Inspection on 14/02/07 for Mill Lane Nursing Home & Retirement Home

This inspection was carried out on 14th February 2007.

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 Lane Nursing Home &... 03/02/06

Mill Lane Nursing Home &... 14/09/05

Mill Lane Nursing Home &... 10/03/05

Mill Lane Nursing Home &... 18/11/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Mill Lane Nursing Home & Retirement Home 79 Garrison Lane Felixstowe Suffolk IP11 7RW Lead Inspector Deborah Kerr Unannounced Inspection 14th February 2007 09:00 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 Lane Nursing Home & Retirement Home DS0000024448.V330311.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 Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill Lane Nursing Home & Retirement Home Address 79 Garrison Lane Felixstowe Suffolk IP11 7RW 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) 01394 279509 01394 279509 Pri-Med Group Ltd. Mrs Jocelyn Leatherman Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: Mill Lane Nursing and Retirement Home is registered as a care home with nursing, for up to 25 older people. It is situated in Felixstowe at the junction of Garrison Lane and Mill Lane, and stands back from the junction, in its own pleasant gardens. It is not central to the town of Felixstowe, although there is easy access to both the shopping area and the sea front, about half a mile away. Healthcare Homes Group purchased the home from Pri-med Group Ltd in April 2006. The new company continue to be registered and trade under the Pri-Med Group Ltd. The statement of purpose has been updated to reflect the new ownership. Healthcare Homes have produced a new colour photographic brochure to support the service user guide providing detailed information about moving into the home, the services provided and access to local services. The building is a converted three-storey house with car parking to the front with ramped access to the front door. A large passenger lift serves the first floor, and there are ample assisted bathrooms and WC’s. There are 21 single bedrooms and two double bedrooms. The lounge and dining room are located on the ground floor. The company has a strong commitment to training, with a comprehensive inhouse training programme, employing dedicated training staff. There is a good management structure, overseeing a suitable quality assurance programme, and staff are well supervised. The company has consistently achieved the Investors in People award, and in 2005 also received a Work Life Balance award. Fees are calculated depending on the needs of the resident and range from £720 – £813 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries, receipt of daily newspapers and any transfers to hospital. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over nine hours during a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 3 residents ‘Have your say about’ comment cards and 7 relatives/visitors comment cards. Time was spent talking with four residents, four staff and the registered manager. Additionally a number of records were inspected including those relating to residents, staff, training, medication, quality assurance and a selection of policies and procedures. What the service does well: What has improved since the last inspection? A previous requirement was made for care to be taken to ensure that all medication records are accurate. Medication documents, policies and procedures were examined which confirmed that staff were administering medication accordingly and accurately. Resources are being made available for the home to continue with a programme of maintenance and decoration. New furniture has been purchased and a number of vacant bedrooms have been decorated. New flooring has been laid in one of the hallways. The main hallway has been redecorated, a dado rail has been fitted and there are plans to paint the lower half of the walls a different colour. There are future plans to redecorate the upstairs landing and hallways to lighten the home. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.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 Lane Nursing Home & Retirement Home DS0000024448.V330311.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): 1,2,3,4,6, Quality in this outcome area is good. Prospective residents can expect to be provided with detailed information about the home and can expect to receive information, which is available in a suitable format to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide was updated in August 2006 to reflect new ownership. Healthcare Homes have produced a new colour photographic brochure to support the service user guide providing detailed information about moving into the home, the services provided and access to local services. The manager confirmed this information is made available in different formats for people with sensory impairments, for example, large print and audiotapes. Resident’s files contained a written contract setting out the terms and conditions of residence, including the method of payment and their current fee and where applicable the National Health Service, nursing care contribution. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 9 Three residents’ personal files and care plans were inspected to track the level of care and support required. Each resident had a pre admission assessment completed prior to admission. These were very detailed and provided information about the resident’s previous history, current health, personal care and general well being and formed the basis of the residents care plans. Prior to the inspection the Commission for Social Care Inspection (CSCI) received an application to vary the home’s registration to include one named person with a confirmed diagnosis of dementia. One other resident has been diagnosed with this condition. The home and social services are in the process of finding an alternative placement that will be able to provide the specialist care to meet their particular needs. Discussion with the manager confirmed that other residents living in the home were displaying symptoms associated with dementia although they did not have a definite diagnosis. The manager was asked to inform the CSCI of numbers of people who have developed dementia and provide evidence that they can continue to meet their needs. Both the manager and staff spoken with had good knowledge of the individual needs of the residents. Training records reflected that staff have attended a range of training, which include dementia awareness, principles of care, care and prevention of pressure areas and person centred care and palliative care. A senior member of staff is to attend training on palliative care to meet the end of life needs of residents according to their wishes and recognition of their rights. The home does not provide intermediate care; subsequently this standard is not applicable. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.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): 7,8,9,10,11, Quality in this outcome area is good. Residents care plans reflect their health, personal and social care needs, however residents cannot be assured that a true reflection of their day-to-day heath and well being will be recorded and monitored within this plan. Residents can expect to have access to healthcare professionals and be protected by the home’s procedures for administering medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been in the process of reviewing and implementing new Healthcare Homes care plans. These are easy to follow and contained detailed information relating to individual’s health, personal and social care needs. Care plans are being reviewed monthly and reflected that key workers had completed a brief overview of the resident’s health and well being for January. However, the ‘daily care records’ at the front of the care plans were not being completed and therefore did not provide accurate and up to date information. The ‘daily care record’ had a list of tasks required to meet the residents’ care needs, which included bathing, hair washed and management of continence. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 11 Staff are required to initial where this particular need of the resident has been completed. The were several missed signatures in particular relating to residents continence. One chart indicated that a resident had not had a bowel movement for 11 days. Their care plan stated that they were prone to constipation with clear interventions of how the condition should be managed. Further discussion with the manager confirmed information demonstrating what action was taken was being kept on a second chart and that medication had been given to remedy the resident’s constipation. Assessments had been completed to promote and maintain the resident’s health. These included moving and handling, pressure area care, weight and nutritional screening, dependency levels, falls and the resident’s ability to self medicate. The assessments detailed the appropriate pressure relieving and moving and handling equipment required. To meet the particular needs of one resident who has a high risk of falls, a pressure mat has been obtained for their bed, which is linked to the call system and alerts staff if the resident gets out of bed. The risk assessments also provided information and guidance for the actions staff are required to take to monitor the resident’s condition and lessen the risk of deterioration in their health. Each of the care plans had a consent form to obtain the resident’s and /or the relatives agreement for the use of bedrails where the resident was identified at risk of falling out of bed. These bedrails are fitted with appropriate bumpers to prevent entrapment and asphyxiation. Regular visits were documented showing residents had regular access to the general practitioner (GP), trained nursing staff, chiropodist, community physiotherapist, Community Psychiatric Nurse (CPN) and older people’s mental health services. The home has sought professional advice and support as to how they can continue to meet a resident’s needs recently diagnosed with dementia. Suffolk Primary Care Trust has agreed funding for 3 months for fully funded continuing health care. The resident will be receiving regular visits from the continuing care team. The senior was observed mentoring a recently qualified nurse during the process of administering medication. The home uses a Monitored Dosage System (MDS). This is a simple and efficient method where the pharmacy supplies pre-packed solid medication for residents in blister packs containing the required dose. Medication is stored in a specialist drugs trolley, which is stored in a locked medication room and secured to the wall when not in use. The medication room also provides space for a small fridge. The Medication Administration Records (MAR) were generally well kept and in order. Each blister pack and MAR chart has a front sheet with the individual’s details and a photograph of the resident for identification purposes. The Controlled Drugs (CD) register confirmed the home currently have three residents prescribed CD’s. An audit of the CD’s against the balance recorded in the register confirmed the number of CD’s held was accurate. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 12 Evidence was seen that the home does not hold large stock of medicines. The home disposes of unused medication though a clinical waste company in line with guidance on safe disposal of waste medicines from nursing homes as determined by the Controlled Waste Regulations. Evidence was seen throughout the inspection that residents were being called by their preferred name as identified in their care plans and residents’ spoken with felt that staff respected their privacy and dignity. Staff were observed knocking and waiting before entering resident’s rooms. Whilst touring the building a female resident was observed being taken in to their room by a male carer. The manager confirmed that residents are consulted on their preference to have male/female staff to attend to their personal care needs. This information is recorded in the service users care plan. There are only two female residents who choose not to have male carers. The interactions between residents and staff were observed to be friendly and appropriate. Each of the care plans has a section for the resident’s ‘end of life arrangements’. One had no information and the other two were partially completed with information following the death of the resident and their chosen funeral arrangements. Guidelines produced by the Department of Health (DOH) about palliative care were discussed with the manager. They confirmed that a member of staff is currently attending training with a view to implementing the Liverpool Care Pathway system for determining the end of life needs of residents, including their choice to remain in the home or be admitted to hospital at their time of death. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.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): 12,13,14,15, Quality in this outcome area is adequate. Residents can expect to live in a home that supports a lifestyle that matches their expectations, however they cannot expect to have assistance where necessary to eat and drink. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A notice board is situated in the main corridor and was seen to advertise activities for the coming week, general information of forthcoming activities and church services. Pinned to the notice board was a Mill Lane Newsletter. This is produced monthly by a visitor to the home and contains colour photographs and items of interest relating to residents, the home and staff. February’s addition had a special feature introducing two new care staff from Poland. The feature included a map of Poland and information about the country and cultural influences. There was also a written article called ‘Memory Lane’ written by one of the resident’s grand children. Special notices included dates and times of family and residents meetings, activities and reminiscence groups. There is a range of age appropriate activities that residents are encouraged to take part in. These include, fitness quest, bus outings of resident’s choice, aromatherapy, reminiscence therapy, pottery and art therapy. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 14 An art therapist visits the home providing residents with the opportunity for stimulation and to maintain dexterity in the hands through painting and other forms of artwork. Samples of some of the artwork residents had completed at these sessions were on display in one of the corridors, including a leaf print. The manger explained that one of the residents had limited means of communication following a stroke and had used a ‘point stick’ to paint their picture and allowing them the freedom to express their feelings. Musicians visit the home to entertain the residents on a regular basis. An entertainer was present on the day of the inspection to celebrate Valentine’s Day. Residents and visitors were observed enjoying the entertainment in the lounge. An outing to the Red Cross hut has been booked for 31st August where residents can go and enjoy lunch on the promenade in Felixstowe. Healthcare Homes have an activities director who works closely with the home as an advisor. They were scheduled to visit the home the following day to discuss additional activities to offer to residents during quite times during the day. The manager is in the process of negotiating with a music therapist based at a local hospice to visit the home. They have equipment so that resident’s could make their own compact disc recording. A table was seen displaying a wide range of goods from a well-known high street store and various book clubs. The height of the table was discussed with the manager as majority of residents use wheelchairs for mobility and would not be able to see the display. The manager confirmed that these objects are taken around to every resident on a ‘shop trolley’, which also has a stock of sweets, cosmetics, note cards and hand made gift cards. The manager and staff were observed engaging in positive interactions with residents. Their approach was positive, polite and supportive. Relationships were warm and friendly with much good-humoured banter. There were a number of visitors to the home and it was clear that they felt welcome. Residents and visitors spent time talking to the inspector and spoke positively about the care provided, however raised some concerns about staffing levels and support for residents that required assistance to eat and drink. These concerns substantiated comments made in the residents and visitors comment cards received prior to the inspection. Comments included “Sometimes when I ring the bell I have to wait a while” and “I feel there is not enough staff to help give drinks to those unable to help themselves”. Concerns were raised that often residents who require assistance to eat and drink are given cups of tea or coffee, which go cold whilst waiting for some one to help them. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 15 A visitor commented that they helped a resident to eat their breakfast after being served egg and bacon and left to eat it on their own, the resident commented, “ What do I do with that”. There were mixed comments about the food, some residents described food as adequate and “Could be better” and another commented “Bacon and meat is always hard and tough, soup is thin and the same every day and food, in particular porridge, is not served hot”. Although a visitor commented that they had eaten at the home on several occasions and had “never seen reason to complain” and described “the liver and bacon casserole as to die for”. These issues were discussed with the manager, who confirmed that in recognition of issues around food they had instigated regular monthly meetings with the chef and staff to discuss meals, menus and mealtimes. The manager agreed that residents might find it beneficial to take part in these meetings to voice their concerns. A Valentines Day menu was displayed on the notice board and consisted of Tomato soup or pate and Melba toast, roast beef with seasonal vegetables followed by black forest gateaux or fresh fruit salad. The dining room had been beautifully decorated to celebrate the occasion with red hearts banners around the walls and fresh red carnations on each table. Residents and staff were observed enjoying the social occasion. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.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): 16,17,18, Quality in this outcome area is good. People who use this service can expect to have their legal rights protected and be confident that complaints will be taken seriously and investigated. They can also expect to be protected by the homes procedures for the Protection of Vulnerable Adults (POVA). This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre inspection questionnaire reflected that there had been 3 complaints made about the service for the period, August 2005 to August 2006. The complaints log seen confirmed this. The complaints log showed that the home’s complaints policies and procedures had been followed, the complaints had been investigated and actions taken were recorded and feedback to the complainants who were satisfied with the outcome. Residents and relatives spoken with confirmed they were confident that any concerns or complaints they might have would be addressed. They felt that both the staff and management were responsive and supportive, listening to what they had to say, and acting upon it. The home’s adult protection policy and procedure had been reviewed in June 2006. The home also had a copy of the Suffolk Vulnerable Adult Protection Committee (VAPC) and are aware that they need to inform the Commission for Social Care Inspection (CSCI). Staff files reflected that staff receive training for ‘Dealing with Abuse’ as part of their induction. They are well trained in abuse awareness and the local Protection Of Vulnerable Adults procedures. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 17 The manager confirmed that residents are supported to take part in their civil duties to register their vote. They had recently completed the voting and electoral register and had consulted residents on their choice to vote by post or attend the local polling station. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.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): 19,20,21,22,24,25,26, Quality in this outcome area is good. Residents can expect to live in a home that is decorated and presented to a high standard, which is comfortable and well maintained, however their safety is at risk until alternative storage is found for mobile hoists. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mill Lane is situated in Felixstowe in its own pleasant gardens. It is not central to the town of Felixstowe, although there is easy access to both the shopping area and the sea front, about half a mile away. The building is a converted three-storey house with car parking to the front with ramped access to the front door. A large passenger lift serves the first floor, and there are ample assisted bathrooms and WC’s. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 19 There are 21 single bedrooms and two double bedrooms. The lounge and dining room are located on the ground floor. The home is nicely decorated, comfortably furnished with good quality furniture, fixtures and fittings providing residents with clean, homely and comfortable accommodation. Vases of fresh flowers had been placed in communal areas, these additional touches helped to create a ‘homely’ environment. The lounge has been redecorated and has had new carpets and curtains and has access to the gardens through patio doors. Air fresheners placed discretely around the home keep the home odour free. The building and surrounding gardens are well maintained. The manager informed the inspector that they were in the process of finishing decorating the hallway, a dado rails is to be fitted and the lower half of the wall painting a different colour to make it more cheerful. Grab rails and other moving and handling equipment were seen around the building. The handrail in the entrance hall stops at the end of the wall and does not carry on round to the lift, the manager acknowledged that the rail needed to be extended to aid residents with poor balance and mobility to maximise their independence. Concerns about the storage of hoists in the corridor’s, which are fire exits routes were raised with the manager. Mobile hoists were seen at various intervals in corridors, these were being kept on charge and could cause congestion in the event of an emergency. The fire officer also raised their concerns at a recent inspection of the home of the risk of the battery charges catching fire rendering the fire exit routes inaccessible. All fire doors are fitted with ‘Dor Guards’ to hold them open during the daytime and close automatically when the alarm sounds. One resident’s room has an exit to the outside however they are a wheelchair user and there was a step up over the threshold. The manager confirmed a ramp is to be fitted. Resident’s rooms seen comfortable and personalised with items of their own furniture and smaller possessions reflecting their individual tastes and personalities. It was noticed that a lot of the rooms had commodes on view and taking up space in the residents rooms. The manager showed the inspector that there are accessible toilets within close proximity of the resident’s rooms, which are fitted with overhead hoists; these residents had chosen to have the commodes in their rooms. One resident who chooses to have bed rest during the day confirmed it was their preference to use the commode in their room. Communal bathrooms and toilets have adaptations to assist access for residents with reduced mobility. Random checks of water temperatures confirmed that hot water is available throughout the day and is close to the recommended 43 degrees centigrade. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 20 Staff had access to a good supply of disposable gloves and aprons and appropriate hand washing facilities of liquid soap and paper towels in the bathrooms and toilets where they might be required to provide assistance with personal care. Plastic bags have been supplied for staff to place clinical waste, which is taken to the sluice room and placed in the appropriate bags/bins for collection by a waste disposal company. The laundry room is situated on the ground floor away from the kitchen and dining area. There are two washing machines; one of which has a sluice cycle for washing soiled articles of clothing. Bed linen is sent to an external laundry service. The sluice room on the first floor is fitted with a sluicing disinfector. The manager informed the inspector that one resident was diagnosed the previous day to have contracted Clostridium Difficile. They had informed the appropriate persons under the Public Health (Control of Disease) Act and had contacted the community infection control nurse for further advice on the prevention and control of the infection. They had put stringent infection control procedures in place to ensure the resident was as an isolated case. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30, Quality in this outcome area is adequate. Residents can expect to be supported by a staff team that have received training and support and have the knowledge to care for them and be protected by the home’s recruitment procedures. However staffing levels need to be reviewed to ensure there is sufficient staff at all times to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mill lane is registered to provide care to 25 people, current occupancy is 22. The staff team is made up of the manager, administrator, 5 registered nurses, 19 care staff and 14 ancillary and maintenance staff. 5 care staff plus 1 nurse on the early shift, 3 care staff and 1 nurse on the afternoon shift and 2 care staff and 1 nurse on the night shift staff the home on a daily basis. The duty roster confirmed this. Shift times are 7.50 – 2pm for the early shift, 1.50-8pm for the afternoon shift and 7.50-8am for the night shift. Staffing levels were discussed with the manager. Comments received prior to the inspection raised concerns that there was not sufficient staff to meet the individual needs of residents, particularly at mealtimes and when requiring assistance to attend to personal care needs. This was reiterated when talking to residents, staff and visitors during the inspection. The manager acknowledged that staff morale had been low and staffing had been an issue. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 22 There is a high number of the residents that are now reaching an age where they becoming increasingly frail and hoist dependent which requires 2 carers. The manager confirmed that work is physically hard at present for the staff, particular due to chest infections where residents are requiring nursing care in bed. Staffing issues were raised and discussed at residents and relatives meeting in September 2006. As a result of the discussions the manager has changed shift times so that one carer from the afternoon shift starts at 1-7 pm instead of 2-8 to help over the lunchtime period to assist residents with meals. Although recognising these changes, concerns still remain that residents requiring assistance with their meals do not receive the support they need (as described in the daily life and social activities section of this report). Three staff files seen confirmed the home operates a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Bureau Records (CRB) check and Protection of Vulnerable Adults (POVA) checks and in the case of overseas workers work permits and police checks. Where two members of staff had been employed prior to a POVA and CRB check the manger had included a non-compliant CRB legislation statement on their files. The staff had signed to agree that they would not have contact with residents until their POVA check was received and then only under direct supervision pending receipt of a satisfactory CRB. The staff had been on the premises in the upstairs flats to attend their induction training. All staff files seen had a statement of terms and conditions of employment signed and dated. Staff files confirmed that there is a commitment to training. Healthcare Homes have their own training manager who is responsible for ensuring that all staff are trained to do their jobs. The training links in with the Skills for Care Common Induction Standards (CIS). Staff files reflected that they have attended training for dementia awareness, care and prevention of pressure areas, person centred care, first aid, medication, health & safety, dealing with abuse, communication skills, role of the worker and principles of care. Information obtained from the pre inspection questionnaire completed in August 2006 identifies that 52 of staff hold National Vocational Qualifications (NVQ) at level 2 or higher. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35,36,38, Quality in this outcome area is good. Residents can expect to live in a home that is managed by an appropriately qualified and experienced manager, however residents health welfare and safety is at risk until more appropriate storage of food is created. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified nurse and has obtained the National Vocational Qualification (NVQ) level 4, Registered Care Managers Award (RMA). They demonstrated a good knowledge and understanding of al the residents needs and medical conditions. They were observed being calm, relaxed and friendly with visitors, staff and residents. Residents, visitors and staff spoken with were very complimentary about the manager; they felt they were approachable and very supportive. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 24 To ensure that the management of the home is open, positive and inclusive regular meetings are held with residents and their families and staff. The minutes of the last meetings were seen confirming that issues about the dayto-day running of the home are openly discussed. The new operational executive director of Healthcare Homes attended the resident and relatives meeting in September 2006 to introduce them self and talked of future investment in the home and the property. The manager welcomes the views and opinions from the residents, relatives and external agencies about the services provided via an effective quality assurance monitoring system. Results of the most recent quality assurance survey were in the process of being analysed. The manager advised the inspector they would forward a copy of the completed survey to the Commission for Social Care Inspection (CSCI). A copy of the results will be available from the manager on request. The home is currently completing all the paperwork to provide evidence for the home to be reaccredited with the Investors in People Award (IPP). The home does not manage the financial affairs of any of the people living in the home. Where residents are unable to manage their own finances this is managed by their power of attorney or family. Residents can choose to have their personal allowances held in the office. Records are kept in a register, which showed that transactions were witnessed and had two signatures against them. These are audited monthly. The balance for three of the residents tracked during the inspection were checked and found to be accurate. Staff spoken with confirmed that they receive supervision training and support to do their job. Supervision records reflected that regular sessions were taking place and consisted of aspects of care, which included practical assessments of the individuals work, philosophy of care and career development. A selection of policies and procedures were seen including, medication, complaints, protection of vulnerable adults and whistle blowing, infection control and restraint. Although the home had a restraint policy, it is not recognised practice and is for guidance only. It clearly states that this practice is used as a last resort and only in accordance with a full and detailed assessment. Following an incident in July 2006 where an intruder had entered the home, improved security measures have been installed. The front door is fitted with a double lock, which is fitted with an override button in the case of fire. The lock is linked to the fire alarm system and will release on the sound of the alarm and has a battery back up in case of power failure. The fire logbook reflected that regular fire instructions and fire drills take place. The fire risk assessment and evacuation plan were reviewed in January 2007. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 25 All staff received fire safety training from an external trainer in May 2006. The fire alarm system, and emergency lighting were serviced in February 2007 and the fire fighting equipment was serviced in December 2006. The kitchen and catering facilities are very small and do not currently give adequate working space. The kitchen equipment is old and could do with a thorough clean. Food is being stored in a shed outside at the rear of the kitchen, although food is being stored off the floor these are not ideal conditions to store food. Additionally food stored in the fridge in the kitchen was only partially covered with reused cling film and would not prevent food becoming contaminated. Serious consideration needs to be given extending the kitchen area to provide better conditions for the safe preparation and storage of food. The manager did confirm that there are plans in place to build a new extension, which will include 2-4 additional beds and will increase the size of the kitchen. Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (2)(b) Requirement The registered manager must make sure that the day-to-day interventions and health and well being of residents is kept under review and records updated to provide a true reflection of their current heath and welfare. Timescale for action 15/02/07 2. OP11 12 (3) The home needs to further 31/03/07 develop the palliative care and end of life needs of residents and record the outcomes in the residents care plan so that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect. The registered manager must make sure that provision of food meets residents needs by ensuring: 1. The consistency of the standard of food being served. 2. There is sufficient staff available based on assessment of resident’s individual needs and level of support required to eat/drink their meal. 31/03/07 3. OP15 16 (g)(i) Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 28 3. Residents who have poor dexterity must be provided with additional support, suitable crockery, cutlery and utensils. 4. Take into account the specific nutritional needs of people who are confused or have dementia. 4. OP22 13 (4) (a) 23 (2)(l) (n) The registered manager must ensure that all parts of the home must be free from hazards for the safety of the resident’s, which includes making suitable provision for storage of equipment so that they are not stored in corridors and/or fire exit routes. A review of staffing levels in conjunction with the residents’ dependency levels must be undertaken to ensure that there are adequate staff rostered to meet resident’s needs. The registered manager must have with regard to the size of the care home and the number of residents adequate facilities for the preparation and storage of food. This must include refurbishment and thorough clean of the cooker and extraction filter. 31/03/07 5. OP27 18(1)(a) 31/03/07 6. OP38 16 2 (g) 31/03/07 Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mill Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Lane Nursing Home & Retirement Home DS0000024448.V330311.R01.S.doc Version 5.2 Page 31 - 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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