Inspection on 11/03/08 for Mill River Lodge

This inspection was carried out on 11th March 2008.

CSCI found this care home to be providing an Poor 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 10/01/09

Mill River Lodge 09/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mill River Lodge Dukes Square Horsham West Sussex RH12 1JF Lead Inspector Ed McLeod Unannounced Inspection 11th March 2008 08:45 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.V359597.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 River Lodge DS0000070879.V359597.R01.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 Ms Rebecca Kelsey 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.V359597.R01.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) Dementia (DE) The maximum number of service users to be accommodated is 70. 2. Date of last inspection New service 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. The registered manager for the home is Ms Rebecca Kelsey. Fees range from the minimum £420.36 per week to the maximum £669 per week. Mill River Lodge DS0000070879.V359597.R01.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 0 star. This means the people who use this service experience poor quality outcomes. The inspection visit was carried out by Ed McLeod over a period of nine and a half hours to assist us in assessing the home’s compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service since we registered the service including the annual CSCI quality self-audit (the AQAA) which was completed by the home’s manager, and the local authority record of a recent safeguarding meeting. As part of our assessment we spoke with three people living in the home and three visiting relatives. We also spoke with the manager Ms Kelsey, Ms Murchan (a manager for Shaw Healthcare) and five care and nursing members of staff. We sampled five sets of admission assessments and the individual plans of care for five people living in the home. Other records sampled included recruitment and training records for three members of staff and two temporary (agency) members of staff, the record of complaints, and records relating to health and safety issues in the home. We visited the main communal areas of the care home and six bedrooms. We observed a number of interactions between people living in the home and staff, and observed sittings for breakfast and lunch. At this visit the provider was found not to have met their legal obligations under the Care Standards Act 2000, including meeting health, personal and social care needs, safeguarding people from harm, staffing, recruitment checks and staff training. The Commission for Social Care Inspection has issued a Statutory Requirement Notice to enforce compliance of the Regulations. What the service does well: Risk assessments are in place for each person to support them living their life as independently as is possible. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 6 Useful information on the personal care, health and social needs of the person accommodated are recorded in the care plan. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. Arrangements are in place to ensure the building is being maintained and problems addressed in good time. Communal bathrooms visited were suitably equipped, and arranged to allow easy access for equipment and wheelchairs. All staff undertake a 4 day comprehensive induction training, which is then regularly refreshed. What has improved since the last inspection? What they could do better: People’s health, personal and social care needs are not being met. People’s care plans need to include the action to be taken by staff to meet the person’s needs. Some people are not being supported to be as independent as they can be, and need to have the opportunity to make the most of their abilities. People are not always being provided with meals and mealtimes which are meeting their needs. Concerns and complaints are not always being acted upon in a timely fashion, and action is not always being taken to put things right. The care home is not always safeguarding people from abuse and neglect or taking appropriate action to follow up any allegations. There are not always enough competent staff on duty at all times to ensure people have safe and appropriate support. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 7 Staff working at the home may not always have completed satisfactory checks to make sure that they are suitable to care for people in the home. Some staff working at the home may not have received the relevant training and support to meet the needs of the people living in 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.V359597.R01.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.V359597.R01.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 the 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. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 10 EVIDENCE: The manager tells us in the AQAA that all prospective residents and relatives are encouraged to visit the home, prior to admission. The service user’s guide and statement of purpose, which provide information on the service provided, are available in the reception area. The home’s annual CSCI self audit questionnaire (the AQAA) advised that these are also available in larger print. During our visit we noted that the service user guide is also available in each of the resident’s rooms, along with the complaints procedure and CSCI contact details. We looked at the terms and conditions of service for people living in the home which are provided in the Service Agreement. The manager told us that for people who are being funded by the local authority, they pay their contribution towards the fee to the local authority. The Service Agreement advises people that admission is initially for a four week trial period. We looked at four sets of care needs assessments which had been carried out before admission to the home was agreed. These indicated that people’s needs are being fully assessed prior to admission. The manager, Ms Kelsey, advised us that intermediate care is not provided in the home. Mill River Lodge DS0000070879.V359597.R01.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 poor. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are not being met. The home has a plan of care that the person, or someone close to them, has been involved in making. The care plan however lacks the detailed action to be taken that would ensure staff know how the person’s needs are to be met. A statutory requirement notice has been issued as follows: The provider must ensure that the care plan is being reviewed with the person or their relative, and that they are provided with a copy of the care plan. Care plans must advise how the person wishes their needs to be met, include the specific action to be taken to meet the person’s care, health and social needs, and be regularly reviewed. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 12 If they take medicine, people manage it themselves if they can. For people who cannot manage their medicine, the care home is not ensuring medicines are always safely administered. People’s right to privacy is respected. The support they get from staff is not always given in a way that maintains their dignity. EVIDENCE: The AQAA tells us that risk assessments are in place for each person to support them living their life as independently as is possible. We looked at five sets of care plans. We found that useful information on the personal care, health and social needs of the person accommodated are recorded in the care plan. We also found that care plans are being reviewed monthly. What we did not find was clear evidence that the care plan is being reviewed with the person or their relative, or that they are provided with a copy of the care plan. The three relatives we spoke to during our visit said they had not seen a copy of the person’s care plan and did not know who the key worker was who is responsible for the care plan. Care plans seen were not clearly setting out for staff and others what specific action they would be taking to ensure the person’s care, health and social needs were met. For example, one person’s daily living assessment recorded that they suffered from dry skin, preferred a bath in the afternoon, and what their interests were. The same person’s care plan did not set out when, how and how often action should be taken to treat their dry skin. The person’s care plan did not advise staff that baths should be offered in the afternoon. The person’s care plan did not set out when, how and how often staff would support the person with their interests and activity needs. As the needs assessment tells us that the person suffers from vascular Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 13 dementia and that their speech is unclear, it would be particularly important that the care plan include detailed advice and action to be taken to properly ensure that the person’s communication and support needs are being met. When serious incidents had occurred, we found that records relating to the incidents were not always being placed on the relevant care plans, and the need to review and update the care plan was therefore not being undertaken. Care plans seen were often not clearly setting out how the person wished their personal care, health and social needs to be met. For example, one relative told us that her mother did not like her hair cut too short and having her ears exposed, and that when her hair had recently been cut too short for her she became agitated and was often seen touching her hair and trying to cover her ears. As the person suffers from dementia and she was noted by us to have limited communication, it is particularly important that this kind of information is given in the care plan and that care staff act on it and ensure this does not happen again. The report for the monthly visit carried out by Shaw Healthcare on the 12th December 2007 tells us that shortfalls in the care plan records included daily reports not always being recorded, gaps in weight loss records, and no plan of action where a person’s health is at risk due to weight loss. During our visit we found gaps in the recording of fluid charts and food intake charts. We also found that some people who were identified at being at risk due to loss of weight were not having their weight regularly recorded. For example, one person was advised in their care plan to be underweight. We found that for the seven days commencing 4th March 2008 there were records for her food intake on only three of the days. The care plan stated that the person should be encouraged to drink, and should be receiving between 1.5 and 2 litres of fluid per day. We looked at fluid charts for five days commencing 6th March 2008. In some of the records staff are failing to record the exact amounts taken, and where records did record the amounts these were often far below the daily amounts recommended in the care plan. Care records seen did not indicate that managers or staff were acting on this Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 14 information which indicated the person may be at risk of dehydration. We looked at the food records for another person whose intake was being monitored and found that records had only been made on three of the seven days which we looked at. We looked at records for another person who was assessed as underweight and whose weight needed monitoring. We found only three records for weighing, and these were dated 27/8/07, 22/11/07, and 21/12/07. All three records indicated there had been further weight loss. The care plan did not indicate that the person’s health or wellbeing had been appropriately reviewed in response to the further weight loss. We received an anonymous complaint which referred to matters including that call bells were going unanswered. During our visit one incident was noted where a temporary member of staff who was doing paperwork chose not to respond to a call bell which was ringing although no other member of staff was available to respond to the call. During our visit incidents were noted which indicated people living in the home are not always being treated respectfully. For example, one person was becoming very upset that a member of staff was being insistent that she put on a bib and accept food she was being offered. This incident took place in a room full of people, and the person’s loud protests were not listened to by the member of staff for a significant length of time. The AQAA tells us that local community mental health team support is accessed for people who need this, and that people are supported to manage their own medicines where it is safe for them to do so. During our visit the manager Ms Kelsey told us that two or three people in the home had been assessed as able to be responsible for their own medicines, and that risk assessments carried out had assessed this to be safe. We received notification on 28/2/08 that incorrect medication had been given to one person on two occasions. The record of the monthly visit by Shaw Healthcare on the 12th December 2007 notes that 126 gaps in medication records were found. During our visit, Ms Kelsey advised us that the gaps identified had included missing signatures and the incorrect use of codes. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 15 There are now three medication trolleys, one for each floor, which assists the medication round being done in good time. Ms Kelsey told us that arrangements are in place for care staff to check medication records made by other care staff to help reduce the number of medication errors. Managerial medication audits are also being commenced. The manager tells us in that the AQAA that planned improvements include regular audits of care plans and medication records. At this visit Ms Kelsey told us that these audits, which would include a weekly check on boxed and liquid medicines, were not yet fully in place. Mill River Lodge DS0000070879.V359597.R01.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 poor. This judgement has been made using available evidence including a visit to this service. The arrangements for activities and meals in the home are not always ensuring that each person is treated as an individual and the care home is responsive to his or her age and disability. Contact with their local community is limited. The care home is not always supporting people to follow personal interests and activities. A statutory requirement notice has been issued as follows: The provider must ensure that people in the care home are supported to follow personal interests and be offered opportunities for appropriate activities. People are able to keep in touch with family, friends and representatives. Some people are not being supported to be as independent as they can be, and have the opportunity to make the most of their abilities. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 17 People are not always being provided with meals and mealtimes which are meeting their needs. EVIDENCE: The AQAA tells us that church services are held monthly, and that the “pat a dog” scheme visits the home. The manager tells us in the AQAA that improvements will be made by recruiting an activities coordinator to ensure regular activities, more social events, activities training for support workers, and more access to events in the community. On the day of our visit, the manager Ms Kelsey advised us that there were no activities coordinators employed in the home, but that one person had been recently interviewed. During our visit, we did not see any programme of activities displayed in any of the units we visited. We found the provision of activities and individual social time spent with people living in the home to be inconsistent. For example, in two of the units visited we observed spontaneous things such as staff playing ball games and doing puzzles with people interested in this, and a person assisting a member of staff to fold table cloths. One relative we spoke to stated her mother liked doing things, and had enjoyed making paper flowers recently. In two other units at around one in the afternoon we asked staff if any activities had been provided that morning. The staff we spoke to told us no activities had been provided as they had been too busy and had not had time. We visited some of the units during breakfast and lunch sittings. In some units we found there to be a calm and unhurried atmosphere, and people being assisted appropriately with eating and drinking where they needed this. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 18 In one unit we found one person in a state of agitation at the lunch table who appeared to need more one to one support than staff were able to provide. As noted in the Health and Personal Care section of this report one other person (in the same unit) was becoming extremely agitated when a member of staff insisted on them eating and wearing a bib. Also in this unit we observed one person eating with their fingers, although the meal provided was not finger food. This may indicate that either the person did not find the utensils provided useable, or that they would prefer finger food. We asked staff on this unit how diabetic diets were being catered for on the unit. Staff told us that the diabetic option for dessert was sugar-free jellies, and told us that one person on the unit was given these. We looked at the needs assessment and care plan for the person, and found no mention of him suffering from diabetes or needing to have sugar-free desserts. In the same unit we found that people living in the home were left sitting at the table long after their meals had finished and the tables had been cleared, and some of them appeared bewildered. As people on this unit suffer from dementia, they may have needed assistance or prompts to leave the table, as most of them did not appear to be enjoying sitting at the table and no social interaction between them was taking place. It was our conclusion from the above examples that this unit was not being adequately managed or staffed to ensure that people were receiving the assistance they required during lunch time. On one of the elderly care units we spoke to three people concerning the food. Two of the people said that the vegetables were usually undercooked and one person described the meat as “too tough”. As people can differ in how they wish their food (for example vegetables and meat) cooked, the home may wish to look at how the tastes of different people can be met for the same meal. Mill River Lodge DS0000070879.V359597.R01.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 poor. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care, they or other people close to them know how to complain. Concerns and complaints are not always being acted upon in a timely fashion, and action is not always being taken to put things right. A statutory requirement notice has been issued as follows: Concerns and complaints must be properly recorded and acted upon in a timely fashion. The care home is not always safeguarding people from abuse and neglect or taking appropriate action to follow up any allegations. A statutory notice requirement will be made as follows: The care home must safeguard people from abuse and neglect and take appropriate action to follow up any allegations. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager tells us in the AQAA that relatives and staff are made aware of the complaints policy and procedure, and that each resident has a copy of the complaints procedure in their rooms in a pack, which also contains the service user guide and CSCI contact details. The AQAA tells us that all complaints are logged onto the home’s computer system, which is regularly audited by the quality audit team. The AQAA tells us that all complaints are dealt with quickly, a letter of acknowledgment is sent out to the person who made the complaint, and any necessary follow up letter. We looked at a letter of complaint received by the home which is referred to later in this section. While a written acknowledgement was sent to the complainant, there was no evidence that the home had acted in a proper way to deal with the complaint. For example, the manager was unable to advise us what action had been taken to protect people referred to in the complaint. The manager was unable to confirm to us if protection and action plans were now in place for the people alleged to have been part of the incidents. In the AQAA the manager acknowledges there is a need for staff to undergo training in the Mental Capacity Act and to consider how the home will seek to comply with the Act. The manager tells us in the AQAA that there has been one safeguarding investigation since the service began. The safeguarding issues in that investigation included an allegation from visitors that they had had to assist staff to turn their relative over in bed. During this visit we observed an incident where a staff member together with a relative manually assisted the person being cared for up from a dining room chair and over to a sitting chair. Another member of staff was sitting close by and, although writing some notes, would have had a clear view of the incident and could have ensured that staff not relatives assist people in the home in this way. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 21 Staff in care homes are required to undertake training and be competent in the safe moving and handling of people being cared for. Should a person begin to fall or overbalance when assisted by a relative, staff would not have been able to ensure that the person or their relative did not come to harm. The home in this situation is therefore failing in its’ duty of care. Since the AQAA was completed, we have received an incident report from the service alleging abuses against people living in the home by a worker employed temporarily in the home. This matter is currently being investigated by the local authority, and a planning meeting concerning this was held on 3/3/08. The record of this meeting notes that they had not to date received the outcome of some previous investigations they had asked Shaw Healthcare to undertake, and that there was an “overall concern” that Shaw Healthcare were not ensuring their responsibility to safeguard people they care for was being met. During our visit we looked at a written complaint received by the home in January 2008 in which it was alleged that two people living in the home had been attacked on separate occasions by a person living in the home. The complainant alleged that the home was failing to ensure a member staff on the unit at all times and that this contributed to the incidents that had taken place. The home is required to inform CSCI of such incidents. CSCI have not received notification of these incidents from the home, and manager Ms Kelsey confirmed that the required notification had not been sent to us. Under local safeguarding protocols, the home is required to inform their local social services authority of such incidents. Ms Kelsey advised us that this had not been done. These shortfalls further indicate that the home is failing to safeguard the people they are caring for. Mill River Lodge DS0000070879.V359597.R01.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 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 rooms feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 23 The premises are a new purpose built home. The ground and first floors have accommodation for people with a dementia, and the second floor has accommodation for people over the age of 65. There are 2 lifts. There is a secure area of garden which can be accessed by people living in the home. The building has areas of secure door entry, including the entrance area. Records seen indicated that arrangements are in place to ensure the building is being maintained and problems addressed in good time. The home is arranged in living units which can accommodate up to ten people. Each unit has communal areas including a dining area and a kitchenette where drinks and snacks can be prepared as required. All bedrooms have en-suite facilities, including either a bath or shower. The AQAA tells us that people are encouraged to personalise their bedroom. All bedrooms visited were clean and comfortable and free from trip hazards, and furnished to a good standard. The AQAA tells us that people are able to have their own phone line installed. Communal bathrooms visited were suitably equipped, and arranged to allow easy access for equipment and wheelchairs. The building has wide corridors, which also make wheelchair access easier. The manager tells us in the AQAA that improvements could be made by having raised flower beds in the garden where the resident’s will be encouraged and supported to plant and tend to the flowers/ shrubs, and by having more activities available in the seated areas along the corridors. Hot water outlets in people’s bedrooms we hand-tested indicated that safe hot water is being provided. Suitable arrangements are in place to ensure incontinence laundry is dealt with to reduce the risk of the spread of infection. All areas of the home visited, including laundry areas, were clean and hygienic. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 24 Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 25 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 poor. 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 to ensure people have safe and appropriate support. Staff working at the home may not always have satisfactory checks completed to make sure that they are suitable to care for people in the home. A statutory requirement notice will be issued as follows: The provider must ensure that people who work in the home are safe to work with the people accommodated. Some staff working at the home may not have received the relevant training and support to meet their needs. A statutory requirement notice has been issued as follows: Ensure that all service users are protected from unnecessary risks by the training of staff on the work they are to perform. EVIDENCE: Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 26 Ms Kelsey told us that individual permanent staff usually work in the units on one particular floor, but on one shift per week work on a different floor perhaps with a group of people with different needs. The manager acknowledges in the AQAA that it has been difficult to recruit enough staff, and that there has been a need to employ temporary (agency) staff to cover some shifts. We looked at the staff rotas for one unit for the week commencing 9th March 2008. We found that several staff were on the rota to work five shifts or more on that unit during that week – which would assist continuity in the care provided. We found that several staff were on the rota to cover one shift on the unit during that week, and that four agency staff shifts (covered by three different agency staff) were on the unit rota for that week. This would not assist in the continuity of care being provided. The staff rotas for a second unit we looked at give a similar picture, with some staff working several shifts, some staff a single shift, and five agency shifts covered by four different agency staff. It was our observation that some of the people living in the dementia care units were at times in need of one to one support for extended periods of time which did not involve personal care. For example, we observed one person who was restless, and tried on several occasions to speak to staff who were supporting other people at the time. Staff took the time to set him up with an activity to do, but he continued to try to talk to staff and became mildly aggressive when staff were too busy to respond to him. This made it difficult for staff to concentrate on the things they were doing with other people. The complexity of the needs of people with dementia was illustrated by this incident, and it was evident that staffing levels were not sufficient to allow the necessary one to one time with this person. During our visit we looked at a written complaint received by the home in January 2008 in which it was alleged that two people living in the home had been attacked on separate occasions by a person living in the home. The Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 27 complainant alleged that the home was failing to ensure a member staff on the unit at all times and that this contributed to the incidents that had taken place. The manager tells us in the AQAA that “when using agency staff, we request the same staff, so that there is continuity with the delivery of care”. We looked at three sets of recruitment records for permanent staff employed in the home. We found that for one person the records available did not indicate if they had received the required PoVA First check before they had commenced employment at the home. Although the manager spent some time trying to locate a record that would confirm the check, it was not found. We attempted to look at the records for five agency staff employed in the home on the day of our visit. This was difficult because staff rotas did not give us the full name of the member of staff, and only one of the staff had signed their full name on the signing in sheets. The manager was unable to confirm the full names of three of the five agency staff working in the home that day. For the two agency staff we were able to identify, we looked at the record of checks and training provided by the agency. The records seen did not provide evidence that the home is obtaining training records for agency (temporary) staff employed. It could not therefore be evidenced that, for example, the agency staff working in the home had an understanding of dementia or had had training in dementia care. It could not be evidenced that, for example, staff had received other training such as safeguarding training or manual handling training which helps ensure the safety of the people being cared for. This indicates a failure to properly ensure that staff employed to work in the home were safe to work with the people being cared for. We received an anonymous call in January 2008 alleging that staff with little or no training in dementia were caring for people with dementia, and another anonymous call received in February 2008 also alleged this. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 28 Training records we looked at indicated that for some permanent staff who had commenced work in the home the only training in dementia care which they had received had been a short introductory training. One member of staff we spoke to on one of the dementia care units told us they had not received any dementia care training since their induction and told us they felt they were in need of more training in dementia care. The member of staff told us they had not yet been booked on a full training in dementia care course. We received an anonymous allegation that staffing levels were poor and that staff were not being replaced on shifts when they were taking part in training. On the day of our visit we noted that one member of staff, who was the only member of staff recorded on the rota for the morning shift for a particular unit, was confirmed as having attended a training session that day between the hours of 10 a.m. and 1 p.m. We discussed this with Ms Kelsey, who confirmed that cover for the member of staff on training had not been arranged. Ms Kelsey said the absence was probably covered by the “floater” member of staff who works between two units, meaning that two rather than three members of staff were employed across the two units between 10 a.m. and 1 p.m. We also spoke to a care worker who told us that there had been no activities provided for people in the unit that morning because “two of us have been on courses which just left the agency (member of staff)”. The AQAA tells us that of 55 permanent care staff, 25 have attained the national vocational qualification (NVQ) in care at least at level 2, and four staff are presently undertaking this training. All staff undertake a 4 day comprehensive induction training, which is then regularly refreshed. The AQAA tells us that all catering staff and 71 of care staff have done training in Food Hygiene. The manager tells us in the AQAA that the service would benefit from all team leaders undergoing the company’s team leader training, as it will give them a better knowledge and confidence to deal with staffing issues. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 29 Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 30 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 poor. This judgement has been made using available evidence including a visit to this service. We found that managers have failed to ensure that care planning and provision which meets the needs and protects the people living in the home are provided. We found that staff were not receiving appropriate supervision. A statutory requirement notice has been been issued as follows: The provider must ensure that persons working at the care home are appropriately supervised. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 31 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: The manager registered for the service, Ms Kelsey, advised that she has two and a half years experience of managing care homes – these being a 34 bedded home and then a 36 bedded home. Previous to being a manager she was a care worker and a team leader in care homes. Ms Kelsey tells us that she has achieved the NVQ in care at levels 2, 3 and 4, and that her training in the registered manager’s award is near to being completed. We were advised by Ms Kelsey that she continues to update her training, and has recently undertaken training in areas such as leadership, assertiveness, and budgeting. The manager tells us in the AQAA that quarterly quality audits are undertaken to identify areas for improvement. During this visit we found that shortfalls in the care provided which the company had been previously identified, such as weight loss and low food and fluid intake, were not being effectively addressed by managers. During this visit we found that people living in the home and their relatives were not being supported to contribute to their care plans. Three visitors we spoke to during our visit said that they were not aware of what their relatives care plan contained, and had not been asked to contribute to the monthly review of their relative’s care plan. This indicates that the managers of the home are failing to encourage feedback on the service provided which can lead to improvements in the care provided. In this report we have noted that managers have failed to advise CSCI and the Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 32 local authority of safeguarding incidents which managers are required to notify to them, which is part of the home’s duty to protect people living there. We have also noted in this report that managers have failed to ensure that some of the people working in the home are safe to work with people living in the home. We found that care plans were not always being reviewed and updated after such incidents to help the protect people living in the home. The monthly report by Shaw Healthcare from December 2007 notes further serious instances of proper recording and action not being undertaken, which again indicates failures in the management of the home. It is also clear from the evidence that Shaw Healthcare have failed to use their visits under Regulation 26 of the Care Homes Regulations 2001 to ensure shortfalls they have identified in the service are addressed. We asked to look at supervision records for three members of permanent staff. We were advised that two of the staff had not yet received sit-down supervision. We were advised that the third member of staff had received one sit-down supervision, but despite a long search the record of this meeting could not be found. Maintenance records we looked at for the home indicated that working arrangements are in place to ensure the upkeep of the premises. Records of staff training seen included some training in health and safety topics. We looked at health and safety checks for the premises dated 27/1/08 and 15/2/08 and recommended that these should also include checks of safety in bedrooms. The manager advised us that a recent Fire Service safety check had been carried out, but that they had not yet received a report on this visit. Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 33 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 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 3 3 3 x 3 x 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 x 3 1 x 2 Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? N/a 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 OP8 OP9 Regulation 12 (1) Requirement The provider must make proper provision for the health and welfare of people living in the home. The provider must ensure issues with weight and food and fluid intake are properly monitored and acted upon. The provider must also ensure that arrangements for the recording, handling and administration of medicines are protecting people in the home. The provider must ensure the home is adequately managed and staffed to ensure that people receive the assistance they require. Timescale for action 20/06/08 2. OP27 18 (1) 20/06/08 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 Good Practice Recommendations DS0000070879.V359597.R01.S.doc Version 5.2 Page 35 Mill River Lodge Standard Mill River Lodge DS0000070879.V359597.R01.S.doc Version 5.2 Page 36 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. 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