Inspection on 09/08/05 for Mill House, The

This inspection was carried out on 9th August 2005.

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 04/12/06

Mill House, The 24/11/05

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 The Mill House Kington Flyford Flavell Worcestershire WR7 4DG Lead Inspector Yvonne South Unannounced 9 August 2005 09:00 am 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 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. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Mill House Address Kington, Flyford Flavell, Worcestershire WR7 4DG Telephone number Fax number Email 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 793110 Mrs Joanne Carroll Mr Anthony William Carroll Mrs Sandra Ann Wills Care Home 30 Category(ies) of DE(E) Dementia over 65 (30) registration, with number of places The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 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. Date of last inspection 15 February 2005 Brief Description of the Service: The Mill House is a care home for older people that currently provides residential accommodation for a maximum of 30 older people who have dementia related illnesses and may also have physical disabilities associated with old age. The home is situated in the countryside near to the village of Flyford Flavell. The building has been adapted and extended to meet the special needs of the people who live there. There are thirty single bedrooms each with en-suite facilities, four communal lounges, a dining room, a conservatory and two enclosed gardens. There is a shaft lift to enable access btween floors. The home is privately owned by Mr and Mrs Carroll and is managed by Mrs Wills. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place during the morning and extended over four and a quarter hours. Mrs Wills gave assistance. Mrs Carroll was present for some of the time. Other contributions were made by five staff, two relatives and one resident. Policies, procedures and care documents were seen and the inspector was shown around the home. What the service does well: What has improved since the last inspection? Since the last inspection the home has purchased a vehicle and the two activities staff that are employed are able to take people out on spontaneous and planned outings. For example people have been to garden centres, craft centres, country parks, and the Safari Park. A 1:1 staff/resident ratio is always provided on any outing. The home has employed an organisation to develop a Health and Safety Book for the staff and they are now working on a Staff Handbook. These are used as training tools and reference books for the staff that work in the home. A new home brochure is in the process of development. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 6 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 Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 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 standard(s) 1, 3, 4 Full information is available to assist prospective residents and their supporters make a decision about moving into the home. Detailed information is obtained from everyone involved to ensure the home can meet the needs of the person within the registration of the home. EVIDENCE: A summary of the Statement of Purpose was readily available in the form of a brochure. The full document was kept at the senior care station and was available at all times. It was also held on the home’s web site. Most of the residents were unable to comprehend the content of these documents and therefore the home worked closely and continuously with families and supporters to ensure good communication. The most recent inspection report was displayed on the reception notice board. Prior to admission a detailed assessment document was completed between the prospective resident, their family/supporter and other concerned people. The example assessed had been completed with as much detail as possible and a personal history was also obtained. This assisted with communication, understanding and planning activities and interaction. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 9 It was observed that staff interacted well with the residents, giving assistance support and social contact. They received on going training from the time of their appointment, to understand and provide the special care needed. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The descriptive care plans enable staff to be kept informed and deliver care appropriate to each individual’s needs. Good health care monitoring and support is given and medication is managed for the well being of the residents. People are treated with courtesy and respect. EVIDENCE: One care plan was selected at random and assessed. It had been drawn up with involvement of the resident. The manager said that contributions and involvement were sought from the resident and close family member/supporter, if available, when care plans were drawn up. The document was detailed and descriptive in how care needs should be met. Risk assessments had been carried out as necessary and appropriate care plans generated to address the identified risks. All documents had been reviewed. Health care records described how needs were monitored and addressed. For example links were maintained with the district nurses, the continence adviser, dietician, optician, chiropodist and the community psychiatric team. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 11 The chiropodist was attending to residents at the time of the inspection. He confirmed that he regularly saw every resident and considered the home to be the “best he visited”. A resident was enjoying his visit. The manager said that residents were able to have the GP of their choice and the home had links with three surgeries. Most of the residents were registered with one surgery where there were three doctors available. Most people were patients of one GP who was said to be excellent. Dental care was not easy to obtain. A peripatetic dentist could not be found so residents visited dentists in the community supported by a relative and a member of staff. Two medication trolleys were used for storage and these were kept suitably secure when not in use. Medication records were well maintained and daily records indicated that the response to medication was monitored. Advice was sought when necessary. The manager said that all senior staff had undertaken a full training course in the management and administration of medicines. Their doctor reviewed the medication of each person when they moved into the home. Privacy and dignity was safeguarded in relation to all personal care. The manager confirmed that staff received training from the time they were appointed. All staff were observed to relate to the residents with kindness and courtesy. Health checks and treatments were given in private, Mail was opened with the resident and support given as necessary. Assistance was given to make and receive phone calls if required. One more able resident had a private phone in her room. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, The residents are able to live interesting lives with freedom of choice and safety. They are able to retain contact with their friends and relatives and the world outside of the home and the home supports people to be free and in control of their lives. A variety of healthy appetising meals are provided that suit the residents in the home. EVIDENCE: The manager said that the residents had total freedom to live the style of life they chose. Residents rose and retired at the time that suited them and were helped to select the clothes they wished to wear. Staff gave advice and made suggestions but the residents’ decision was respected. Their preferences were recorded in their care plans and a full page was seen of their known interests, social contacts and recreational activities. Two activities organisers were employed in the home. One person was observed to interact well with residents in the dinning room and later she took a resident out for a walk. A range of in house activities was available. Staff were aware of residents’ interests and preferences so were able to provide suitable occupations, which were enjoyed. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 13 A visiting musician regularly came and played the organ the home’s organ or his own guitar. Music was a great pleasure to the residents and one person had her own instrument to play. Keep fit sessions with residents had successfully commenced with a trained exponent but she had found it difficult to accept the short attention span and poor memory of the residents so sadly had withdrawn her services. Facilities were available for people to participate in ‘gardening and watering’ the raised flower beds if they wished. Even though this frequently resulted in the need for replanting. A vicar called at the home each month with some of his parishioners and most residents enjoyed participating in the service. The manager said that he was kind, sensitive and understanding. Planned activities were announced on the notice board. Few residents could retain the information but visitors were able to keep abreast of what was happening in the home and were frequently invited to join in. The manager said that there had recently been a successful BBQ involving residents, relatives and staff. The manager said that residents responded well to small groups, one to one activity and spontaneity. The frequency of outings had increased now that the home had transport. Residents were taken out to a variety of venues. Photographs taken at the time indicated that a large visit to The Safari Park had been most successful. The photographs were also used as a means of reminding people of events that they had enjoyed. Six residents had joined the ‘Over 60s Club’ and enjoyed attending their meetings. The local school also visited and gave support and performances. Links with family and friends were valued and communication maintained. Two relatives confirmed that in their opinion the care given was excellent. None of the current residents were able to manage their own finances so they had all given their Power of Attorney to a relative. No one currently needed an advocate but the home had contact numbers should the need arise. The kitchen was observed to be clean tidy and well organised. Lunch looked and smelt delicious. Two residents commented on how good the food was and how much they enjoyed their meals. No special diets were currently needed but everyone’s likes and dislikes were displayed for the catering staff to consult. Due to the residents’ mental ability the provision of a choice had not been successful as making a decision and remembering it was frequently beyond their ability and caused distress. However care plans contained details of likes and dislikes on admission and the lists were expanded as information was obtained. The type of help individuals needed was also displayed in the kitchen and recorded in care plans. The manager reviewed this weekly. In addition she said that she liked to do the residents’ breakfast as this gave her an insight into their well being each day. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Staff are able to identify and support residents when anxieties arise and relatives have the information they need to enable them to raise concerns and be confident that they will be addressed. EVIDENCE: Most residents were unable to understand or process a complaints procedure therefore staff were alert for signs of distress or unhappiness which they could respond to. An acceptable complaints procedure was available in the brochure and a copy was given to all relatives. A complaints record was seen. One complaint had been received since the previous inspection. This had been appropriately investigated and was unfounded. The Commission for Social Care Inspection had been kept informed. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23 Residents live in a safe pleasant environment that suits their individual needs. They are able to move around the home and gardens with ease and security. Special aids and equipment are fitted and provided to assist residents and staff. EVIDENCE: It was observed that the premises were well maintained. The design and lay out of the home enabled the residents to walk about in safety and freedom, making full use of the varied communal areas in the house and in the garden. The décor and furnishings were of a high standard. The provision of toilet and bathroom facilities met the needs of the residents. En-suite facilities were provided for each bedroom. Handrails and ramps were fitted where needed to provide security and support for residents as they walked around the home and gardens. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 16 The bedrooms were individually decorated and furnished. Residents were encouraged to bring in familiar photographs, pictures and treasures to arrange in their room. Standards of hygiene were high and a credit to the staff concerned. In one bedroom there was a hygiene issue. The manager described the efforts that had been and were being made to address the concern and confirmed that the work was continuous and relatives were kept informed and aware. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection and therefore have not been scored. During the inspection the five staff on duty were observed to be working in a confident manner. It was apparent that they relaxed and competent in their work and they were observed to relate to the residents and provide care with skill and sensitivity. They confirmed that they enjoyed the work and working in the home. The manager said that an Employees’ Hand Book was currently being devised for staff. When ready everyone would receive a copy and assistance if necessary with understanding the contents. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection and therefore have not been scored. However the atmosphere in the home was both friendly and reassuring. Relationships between the manager and the staff appeared very positive. Assistance was given with the inspection in a confident manner. The records seen were readily available and well maintained. Completed questionnaires were seen that demonstrated a commitment to obtaining views of the home and the service. The records indicated that where necessary a response had been made. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 19 The Fire Log indicated that routine fire safety checks of systems and equipment were being made. At the time of the inspection a new fire alarm/detection system was being installed, as it had not been considered satisfactory to have one system in the original building and a separate system in the new extension. The manager confirmed that fire training from an external trainer took place twice a year and additional internal training and drills were carried out to ensure everyone received the required three monthly refresher training in fire safety awareness. Training records were maintained. The home had employed a company to provide a Health and Safety Manual compiled specifically for the home, for every member of staff. All staff were required to read the manual and sign to say that they had received their copy and understood the contents. The manager said that new employees would be supported to understand it as part of their induction training. The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION 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 Standard No 16 17 18 Score 3 x x x x x x x x x x The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 21 No 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. 1. 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 Good Practice Recommendations The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 22 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 The Mill House E52 S18688 Mill House V240871 090805.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!