Inspection on 10/01/09 for Mill River Lodge

This inspection was carried out on 10th January 2009.

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

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 River Lodge 09/09/08

Mill River Lodge 11/03/08

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

CARE HOMES FOR OLDER PEOPLE Mill River Lodge Dukes Square Horsham West Sussex RH12 1JF Lead Inspector Ed McLeod Unannounced Inspection 10th March 2009 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 River Lodge DS0000070879.V373905.R02.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 River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill River Lodge Address Dukes Square Horsham West Sussex RH12 1JF 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) 01403 227070 Shaw Healthcare Ltd Manager post vacant Care Home 70 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 70. Date of last inspection 1st December 2008 Brief Description of the Service: Mill River Lodge is a new-build care home situated in a central location in the town of Horsham in West Sussex. The premises are situated on four floors, with the ground, first and second floors providing accommodation to the people living in the home. There are two lifts, and an electronic system for entering and leaving parts of the building including the central entrance. The home is registered to provide accommodation up to 70 people, and accommodates on the second floor people who come into the category of old age, and accommodates on the ground and first floor people who are diagnosed as having a dementia (such as vascular dementia). The service is operated by Shaw Healthcare, for whom the responsible individual is Mr Peter Nixey. At the time of these visits there was no manager registered for the home. During our previous visit we were advised that the fees are £669 per week. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit was arranged to assess the homes compliance with the key national minimum standards for care homes for older people and with a previous requirement found not to have been met at our compliance visit on 1st December 2008. The visit was undertaken by two inspectors, Ed McLeod and Elaine Green, who were on the premises for 6.5 hours. In preparing for this visit we obtained completed CSCI survey forms from three people living in the home, and one from a member of staff. We also required that the home provide us with their annual CSCI quality selfassessment audit (the AQAA) which we sampled in draft form during our visit and which we received subsequent to the visit and within the timescales within which we had asked for it. Some of the information we received has been used in the writing of this report. During our visit we sampled pre admission assessments for four people and care plans for five people living in the home to assist our assessment of the quality of care planning in the home. We talked to eight people living in the home, four members of staff, the manager and the area manager. To assist our assessment of the homes recruitment procedures and staff training we sampled the recruitment records for three members of staff, and training records for the staff team. We also sampled other records, policies and procedures, including complaints records and records relating to health and safety issues. We visited all the communal areas of the home and a number of bedrooms. What the service does well: A clean and well maintained environment and good accommodation are being provided. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 6 Good arrangements are in place for peoples needs to be assessed before the decision to admit them to the home is taken. A good standard of meals and choices of meals are being provided which people enjoy. Arrangements for staff recruitment are ensuring that staff working in the home are safe to provide care for the people in the home. What has improved since the last inspection? What they could do better: Care plans sometimes include conflicting information which does not assist staff in providing the right support for the person. Care records are not always recording the persons wishes concerning their end of life care and the arrangements they would wish made in the event of their death. Staffing numbers are not always ensuring that peoples care needs can be met and that residents, for example those with dementia, are receiving the level of supervision they need for their safety to be maintained. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 7 On the day of our visit the home had thirty five residents and thirty five vacancies, and therefore it is important that good values and a good culture of care is imbedded fully in practice as new residents are admitted to the home. 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 River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 8 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 River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. EVIDENCE: At the time of our previous visit the provider had agreed not to admit new residents until standards had been raised in the home. At our compliance inspection visit on the 16th December 2008 we found that most of the shortfalls had been addressed. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 10 The manager told us during this visit that the home had been admitting two new residents per week since February 2009. During this visit we looked at the pre-admission assessments and personal preference plans for four people who had been admitted to the home in February 2009, and found that most of their needs were being properly assessed and information which supported the planning of their care was being obtained. We found however that peoples wishes regarding their end of life care and how they would wish their funeral arranged were not always being recorded in the pre-admission assessment. This is discussed more fully in the next section, where the need to record the persons wishes in this regard in the care plan is part of a requirement we have made. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not always ensuring that peoples health, personal and social care needs will be met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, people manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. People are not always receiving support in a way that maintains their dignity. EVIDENCE: We visited the home on 16th December 2008 to assess compliance with the statutory requirement notice dated 9th July 2008, which included a requirement that the provider (i) Ensure that all service users care needs are fully identified and documented in a care plan, which contains sufficient detailed DS0000070879.V373905.R02.S.doc Version 5.2 Page 12 Mill River Lodge information on their care needs and guidance necessary for staff to support service users and fully meet their needs. (ii) Have a system is in place to ensure that care plans for service users continue to be kept under review and updated when necessary to reflect the changing and current needs of individuals. At our visit on the 16th December 2008 we found that care plans were including more detailed information on how the persons needs were to be met, and that the care plans were being regularly reviewed. We found the requirement to have been met. Prior to this visit the three people living in the home who wrote to us told us that they were receiving the care and support they needed, and that staff listened to them and acted on what they said. Three people we spoke to during this visit told us that the home were meeting their needs and that they valued the care they were receiving. A team leader we spoke to told us that care plans were becoming much more specific to the person receiving the care, and that team leaders were monitoring peoples care more effectively. The team leader gave the example of how one persons care needs were being better monitored. The manager of the home also showed us a communication sheet and a picture book with Spanish phrases created with a person living in the home who sometimes talks only in Spanish to assist the communication with staff. The homes annual CSCI quality assurance audit (the AQAA) completed by the manager tells us that personal preference plans have been developed and implemented to help ensure that peoples wishes concerning their care can be followed. The AQAA also tells us that relatives are invited to quarterly reviews of the care plan. During this visit we sampled the care plans for five people living in the home. For one person we found that the care plan was clearly recording their preferences and how staff should assist them with their care. The care plan had separate sections on what their needs were and meeting those needs, for example sections on mobility, night care and personal care. We noted however that the persons wishes concerning their end of life care and arrangements had not been recorded. We spoke with the person, and it was clear that they had strong religious beliefs and this indicated that they Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 13 would have clear wishes about their end of life care and arrangements which they may wish to advise the home of. We looked at the care plan for one person who was bed bound, and found that arrangements were in place to closely monitor their food and drink intake, their skin condition, and medical care. The care plan evidenced that the staff were working closely with the doctor and the district nurse to provide the level of care and support needed. We looked at the risk of falls assessments provided for one person, and found that the advice given in the care plan was not consistent. We considered that this may lead to staff not taking a consistent approach to supporting the persons mobility. For example, the care support plan dated 27/10/08 states that the person needs assistance with transferring from bed to chair, but the handling plan most recently reviewed on 11/1/08 tells us that the person is independent in transferring. The most recent care notes indicate that the persons mobility is decreasing. We found care planning in the home had continued to improve and care plans were on most occasions documenting well how peoples needs are to be met. As evidenced above however we found that for some people the care plan was not recording the persons wishes concerning their end of life arrangements and care and was not for some people providing consistent advice for staff on meeting the individuals care needs. We visited the home on 16th December 2008 to assess compliance with the statutory requirement notice dated 9th July 2008, which included a requirement that the provider ensure that all staff promote and respect the dignity of all the people who use the service at all times and that a system is in place to ensure staff are trained and competent in this area. At our visit on the 16th December 2008 we found that staff were promoting and respecting the dignity of people receiving a service and this requirement was assessed as met. At this visit we observed an incident when staff failed to acknowledge a persons request for assistance, and where we believed the persons care and dignity needs were not met. The person concerned wanted to go to the toilet and was calling for staff help. Staff didn’t come so one of our inspectors went around the corner to where a member of staff was writing up notes and brought it to their attention. The Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 14 member of staff replied that she knew that the lady required assistance but that she already had someone on the toilet. We returned to the resident concerned who was by this time was becoming distressed and repeatedly calling out loudly. We observed her calling out to two members of staff who walked by but neither of them responded to her. There were five or six other residents in the room and several visitors. This was not a dignified experience for this lady. At no time did any member of staff come to give her reassurance. We observed the staff member we had talked to returning to the lounge with another resident and she then assisted the lady to the toilet. We learned that the two members of staff who had walked past the resident and not acknowledged her calls for assistance were not working on the residents unit. We observed that these members of staff were not asked to assist the lady in the absence of other available staff. We observed that no one offered to reassure or assist this lady while she was in distress, and none of the three staff concerned called for help. Also during our visit one member of staff stated that it was difficult getting people up and putting them to bed with only two staff as all nine residents they were caring for were in need of assistance of some sort. The member of staff explained that this means that for a large part of the morning and evening residents are left in the lounge on their own. A regulatory requirement to be met by 3rd November 2008 was that the provider make proper provision for the health and welfare of people living in the home, and ensure that arrangements for the recording, handling and administration of medicines are protecting people in the home. At our visit on the 16th December 2008 we found that the provider is ensuring that issues with weight and food and fluid intake are being properly monitored and acted upon. During this visit we looked at the arrangements for ensuring the food and fluid intake for one person who was bed-bound, and found that this was being appropriately monitored and the necessary assistance given. At our visit on the 1st December 2008 we found that arrangements for the recording, handling and administration of medicines were not always protecting people in the home. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 15 On the 1st December 2008 we found that risk assessments for supporting people to manage their medication were not properly in place, that advice to staff concerning medication to be given as needed was not explicit enough, and that the medication refrigerator on one unit was too cold. During this visit we found that advice to staff concerning medication to be given as needed was clearer and more explicit, and will better ensure that this medication is administered safely. We found during this visit that one person was being supported to manage their own medication, and that a risk assessment relating to this had been completed to better ensure that this was safe. During this visit we found that the temperatures of the two medication refrigerators were being recorded twice a day. Advice for staff on acceptable temperature levels were posted on the doors of the fridges, and records indicated that temperatures were complying with those acceptable levels. We found that clear arrangements were in place for monitoring medication records twice a day, and a team leader we spoke to confirmed that this was taking place with a first floor team leader checking the second floor records and a second floor team leader checking the first floor records. Regular medication audits are also being carried out to better ensure safety. The manager advised us that only team leaders are administering medicines in the home. We looked at the records of training for six team leaders and found that they are receiving regular training in the safe handling of medication. We found that the requirement concerning medication had been met. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks at a time and place to suit them. EVIDENCE: We visited the home on 16th December 2008 to assess compliance with the statutory requirement notice dated 9th July 2008, which included a requirement that the provider i. Ensure that a system is in place to fully assess and document the emotional, spiritual, cultural and recreational needs of people who use DS0000070879.V373905.R02.S.doc Version 5.2 Page 17 Mill River Lodge the service by a suitably qualified and competent person and that the assessment is kept under review and revised as and when necessary. ii. Ensure a system is in place to provide all service users with regular opportunities to take part in a suitable programme of activities and stimulation based on their needs, wishes and preferences. Records must be kept of such activities and be available for inspection. At our visit on the 16th December 2008 we found evidence that peoples emotional, spiritual, cultural and recreational needs were being suitably assessed and a suitable programme of activities was in place. This requirement was assessed as met. The AQAA completed by the manager acknowledges that by having a more structured activities programme and appointing activities co-ordinators to vacant posts that people would have more choice of activities. During this visit the manager advised us that interviews have been completed and the paperwork is now being done to appoint activities co-ordinators. On the day of our visit we observed five people in one sitting room who were chatting about Marlene Dietrich and singing along to the radio. There was a relaxed atmosphere and activities that were to take place were posted on the notice board. Later in the morning seven residents on the same unit were taking part in a quiz, and one member of staff was talking to a resident about the area she used to live in. On another unit one person was doing a jigsaw and another had been out for a walk, and staff told us that a film had been shown in the cinema room set aside for this purpose. A member of staff we spoke to told us that residents like the war-time music, old films, drawing, painting, entertainers – and said that the most recent entertainer was a piano player about 3 weeks previously. Staff also told us that people suffering from dementia liked staff just chatting to them or reading the newspaper with them. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 18 One care plan we looked at told us that the person liked music and singing, and care notes told us he was having the opportunity to take part in music and singing. We observed him singing on the day of our visit. We visited the home on 16th December 2008 to assess compliance with the statutory requirement notice dated 9th July 2008, which included a requirement that the provider ensure that service users are provided with appropriate arrangements to assist eating and drinking including the provision of specialist equipment and staff support to protect the dignity of people who use the service and ensure they receive adequate nutrition according to their needs. At our visit on the 16th December 2008 we found that arrangements which were respecting the dignity and needs of people around meals and nutrition were in place, and this requirement was assessed as met. The CSCI survey forms we received previous to this visit from three people living in the home told us that they enjoyed the meals in the home. During this visit we found at lunch that there were two choices of main meal and where people wanted something different this was being provided. One person received a salad they had requested. One person who needed a soft food diet was receiving this. We noted that people who were in need of assistance were being assisted in a calm and unobtrusive way. It was our observation that people were enjoying the meal and eating well, and the two people we asked confirmed that they had enjoyed the meal. The manager tells us in the AQAA that the menus have been developed and improved through feedback from residents and staff. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: We visited the home on 16th December 2008 to assess compliance with the statutory requirement notice dated 9th July 2008, which included a requirement that the provider i. Ensure that all service users are protected from unnecessary risks by the training of staff appropriate to the work they are to perform. Where staff are working with people who have dementia they must have received appropriate training. Ensure a system is in place to ensure that you and all staff employed at the care home adhere to the agreed multi-agency procedures for safeguarding adults and that all incidents and allegations of abuse are handled in accordance with those procedures in order to protect service users from abuse and harm. DS0000070879.V373905.R02.S.doc Version 5.2 Page 20 ii. Mill River Lodge iii. Ensure a system is in place to ensure all complaints received by the home are investigated and fully documented including the outcomes of the complaint. This must be kept in the home and be available for inspection. At our visit on the 16th December 2008 we found evidence that the provider was protecting service users from unnecessary risks, including by the training of staff and handling incidents and allegations of abuse in accordance with agreed multi-agency procedures. We also found evidence that the provider is fully investigating and documenting complaints received on the service. This statutory notice requirement was found to have been met at our visit on 16th December 2008. People responding to our CSCI survey told us that are aware of how they would make a complaint to the home. At this visit we looked at a complaint recorded since our previous visit, and the records indicated that an investigation had been undertaken and the outcome and feedback to the complainant had been recorded. We looked at the record for two investigations on safeguarding incidents which the local authority had asked the home to undertake. Records seen indicate that this was done in a timely fashion and appropriate action had been taken after the investigation had been completed. Staff training records we sampled indicated that staff are receiving training in safeguarding adults. The manager told us that staff are now clearer about what needs to be reported, and that the quality of the records relating to concerns and safeguarding issues has improved. The manager advised us that he was attending a local authority briefing on new local safeguarding procedures in the coming month which would help the home keep up to date with changes in local safeguarding procedures. It was the view of the manager that incidents of aggression have reduced since residents previously on the ground floor have moved to the first floor where they have more freedom of movement and are happier as a result. We noted that one resident in particular has benefited from this move. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 21 A reduction in the number of notifications received from the home concerns incidents of aggression indicates that there is a calmer atmosphere in the home. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: We visited the main communal areas of the home and a number of bedrooms. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 23 We found that the home is being well maintained, and good arrangements are in place to ensure that maintenance and redecoration work is carried out when needed. The decoration and furnishing of the home we found to be of a good standard. Care plans we looked at indicated that specialist equipment needed such as hoists are being provided to ensure people are safe when they are assisted to move or mobilise. Hot water temperature check records we looked at indicated that potential hazards such as high hot water temperatures in communal kitchen areas had been identified and action taken to ensure the provision of safe hot water in those areas. People have been able to personalise their bedrooms and one person we spoke to described their bedroom as nice and comfortable. All areas of the home visited were found to be clean and free from odours. The CSCI survey forms we received from three people living in the home told us that the home is kept fresh and clean. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are not always enough competent staff on duty at all times. People have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: A regulatory requirement to be met by 3rd November 2008 was that the provider must ensure the home is adequately managed and staffed to ensure that people receive the assistance they require. At our visit on the 16th December 2008 we found that agency staff had largely been replaced by more permanent staff, and that new staff were being well supported. During that visit we found that there were enough staff available to meet peoples care needs, and we found that the requirement had been met. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 25 At this visit the manager told us that continuity of care is being provided by staff working on the same floor and same unit most of the time. The manager told us that the use of agency staff in the home has continued to reduce, and that since the end of December 2008 ten hours of agency cover had been provided. The manager believed that the reduced use of agency staff also assisted in providing people with consistent care. One member of staff told us in their CSCI survey form that staff feel more supported and most importantly know their roles and responsibilities. However we did find some evidence during this visit that numbers of staff available were not meeting peoples needs. For example, during our visit a resident was calling out for assistance in going to the toilet but was not receiving a response from staff. A member of staff we told about the lady needing help told us she was too busy to assist the person right away. Although the person was becoming distressed and repeating aloud that she needed help urgently staff were not available to come to her assistance until other tasks had been completed. Also during our visit one member of staff told us that getting people up and putting them to bed is difficult as on the unit being discussed there were only two staff and all nine residents on the unit needed assistance of some sort. The member of staff told us that this means that for a large part of the morning and evening residents (some of whom may be suffering from dementia) are left in the lounge on their own. These two examples indicate that staffing levels sufficient to meet peoples needs keep them safe are not being provided. On the day of our visit the manager told us that there were thirty five people accommodated in the home and thirty five vacancies, and that the home was now admitting two new residents per week. This is further indication that there is a need for managers to review if the numbers of staff employed are sufficient to meet peoples needs and keep them safe. The manager said he believed that team leaders were now better leading their teams, providing better guidance and supervision and overview of care needs. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 26 A team leader we spoke to told us that team leaders are now taking action if they believe staff will benefit from extra training and gave the example of a member of staff who needed more manual handling training so this arranged. The team leader told us the member of staff is now more aware she can ask for help with carrying out manual handling, is more competent and feels better supported. It was our observation during this visit that staff were interacting well with people and that staff working with people with dementia had the understanding and skills to support them. We found that people looked well cared for and that during lunch sufficient numbers of staff were available to assist people with eating who needed this assistance. We looked at the recruitment records for three staff who commenced work in the home in January 2009 and found that the required checks and references had been in place before they started work. The AQAA tells us that new staff undertake a 4 day induction programme and that new staff have a mentor and supervisor assigned to them. We sampled the induction and supervision records for a new member of staff which indicated that staff have the opportunity to learn a range of things relevant to their job during their induction period. We sampled a broadsheet which summarises when staff have most recently undertaken core trainings such as safeguarding, health and safety, fire procedures, and moving and handling. We found that staff were up to date with this training. We looked at the training records for five team leaders for the extent of dementia training they had undertaken and found that four of the five team leaders had completed at least three days dementia training in the past nine months. The manager told us that it was intended that care staff will undertake a 3 day course in dementia rather than the usual one day. The AQAA tells us that four staff were due to commence their national vocational qualification (NVQ) in care in March 2009 and that other staff are being considered for the next intake. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 27 We are also told in the AQAA that all team leaders have attained at least level 3 of the NVQ in care. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 28 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 29 The AQAA acknowledges that there have been four changes of manager, including an interim manager, since early 2008. The present manager has been managing the service in effect since December 2008 and has applied to be registered as manager of the service. The present manager has attained NVQ in care at level 4 and the registered managers award, and is experienced in managing care homes. The manager has been previously registered as a care home manager. Despite the number of changes of manager the home has been able to improve practice and care provision in the home significantly over the past six month. We found during this visit however that the home needs to ensure that good practice is resulting from the changes brought about – for example by ensuring that all residents are supported with dignity at all times and that staff listen to them and act on what they say. This did not happen in an incident referred to in the Health and Personal Care and Staffing sections of this report. We found that managers also need to ensure that the staffing numbers provided ensure that peoples needs are met at all times. On the day of our visit the home had thirty five residents and thirty five vacancies, and therefore there is a need for the service to ensure that improvements are sustained and embedded in good practice before more residents are admitted. Three members of staff we spoke to during this visit told us that they were happy with the changes brought in and that the new manager was open and that he listened to them. One person stated that everyone was more settled and happier. Staff told us they now know where they stand and understand that if they do something wrong that they will be corrected. This is raising standards. One person said the home is now run in the interest of the service users where before often things happened for the staffs benefit. There was a regulatory requirement to be met by 3rd November 2008 that the provider ensure a system is in place for all staff to receive appropriate and formal supervision at regular intervals and that this is documented in order to meet the needs of service users. At our inspection visit on 16th December 2008 we found that a system was in place for regular supervision, and that staff were receiving regular supervision Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 30 which was supporting staff to do the job they are doing and identifying training which will help improve their skills and knowledge. This requirement was found to have been met at our visit on 16th December 2008. During this visit the manager told us that the quality and frequency of staff supervision has improved and that performance issues are being better picked up and recorded to ensure that care in the home continues to improve. Supervision records which we sampled indicated that most people were on track to receive supervision six times a year, which is the minimum recommended frequency advised in the national minimum standards. We were satisfied by the evidence provided by a team leader and the manager that all staff would be receiving regular supervision in the near future. We looked at the records for two people for whom the home was holding small amounts of money and found that arrangements in place included staff signatures for each transaction, receipts, and accounting. The home have advised us in the AQAA of the most recent services and checks which have been carried out on the equipment in the home to support health and safety in the home. We sampled the providers report of their statutory monthly visit to the home on 14th January 2009 and this advises us that the provider is monitoring that checks such as fire drills, hazardous substances assessment, handyman tasks, and hot water temperatures are being carried out. Where checks have found there to be safety issues, for example the temperature of hot water in kitchenettes accessed by residents, action has been taken to better ensure safety. Staff training records sampled indicated that staff are up to date with required health and safety training including fire training, health and safety, and manual handling. The AQAA advises us that safe food handling training has been completed by five domiciliary staff and sixty one care staff. Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 31 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 32 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 15.1 Requirement The registered person shall after consultation with the service user or their representative prepare a plan as to how the service users needs in respect of his health and welfare are to be met. This to include the service users wishes concerning their end of life care and arrangements. The service users plan must provide clear advice to staff on how the persons needs are to be met. Timescale for action 29/06/09 2 OP27 18.1 This is because we found that care plans were not always including a record of the individuals wishes concerning their end of life care. We also found that care plans were not always providing clear advice on how the persons needs e.g. mobility needs were to be met The registered person shall, 01/05/09 having regard to the size of the care home, the statement of purpose and needs of service users ensure that at all times suitably qualified, competent and experienced person are working DS0000070879.V373905.R02.S.doc Version 5.2 Page 33 Mill River Lodge at the care home in such numbers as are appropriate for the health and welfare of service users. This is because we found during our visit that staff numbers were not sufficient to meet the care and safety needs of the people accommodated. 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 River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill River Lodge DS0000070879.V373905.R02.S.doc Version 5.2 Page 35 - 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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