CARE HOMES FOR OLDER PEOPLE
Mill Lodge Care Home Belmont Road Great Harwood Lancashire BB6 7HL Lead Inspector
Mr Graham Oldham Unannounced Inspection 23rd March 2006 10:00 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 Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 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 Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Mill Lodge Care Home Address Belmont Road Great Harwood Lancashire BB6 7HL 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) 0161 6886242 Mr Karamchand Jhugroo Mrs Pryamvada Jhugroo Mrs Pryamvada Jhugroo Care Home 16 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (15), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (3), Old age, not falling within any other category (6) Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 16 service users to include: Up to 15 service users in the category of DE(E) (dementia over 65 years of age) requiring personal care. Up to 6 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 3 service users in the category of MD(E) (mental disorder, excluding learning disability or dementia over 65 years of age) requiring personal care. 1 named female service user in category DE ( Dementia under 65 years) requiring personal care. When any of the service users in the category of MD(E) leave the care home, the registered person must apply for a variation to have maximum numbers of 3 reduced accordingly. The care home should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. When the female service user in category DE (Dementia under 65 years) leaves the care home, the registered person must apply for the variation to be removed and the number of service users in the category of DE(E) Dementia over 65 years) raised to 16. 2. 3. 4. Date of last inspection Brief Description of the Service: Mill Lodge is situated within walking distance of the town centre of Great Harwood. There are 14 single bedrooms and one double bedroom situated on two floors. Access to the first floor is via a passenger lift. Communal space consists of a separate lounge and a dining room that leads to a furnished conservatory. Some internal areas are ramped. Toilets and baths are located near to communal rooms and bedrooms. Residents have access to all community health services, and activities and functions are available to everyone living at the home. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 22nd March 2006. One resident was able to give limited information about the home and therefore most of the information gained was obtained from staff members and one visitor. Other residents were able to give some information. Two residents were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of care, other documentation and talking to residents and staff. Two staff members were talked to about care issues. The registered manager was present throughout the inspection. Some of the views have been reported collectively with specific comments contained within the body of the report. The inspector took detailed notes during the inspection, which have been retained as evidence. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. Core standards – inspected and met on 13th December 2005 were not re-inspected if evidence was not found to warrant further investigation. A tour of the building was conducted. This service has recently been sold to the new owners. Documentation needs to be reviewed for all standards and contain information, which is up to date. The new owners will have several weeks before the next inspection to complete this task and the obvious errors observed by the inspector noted but not reported upon. What the service does well:
Staff were observed to provide a good atmosphere for the enjoyment of residents. Staff were observed to carry out tasks in a discreet and professional manner to help protect the privacy and dignity of residents. The assessment of residents prior to admission ensured new residents were suitable to be admitted to the home. The registered manager, whilst being new, was receptive to new ideas and improving the service for the benefit of residents. Staff accurately described the care given to residents, which matched the care written in the plans of care. This ensured each residents health and care needs could be met. Food was observed to be good for residents to enjoy. One visitor said, “I come in and out of the home when I like. Staff are brilliant”. Visitors were welcome at the home.
Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 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. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 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 Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The assessment process prior to admission ensured the home gained sufficient knowledge to help meet each resident’s individual needs EVIDENCE: Two plans of care were examined during the case tracking process. One newly admitted resident had been assessed by the service. Copies of social services assessment were observed and matched those of the home. The assessment of residents enabled staff to have the knowledge to develop a plan of care. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Care plans showed residents involvement and contained the information required by staff to meet the needs of the residents. Medication policies and procedures were good. EVIDENCE: Plans of care were examined and demonstrated resident’s health, personal and social care needs had been assessed and reviewed. Plans of care were contained within a communal document. Other documentation was contained in further separate files. Some parts of the plans of care had not been completed and in several instances the problem highlighted did not match the outcome a resident would expect. Two staff members accurately gave an account of the care given to the resident’s case tracked and this reflected well with the plans of care. One resident was able to confirm he was assisted as detailed within the plan. One visitor said, “the care given is good and staff inform me every day of my wife’s condition”. The registered manager is a nurse and was aware of the problem and said she was going to review the plans. Several recommendations were made to help develop the plans. Plans of care had been reviewed and showed residents or their families had been
Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 10 involved in developing the plans. In general the plans of care needed some work to fully take account of a residents needs. There were policies and procedures for staff to follow to administer medication. Staff administering medication had attended suitable training. The registered manager was a registered nurse and had already made arrangements to locate a controlled drug register which would be classed as far more suitable than the current one. The registered manager was aware of the need to review current policies and procedures. Medication policies and procedures protected residents from possible harm. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Resident’s expectations were met for their social, cultural and recreational activities. EVIDENCE: Several residents talked of what they liked to do and were satisfied enough was going on for them. One of the residents case tracked said his main hobby was, “looking after the tropical fish and I like the music and movement”. One visitor was not as satisfied and said, “I would like more activities for my wife. I am happy with her care here but there is not enough to do for someone her age. (The resident was younger than all the other residents). Staff said they usually held activities each day and residents remembered the musical session held the day before the inspection. Due to the nature of the residents admitted it would be good practice to record the type and attendance of activities. When other more pressing matters have been addressed the registered manager needs to look at organised activities to ensure residents are able to lead a fulfilling lives. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents or their families had information on how to complain. EVIDENCE: There was a complaints procedure contained within the service user guide. The procedure gave residents information of various bodies they could contact including the Commission for Social Care Inspection and gave a commitment to attend to a complaint within the relevant timescales. Residents or their families had sufficient information to be able to complain if they wished. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 –25 The home was warm, clean and comfortable. Furnishings and equipment was domestic in style and met residents needs and individual tastes. Suitable equipment such as hand rails disability equipment had been provided where necessary. Toilets and bathrooms were of a type that met residents needs. Shared space was provided to give a variety of activities and uses for residents. EVIDENCE: A tour of the building was conducted during the inspection. All communal areas and some bedrooms were inspected. Rooms had been individualised to resident’s tastes. Equipment was observed for residents with mobility problems such as wheelchairs, walking frames, grab rails and hoisting equipment. Bathrooms had suitable adaptations. Radiators were guarded. Hot water temperatures were controlled and windows were restricted to protect residents. Access to the home was via a keypad lock. Equipment for pressure relief was observed during the tour. Residents said the home was kept very clean. Rooms were clean, tidy and contained sufficient equipment to provide residents with a comfortable environment.
Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The registered manager was aware of the need to recruit staff in a manner, which protects residents from possible abuse. EVIDENCE: The registered manager had not employed anyone during the short time she had been in post. The registered manager said she was aware of the CSCI guidelines and would recruit staff using the regulations to protect the vulnerable group accommodated at the home. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Quality assurance systems had been developed to take account residents or their family’s wishes. Resident’s financial interests were safeguarded. EVIDENCE: Questionnaires had been developed for some aspects of quality assurance. The views of stakeholders had not been obtained and a summary produced of any of the results. The registered manager was advised that the views of all concerned with the home should be obtained in order for her react to the views in order to provide a better service. The financial systems used at the home were satisfactory to protect residents from possible abuse. Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X X Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 17 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. Standard Regulation Requirement Timescale for action 1 OP9 13(2) The registered manager must 30/05/06 review the medication policies and procedures to follow the Royal Pharmaceutical Societies guidelines. 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 2 3 4 Refer to Standard OP7 OP7 OP9 OP33 Good Practice Recommendations The registered manager should ensure that when she reviews the plans of care all sections are completed. The registered manager should ensure the plans of care are stored within the confines of the Data Protection Act. The registered manager should ensure the controlled drug medication record meets current guidelines. The registered manager should ensure all aspects of quality assurance are carried out to take into account the views of all concerned with the home Mill Lodge Care Home DS0000066089.V282867.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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