stated that the staff would use techniques that would distract and divert such behaviour. The service users’ contract stated, ‘The home is unable to act as representative for service users’ financial affairs’. The Employee Handbook also precluded staff involvement in assisting in the making of service users’ wills. However, no other information was included that reflected the other matters referred to in Standard 18.6. The registered manager stated that the home did not normally handle any money on behalf of the service users. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 18 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users lived in a clean, comfortable and well-maintained environment. EVIDENCE: The premises were purpose built and provided safe and easy access. The home was installed with a passenger lift to enable the service users to gain easier access to the accommodation on the first floor. The premises were well maintained and appropriately decorated and furnished. The bedroom doors were numbered and a photograph of the individual service user was displayed on the outside of each door to enable the occupant to identify their room more easily. A daily list was maintained by a senior member of staff in respect of all of the service users’ bedrooms to enable any items that required repair or replacement to be dealt with quickly. The registered provider maintained close contact with the home. It was stated that this enabled the registered provider and the registered manager to respond quickly to any maintenance issues that required attention. The registered provider was advised to introduce a Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 19 programme of routine maintenance and renewal of the fabric and decoration of the premises. It was noted that there were no handrails in parts of the corridors. The registered manager stated that consideration was being given to providing in the corridors handrails that were of a suitable colour to meet the needs of the service users. The registered manager subsequently confirmed that new handrails had been ordered. There was safe access to the enclosed gardens at the rear of the premises. A member of staff was employed for three days a week to help maintain the premises. A gardener was also employed. The registered manager stated that there were no outstanding issues arising from inspections of the home by the Fire Safety Officer and Environmental Health Officer. The bathrooms and toilets for communal use had appropriate aids and adaptations e.g. grab rails and bath hoists, and were provided with paper towel and liquid soap dispensers. The premises were clean and free from unpleasant odours. The laundry was sited in a suitable location on the ground floor. It contained a wash hand basin, two washing machines and two tumble dryers. It was confirmed that the washing machines had the specified programming ability to meet disinfection standards. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. The requirement that was made as a result of the previous inspection that the laundry facilities must be maintained with due regard for the risks of cross infection, had been implemented. The home had a satisfactory infection control policy. The relative of one service user stated that his mother was always clean and well groomed and that her bedroom was always kept clean and tidy. The home employed two full-time cleaning staff. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 20 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users’ needs were being met by a group of staff that were competent and appropriately trained. EVIDENCE: A copy of the home’s staff duty rota was made available for inspection. The staff duty rota showed that an adequate number of care staff were employed by the home and on duty during the waking day. In addition, three members of staff were on waking duty at night. The home employed a satisfactory number of catering, cleaning and maintenance staff. The registered manager was advised to record the hours she worked on the staff duty rota. The home did not employ a deputy manager. However, the registered manager was supported in her role by eight senior care assistants and a training and quality assurance coordinator. In addition, the home also employed an administrative officer for three days a week. Newly appointed staff were given a copy of the home’s ‘Employee Handbook’ and a copy of an ‘Employee Safety Handbook’. Staff meetings were held approximately every two months. The one service user with whom a discussion was held spoke positively about the staff. She confirmed that she was well looked after and described the staff as ‘very good and very helpful indeed’. She said that the staff ‘worked very hard’ and confirmed that there was always a sufficient number of staff on duty. The relative of one service user with whom a discussion was held felt that his mother was ‘looked after very well and that her needs were being met’. He Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 21 stated that he was contacted by the home when necessary and he felt that his mother’s admission process was ‘handled very well’. The staff with whom discussions were held and the observations that were made during the inspection confirmed that the staff were aware of the needs of the service users and responded to them in a sensitive and caring manner. In addition to the registered manager, the home employed a total twentyseven care staff. Twelve of the care staff had achieved NVQ level 2 or above. The number of care staff with NVQ level 2 or equivalent fell below the target of 50 of the number of care staff with NVQ level 2 as laid down in the National Minimum Standards. However, it was pleasing to note that six members of staff had completed the NVQ level 3 training and that several other members of staff were working towards the completion of the NVQ level 3 training. The files of two members of staff were inspected at random. The files contained relevant information including two written references, CRB checks and training certificates. However, the files did not contain photographs or proof of identity. The staff with whom discussions were held confirmed that they had been issued with a contract, job description and a copy of the code of conduct and practice produced by the General Social Care Council. The induction training provided by the home exceeded the Skills for Care requirement. An individual record of the training undertaken by each member of staff was kept in one book. It was intended that staff training portfolios would be developed that will include detailed evidence of all the training that is undertaken by the staff. The evidence of training contained in the portfolios would be used in order to reduce the amount of time spent on NVQ training. A copy of the portfolios will be kept in the home and will be taken away by the individual staff members when they leave the home. The staff will be able to use their portfolios to evidence their training and to support their career development. The introduction of staff training portfolios had commenced with newly appointed staff. The registered manager intended that the process would be completed for all the staff within twelve months. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 22 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users benefit from the ethos, leadership and management approach of the home. The registered manager is an excellent role model and leads a staff team that is well trained and positive in their approach. EVIDENCE: The registered manager had been managing the home for over five years. She had relevant experience and possessed the competence and the appropriate skills to manage the home effectively. She had successfully completed the NVQ level 4 training in 1999 and the Registered Managers’ Award training in 2001. The registered manager was also an NVQ Assessor and attended update courses on NVQ training. In April 2006, she attended a two-day course on Dementia Care and, in November 2006, a study day on dementia. In October 2006, she attended a two-day course on Managing Staff Effectively. The Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 23 registered manager was undertaking an ‘open university’ course to obtain a B.A. (Honours) in Health and Social Care. She stated that she kept up to date with current trends via the Internet. The registered manager had a satisfactory job description. However, the job description should be enhanced by an appropriate reference to ensuring compliance with the Care Homes Regulations 2001 (as amended) and the conditions of registration. All the senior staff had undertaken relevant core training. In addition, all the senior staff had completed or were undertaking NVQ level 3 training. The home provided six-month induction training for all the senior staff. The registered manager stated that the home’s quality assurance system was ‘dispersed in various formats around the home’. Weekly and monthly checks on different aspects of the environment were carried out. It was intended to bring all of the elements of the quality assurance system together into one folder in accordance with the CSCI guidance. The registered manager confirmed that questionnaires were issued to the relatives of service users twice a year and also to other stakeholders. However, the results of the questionnaires had not yet been published. The home did not have a formal annual development plan based on a systematic cycle of planning-actionreview, reflecting aims and outcomes for service users. The registered manager stated that plans were being developed to establish a Relative Support Group. It was confirmed that the home did not hold any money for safekeeping on behalf of any of the service users. The registered manager stated that no one connected with the running of the home acted as an appointee or an agent on behalf of any of the service users. Individual accounts were maintained of all monies that were spent by the home on behalf of the service users. The service users’ relatives were invoiced at the end of each month for money that was due for payment. The home had a safe in which any money or valuables could be stored securely on behalf of service users. Personal items that had been found in the home that belonged to present and/or former service users and whose owners had not been identified were kept in the safe. A requirement was made in regard to Standard 36 as a result of the previous inspection. The requirement was that care staff must receive formal supervision at least six times a year. It was confirmed that the requirement had been implemented. It was pleasing to note that risk assessments were in place for all safe working practice topics. The risk assessments were clear and well written and reflected positively on the effectiveness of the support provided by the home’s administrative staff. Bacteriological tests for Legionella had been carried out on the home’s water supply on 15 November 2006. Radiators with a low surface temperature had been installed throughout the home. PAT tests had been carried out on 14 December 2005. There was evidence to show that monthly and annual checks were being carried out on the home’s equipment Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 24 and machinery. A record of accidents was maintained. Staff training had been carried out in respect of food hygiene on 17/11/05, moving and handling on 24/04/06, first aid on 27/07/06, fire safety on 28/09/06 and infection control on 03/11/06. However, it was noted that six members of staff had not undertaken training in dementia care. The registered manager confirmed that all the staff had undertaken ‘in-house’ training in the protection of vulnerable adults from abuse. It was also confirmed that the protection of the service users from abuse was covered in the staff induction and that a booklet on the protection of vulnerable adults produced by the Worcestershire Vulnerable Adults Protection Committee was issued to all the staff. The home provided a DVD training video on abuse and there was a reference to abuse in the Employees Handbook. All of the main doors were fitted with a combination lock. The cleaning store cupboard was kept locked. The registered provider was in contact with the home on a daily basis either by visiting in person or by telephone. However, reports made in accordance with Regulation 26 had not been carried out on a regular monthly basis. The completion of such reports would help to enhance and support the home’s quality assurance system. The home had its own website and this included advice about the availability of the latest inspection report. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 25 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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 4 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 26 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 Standard OP1 Regulation 4 Requirement The statement of purpose must be amended so that it includes all the information detailed in Regulation 4, Schedule 1 and Standard 1.1. A service users’ guide, which includes all the information detailed in Regulation 5 and Standard 1, must be available in the home and copies must be given to all current, and any prospective, service users and/or their representatives. A copy of the amended statement of terms and conditions of residence (contract) must be issued to all of the service users and/or their representatives. The care plans must set out in detail the action which needs to be taken by the staff to ensure that all aspects of the health, personal and social care needs of the service users are met. All staff involved in the administration of medication must undertake accredited training that includes basic DS0000018688.V317801.R01.S.doc Timescale for action 31/01/07 2 OP1 5 31/01/07 3 OP2 5 31/01/07 4 OP7 15 28/02/07 5 OP9 13 28/02/07 Mill House, The Version 5.2 Page 27 6 OP18 12,13 7 OP29 19 8 OP33 24 9 OP38 18 10 OP38 26 knowledge of how medicines are used and how to recognise and deal with problems in use, the principles behind all aspects of the home’s policy on medicines handling and records. The home’s policy and procedure on abuse must be amended in accordance with the Department of Health guidance ‘No Secrets’ and the guidance given in this report. Proof of identity, including a recent photograph must be maintained by the home in respect of each member of staff. The home’s quality assurance procedures must be brought together into one comprehensive system in accordance with the requirements of Regulation 24 and Standard 33. Training in dementia care must be undertaken by all of the staff who have not yet received the training. The registered provider must prepare a written report on the conduct of the home once a month and supply a copy to the registered manager. 31/01/07 31/01/07 28/02/07 28/02/07 31/01/07 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 OP1 Good Practice Recommendations A written record should be maintained on each of the service users’ files as evidence to show that they and/or their representative have been issued with a copy of the service users’ guide. DS0000018688.V317801.R01.S.doc Version 5.2 Page 28 Mill House, The 2 3 4 OP9 OP9 OP13 5 OP14 6 OP18 7 8 9 OP19 OP31 OP33 10 OP33 Two staff should check and sign any hand written recordings on the MAR charts in order to ensure the accuracy of the information. The policy and procedure for the administration of medication should be amended in accordance with the guidance given in this report. Relatives, friends and representatives of service users should be given written information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends’ involvement with service users at the time of moving into the home. Details of the local advocacy service and other relevant agencies and the service users’ right of access to the records held about them by the home and how this is facilitated should be included in the service users’ guide. A policy should be developed and implemented regarding service users’ money and financial affairs, ensuring service users’ access to their personal financial records, safe storage of money and valuables, consultation on finances in private and advice on personal insurance. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept. The registered manager’s job description should be amended in accordance with the guidance given in this report. The results of service user surveys should be published and made available to the relatives/representatives of service users and other interested parties, including the CSCI. An annual development plan for the home should be introduced based on a systematic cycle of planning-actionreview, reflecting aims and outcomes for service users. Mill House, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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, The DS0000018688.V317801.R01.S.doc Version 5.2 Page 30 - 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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