Inspection on 09/09/08 for Mill River Lodge

This inspection was carried out on 9th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mill River Lodge 10/01/09

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Mill River Lodge Dukes Square Horsham West Sussex RH12 1JF Lead Inspector Ed McLeod Unannounced Inspection 09:30 9th and 17 September 2008 th 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.V372038.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.V372038.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 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.V372038.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) 2. Dementia (DE). The maximum number of service users to be accommodated is 70. Date of last inspection 9th June 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 the visit we were advised that the fees are £669 per week. Mill River Lodge DS0000070879.V372038.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 was arranged to follow up requirements made at the previous key inspection visit on 11th March 2008. This visit was also to assess compliance with key standards from the Care Homes for Older People National Minimum Standards and compliance with the Statutory Requirement Notice issued on 9th July 2008. The inspection was carried out by Ed McLeod and Annette Campbell-Currie, inspectors, on the 9th September 2008 between the hours of 9.30 a.m. and 7 p.m. and by Ed McLeod, inspector, on the 17th September 2008 between 10.30 a.m. and 2.10 p.m. At the visit on the 17th September 2008 a notice in accordance with code B of the Police and Criminal Evidence Act 1984 was served which referred to suspected non-compliance with the statutory requirement notice. Planning for the inspection took into account information received on the service such as the home’s annual CSCI annual quality assurance assessment (the AQAA), CSCI survey forms completed by three people receiving a service and four staff, and information received from other agencies and individuals. Some of this information has been included in this report. During our visit we spoke with three people receiving a service, two relatives, three members of staff, and three managers, and observed a lunch in several units in the home. We sampled seven sets of care records, five sets of staff recruitment and training records, and records relating to complaints, notifications, health and safety, and safeguarding vulnerable adults. What the service does well: If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. Staff ensure that people who need assistance with washing and dressing are clean and well dressed. People are able to keep in touch with family, friends and representatives. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 6 Some staff are able to engage positively with people being cared for. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. A comprehensive training programme for staff is in place. What has improved since the last inspection? What they could do better: We found that care planning and provision is not yet ensuring that people’s health, personal and social care needs are met. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 7 Where people cannot manage their medicine, the home has not always been ensuring they are supported with taking medicines in a safe way. People’s right to privacy is not always respected and the support they get from staff is not always given in a way that maintains their dignity. The care home is not always supporting people to follow personal interests and activities, or to make the most of their abilities. There are sometimes delays in people receiving meals, and people are not always being asked if they would like to eat at a different time. Since our previous visit, the home has not been consistently managed and staffed in a way which has ensured people living in the home are safe and receive quality care. Some staff working in the home are not receiving staff supervision, and this puts people living in the home at risk. 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.V372038.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.V372038.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 adequate. This judgement has been made using available evidence including a visit to this service. The registered person has been unable to demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of people admitted to the home. EVIDENCE: People are given a service user’s guide which tells them about the services provided by the home, a complaints procedure, and menu information. We noted during our visit that this information is gathered together in a pack which is placed in each person’s bedroom. As the home has not been accepting new admissions since our previous visit, we did not sample any pre –admission assessments during this visit. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 10 The poor practice recorded in the Complaints and protection and Health and personal care sections of this report indicates that staff may not have the skills and experience to deliver the services and care which the home offers to provide. Mill River Lodge DS0000070879.V372038.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. Care planning has not been ensuring that people’s health, personal and social care needs are met. Where people cannot manage their medicine, the home has not always been ensuring they are supported with taking medicines in a safe way. People’s right to privacy is not always respected and the support they get from staff is not always given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. EVIDENCE: Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 12 At our previous visit on the 9th June 2008 we found that care plans were not always clearly reflecting people’s needs or providing good guidance for staff in how to meet those needs. We found no evidence that people receiving the care or their relatives are receiving a copy of their care plan or how the staff will carry out the care plan. At this visit managers told us that care plan review sheets are being checked by managers, and a help sheet to assist staff in writing care plans was seen by the inspectors. During our visit we noted on the second floor that there was a care plan monthly review record on the office wall which was being filled in with due dates for reviews. Previous to this visit we received three staff survey forms and these indicated that communication in the home about people’s needs is inconsistent and that sometimes important information is not always being recorded or passed on. For example, one member of staff wrote that “we don’t always find out daily information until we have already dealt with a resident eg if someone is going out in the morning and needs to be ready by a certain time”. In the survey forms we received from care staff they indicated ways in which they believe peoples’ care needs are not being met in the home. For example, one person said that “some residents are wrongly placed – management have been informed but it seems as if nothing is being done”. A report we received on 11th September 2008 from area manager Sandra Panton on a complaint found that on one care plan “the care plan information does not inform of how each area is to be managed to ensure his safety as best as possible”. During this visit we sampled seven sets of care plans. We found some information in the care plans about the way people like their care to be provided - for example in one care plan it was noted that the person did not wish care to be provided by a male member of staff. Some of the other care plans we looked at were not reflecting how people wished their care to be provided. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 13 We observed that people who needed assistance with washing and dressing were well presented, and one relative we spoke to said that staff were ensuring that her mother was always clean and well dressed. One care plan we looked at had been recently reviewed. The person being cared for would not have been able to participate very well in the review due to her level of confusion, and the review did not refer to any action taken to seek the views of the person’s relatives on the care provided as part of the review. We spoke to the person’s daughter during our visit, who told us that she had not seen her mother’s care plan or been asked to participate in a review. She said she did not know who her mother’s key worker was. The daughter told us that her mother had been more agitated recently which she thought was due to the change of staff teams, although we noted this was not recorded in the review notes. The weight records for her mother indicated that she was losing weight, but this was not noted in the review notes and no new action on this had been recorded. We looked at the weight charts for another person where it had been recorded on 7/2/08 that he was 89.4 kg and that “BMI indicates obese”. The most recent weight record (27/8/08) was recorded as 97.4 kg. This weight gain was not referred to in the notes of the most recent review, and the care plan had not updated to include further action to be taken. At this visit we found the following parts of the statutory requirement notice had not been met: Ensure that all service users care needs are fully identified and documented in a care plan, which contains sufficient detailed information on their care needs and guidance necessary for staff to support service users and fully meet their needs. Have a system is in place to ensure that care plans for service users are kept under review and updated when necessary to reflect the changing and current needs of individuals. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 14 At our inspection visits on 11th March 2008 and 6th June 2008 we found that the home was failing to ensure that people who use the service were receiving their personal care in a manner which reflects their wishes and respects their dignity. During this visit we witnessed an incident in which a visiting nurse was attempting to change a dressing in a lounge where other residents were sitting. The woman was becoming distressed and shouting out, and a carer and a team leader were present attempting to calm her. It was the view of the inspectors that this incident showed a lack of understanding about the issue of privacy and dignity and was abusive as the lady was showing distress and suffering pain. Staff told us that the woman often refuses to have treatment in her room, and that staff had asked the previous manager for screens to provide some privacy in such situations but that screens had not been obtained. We also witnessed one woman who was fast asleep in her chair being awoken by two care staff and brought to the lunch table. The woman appeared still very sleepy and there was a look of annoyance on her face about being roused. Her movements indicated a reluctance to co-operate with the staff who were using mobility equipment to assist her to the table. It was the view of the inspectors that the woman was not being offered the choice of coming to the table or eating later, and her right to be treated as an individual and for staff to flexibly respond to her needs was not being observed. At this visit we found that the following part of the statutory requirement notice had not been met: 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. Safeguarding conferences held on 3rd July 2008 and 13th August 2008 found that concerns about some of the health care provided in the home (such as Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 15 managing pressure areas, wound care, and dietary issues) had been substantiated by investigations carried out by West Sussex County Council. Social workers also advised us of concerns that no protection plan had been put in place to protect people after a suspected infectious outbreak in the home. We wrote to Mr Nixey responsible individual for the service to investigate this matter. In his letter dated 21/7/08 Mr Nixey agreed that there had been a failure to advise the relevant authorities when the suspected outbreak was identified, and that visitors to the home were not being informed of the outbreak until several weeks after this. Mr Nixey did not provide us with evidence that a plan of action to protect people from the spread of infection had been put in place when the problem was identified. Managers in the home had an opportunity to advise CSCI inspectors of this suspected outbreak when we visited the service on 9/6/08, but did not advise us. Since our previous visit, there have been a number of safeguarding investigations carried out by the local authority into allegations of people’s care at times being neglected – for example poor continence care, and failure in some cases to undertake risk assessments. West Sussex County Council provided us with a list of 21 safeguarding investigations in the home which were ongoing as at August 1st 2008. Safeguarding conferences held on 3/7/08 and 13/8/08 found that many of the allegations made had been substantiated, which indicates that the service has not been able to consistently deliver quality and safe care for people being supported in the home. A requirement made at the two previous inspections was that the provider must ensure that the arrangements for the recording, handling and administration of medicines are protecting people in the home. Our pharmacist inspector visited the home on the 30th June 2008 and found that this requirement had not been met. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 16 We found at that visit on 30th June 2008 that training and detailed procedures have been provided for staff to enable good practices to be in place. At that visit we found that medicines were not being given at times that are suited to peoples’ lifestyles whilst meeting their medical needs. We also found that there was not consistent good practice established throughout all units of the home so that all people can receive good standards of care. At this visit managers and team leaders told us that team leaders are now peer-checking medication records each shift and are now more vigilant about reporting any issues to a manager and completing a regulation 37 report if needed. We observed part of the lunch time medication round and found that medicines were being administered appropriately. Medication records were not looked at in detail. We received a copy of a complaint sent 6/8/08 to Mr PJ Nixey by a relative of a person receiving care at the home. The complaint refers to a number of incidents where her mother was administered the wrong medication and possible consequences for her health. We spoke to the complainant during this visit, and they felt that the issues had now been resolved. Social workers have also raised concerns about medication issues at the home and the record of a Safeguarding Conference held on 13/8/08 states that “allegations of neglect (were) substantiated relating to numerous poor administration/ management of medication issues” in relation to eleven people who are living or had lived in the home. CSCI has received a number of reports from the service concerning medication mistakes, for example that on 8/7/08 one person was administered medication which had already been given, and that five mistakes in medication administration had been made between 28/7/08 and 29/7/08. At this visit the following part of the statutory requirement notice was found not to have been met: 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 Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 17 provider must also ensure that arrangements for the recording, handling and administration of medicines are protecting people in the home. We spoke with a district nurse during our visit who said the staff team had provided palliative care to a resident with the help of the nurses and the person had been well cared for and the family had been very pleased. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 18 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. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and sexual orientation. They are part of their local community. The care home is not always supporting people to follow personal interests and activities, or to make the most of their abilities. People are able to keep in touch with family, friends and representatives. People have nutritious and attractive meals, but these are not always at a time to suit people. EVIDENCE: Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 19 At our inspection visits on the 11th March 2008 and 9th June 2008 we found the service was failing to assess, develop and document strategies to ensure people who use the service are provided with meaningful stimulation and activities which would meet their needs, wishes and expectations. At this visit area manager Sandra Panton told us that the home did not at present have someone to co-ordinate activities in the home, and it was proving difficult to recruit staff for this role. Ms Panton told us that an area on the ground floor is used twice a day for planned events, and that they would like to plan external activities in the future. An activities schedule seen on the board in one of the units indicated that one morning and one afternoon activity are planned, and on the day of our visit an activity including prayers and singing was taking place which was being enjoyed by a number of people attending. A team leader we spoke to told us that a month previously some residents were taken to watch cricket, and that one woman is often taken to the shops. Care plans we looked at were inconsistent in the extent to which people’s social and activities needs had been assessed. There was a lack of specific detail in care plans about how the individual would be assisted to participate in activities he or she enjoyed. On one care plan we looked at no activities other than watching television had been recorded between 31/8/08 and 8/9/08, although the pre admission assessment identified that he enjoyed gardening and skittles. For one person we could find no activities recorded since the week commencing 9th June 2008 although things such as walks in the garden were recorded as things he would be interested in. We discussed this with the manager who said that staff did not always recognise things such as chatting to people or playing games with them as an activity which could be recorded in the care notes. During our visit we observed that some staff were engaging with people in a positive way which they were responding to, for example holding hands and talking. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 20 We also observed a woman sitting at a dining table with her head in her hands. An agency carer was standing close by but was not making any attempts to communicate with the woman. One person we spoke to told us she used to like reading but could not now due to sight problems. She would like to have access to large print books, and when we spoke to staff they said that a member of staff was contacting the library. Staff advised us that people living on the 2nd floor are frail and don’t like going down stairs to join in with activities. One person had been downstairs in the morning and another person is able to go out independently. There is no activity programme for people taking place on the 2nd floor and one member of staff said they have time to carry out personal care tasks but not to spend time with residents one-to-one. At this visit we found that the following parts of the statutory requirement notice had not been met: Ensure that a system is in place to fully assess and document the emotional, spiritual, cultural and recreational needs of people who use the service by a suitably qualified and competent person and that the assessment is kept under review and revised as and when necessary. 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 11th March 2008 the home was required to ensure that people 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 9th June 2008 we found that meals were not of a good standard and mealtime arrangements on one unit were causing 40 to 50 minute delays in receiving their meals and distress to the people being cared for. At this visit the manager told us menus have been reviewed to include more roast dinners, and daily menus are provided on each table. The manager told Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 21 us the next residents’ meeting will consider times of meals and menus, and that she eats twice a week with residents to get an idea of the meals. During our visit we observed the arrangements for lunch on the first and second floors. We found that for many people on the first floor lunch was relaxed and unhurried, and people who needed assistance with eating were receiving this. The manager said that people had made suggestions for improving the evening meal which had been implemented by the home. The tables were pleasantly laid and the menus showed a choice of meal: shepherd’s pie, egg, cheese, ham or tuna salad or vegetable pie with gravy, mashed potatoes, peas and sweet corn. People choose their meal each evening for the following day. On one unit the food trolley arrived at 12.35 and was delivered by kitchen staff who did not explain to staff what food was on the trolley. Staff used the printed chart to find out what people had ordered. The food looked appetising and the portions were large. As staff were unsure of what some of the food on the trolley was one person was almost given chocolate sauce instead of gravy. A complaint we looked at during our visit also referred to chocolate sauce being mistaken by staff for gravy. All the food was checked with a temperature probe before it was served and this slowed down the delivery to the tables. The last meal on the unit was served at 1.14 p.m. and the person receiving this meal had been becoming annoyed about the delay. This was discussed with the management team who said they are considering plating the meals to avoid the delay. As recorded in the previous section during lunch we saw a woman being awoken from sleep and brought to the table when she may have preferred to carry on sleeping and eat later. This was not a choice she was offered by the two staff who attended to her. A written complaint made to the home by a relative alleges that their relative was found sitting slumped and uncomfortable at the table with a meal which Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 22 had gone cold. The person requires assistance with eating, but it was alleged that no-one had assisted him and he had food all over his hands. The complainant alleged that at the same meal staff were attempting to force feed a woman who didn’t want food. The complaint was investigated by area manager Sandra Panton, who found the allegation of failure to assist the person with eating was substantiated. Ms Panton’s report notes that staff denied they attempted to force feed the woman resident at that meal. We also looked at the records of a complaint made by a woman living in the home that staff had refused to provide her with a jug of water, and a written apology was given by the previous manager concerning this. At this visit we found that the following part of the statutory requirement notice had not been met: 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. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 23 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. Any concern is looked into and action taken to put things right. The care home is not always safeguarding people from abuse and neglect and taking the appropriate action to follow up any allegations. EVIDENCE: At our visits on the 11th March 2008 and 9th June 2008 we found that the service had failed to properly record and investigate complaints made to them. During this visit we sampled the record of four complaints received by the service since our previous visit. A record was found of a complaint forwarded to the service by CSCI on 22/7/08, and the investigation of the complaint was recorded. The outcome of the investigation had not received by CSCI on the day of our visit. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 24 Sandra Panton advised us that the response to complaints is sent by the company’s head office and there is therefore sometimes a delay in responses being forwarded to the complainant. The four complaints we looked at had been appropriately recorded and investigated. Ms Panton assured us that the two complaints where the outcome had not been advised to the complainant would be advised to the complainant. This requirement was assessed as met. At our visits on the 11th March 2008 and 9th June 2008 we found that the service had failed to advise the Commission of notifiable events. Since our visit on 9th June 2008 the service has sent us a number of notifications for events which the Commission needs to be advised of. At this visit we found records for a number of incidents during June and July 2008 which should have been notified to the Commission under regulation 37 of the Care Homes Regulations, which included admissions to hospital, medication issues and serious illness, and for which the Commission has not received notification. At this visit we found that the following part of the statutory requirement notice had not been met: Ensure that a system is in place to report all notifiable and significant incidents and events, which adversely affect the welfare of service users to the Commission without delay. At our visits on 11th March 2008 and 9th June 2008 we found that people were not being protected from unnecessary risks by the training of staff on the work they are to perform. Training records we looked at during this visit indicated that the staff training programme since our previous visit has included more training in working with people who have a dementia, and a session on local safeguarding procedures. There is evidence that staff and managers are better protecting people from risk, for example safeguarding referrals have been initiated by staff and managers at the service. Where medication errors have taken place, managers have advised us that staff have received counselling or further training concerning this. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 25 A complainant we spoke to during this visit who had serious concerns following a number of medication errors told us she felt these problems had now been resolved. The following part of the statutory notice requirement was assessed as met: Ensure that all service users are protected from unnecessary risks by the training of staff on the work they are to perform. At our visits on 11th March 2008 and 9th June 2008 a requirement was made that the service must ensure a system is in place to ensure that the provider 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 reported and handled in accordance with those procedures in order to protect service users from abuse and harm. The minutes of a safeguarding conference held on the service by West Sussex County Council on 3rd July 2008 record that there is a “poor understanding of reporting and investigation of Safeguarding issues for all levels of staff”. The minutes of a safeguarding conference held on the service by West Sussex County Council on 13th August 2008 also record that there was a failure to follow proper reporting guidelines after incidents where individuals living at the home had been put at risk or suffered neglect. At this visit we found records relating to an allegation made on 5/8/08 by a resident that bruises on her had been caused by being roughly handled by staff. No notification of this alleged abuse was received by CSCI, and there is no record of a referral having been made to the local authority or the police. Area manager Sandra Panton, who had completed a report on the incident, confirmed to us that referrals concerning this incident which the service is required to make under the Care Homes Regulations 2001 and local safeguarding procedures were not made. We looked at the care plan for the person with Sandra Panton and the team leader for the unit on which the person is cared for. We found that the incident was not recorded in the adverse incident log, or in the monthly support plan. A care plan review carried out on 11/8/08 does not refer to the incident. No protection plan was put in place for the person to ensure that they would be safe from harm. Sandra Panton and the team leader agreed that these records had not been made. A safeguarding referral concerning this incident was subsequently made by CSCI on 10/9/08. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 26 We received five notifications from the service on 12/9/08 which advised us that safeguarding referrals had been made in each case. We looked at records concerning these incidents on the second day of our visit, 17th September 2008, including care plans for the four people referred to in the incidents. We found that the care plans for three of the people did not refer to the abusive incident or the safeguarding referral, and no adverse incident record had been completed. The care plans for the three people did not set out how they were to be protected. We discussed at length with the manager the care plan for a fourth person. The manager advised us that there was a reassessment of the person’s needs taking place and the circumstances under which the person has been known to strike out have been previously identified. We also noted on the care records that a member of staff had been hit by the person on 28/7/08. We asked the manager if she would be able to assure a relative of a resident hit by this person that their relative would be safe from being attacked by the other resident in the future. The manager said she would not be able to give this assurance. At this visit we found the following part of the statutory requirement notice had not been met: 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 reported and handled in accordance with those procedures in order to protect service users from abuse and harm. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 27 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.V372038.R01.S.doc Version 5.2 Page 28 The premises are purpose built, and people live in units of ten bedrooms attached to a sitting room and dining area. We observed that the building and the grounds are being well-maintained, and decoration and furnishings are of a good standard. The design of the building is such that, for example, some singing which was taking place on the ground floor could clearly be heard on parts of the first and second floors as sound was reverberating around the building. People can access the gardens from the ground floor, and stairs and passenger lifts travel between the floors. People we spoke to told us their bedrooms were kept clean and tidy and they had a choice about decorating and personalising their bedrooms. For example, for one person who had wanted to change the colour of the walls in her room this was arranged for her and painted within a few days. One person we spoke to said the maintenance staff were very good and get things done quickly. We found that there were a number of domestic staff on duty, and the premises were clean and fresh. A relative we spoke to said her mother’s room was always clean, tidy and fresh. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 29 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. Staff in the home are not ensuring that people have safe and appropriate support. People are being supported by staff who have had checks done to make sure that they are suitable to care for them. i EVIDENCE: At our visits on the 11th March 2008 and the 9th June 2008 a requirement was made that the provider must ensure the home is adequately managed and staffed to ensure that people receive the assistance they require. At this visit the area manager told us that staff tell them there is now more stability, that they feel more supported by managers, and are now more aware of the home’s policies and procedures. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 30 The manager told us they have been putting in place more regular shift patterns that will have staff working one unit rather than several units and therefore provide more continuity for people receiving a service. Sandra Panton told us that staff rotas have changed, and that managers are looking to bring in more management cover in evenings and at weekends. We have received some notification reports which tell us the home has not always been able to achieve a full staffing complement but that on these occasions there has been no detriment to people receiving care and support. Since our last visit, we have received concerns and complaints from two members of staff alleging that at times the home is not maintaining adequate staffing levels and that there have been incidents of agency staff sleeping while on night duty. We asked the service to investigate these allegations. At the time of our visit, we had received a report from Sandra Panton concerning one of the sets of allegations which found that there have been incidents of agency night staff sleeping on duty and that action had been taken accordingly. Staffing rotas sampled and discussion with staff and managers indicates that high numbers of agency staff continue to be employed in the home, including agency staff covering some team leader positions on weekends. Managers advised us that recruitment of full time staff is continuing. On the day of our visit we found adequate numbers of staff to meet the personal care needs of people living in the home were provided. However, as evidenced in the Lifestyle section of this report on some units of the home there were not enough staff to provide social support and activities for some people accommodated. A further concern to us was that the poor practice in protecting people and ensuring their dignity we had found during our visit was indicating that the skills mix of staff in the home was not meeting the needs of people accommodated. We found that the requirement concerning a need to review staffing levels had not been met. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 31 We looked at records of checks and training held for two agency staff who had worked shifts in the home on 7/9/08, and for three recently appointed staff, and found that the home had obtained the required information which helps ensure that the staff employed were safe to work with people receiving a service. During this visit we did not look at records for staff undertaking qualification (NVQ in care) training, but staff and managers we spoke to indicated that staff continue to be put forward for qualification training. This standard was found to have been met at our visits on 11th March 2008 and 9th June 2008. We had discussions with managers about the training being provided for staff, and managers advised us that training provided has focussed on topics such as safeguarding, dementia, and staff supervision. Training records we looked at indicated that new staff are receiving induction to prepare them for the work they are to do. Training in required topics such as health and safety, food hygiene and manual handling are being provided for staff. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 32 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. The service has not been managed to ensure consistent safe and good quality care. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: On 14/5/08 responsible individual Mr Nixey advised us that Diane Denyer had replaced Rebecca Kelsey as manager of Mill River Lodge. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 33 On 15/7/08 we were advised that Sandra Panton was temporarily managing the home following the departure of Diane Denyer. On 18/8/08 Mr Nixey advised us that the manager of the home is now Frances Mackenzie. Ms Mackenzie told us during our 17th September 2008 visit that she had not yet submitted an application to register with CSCI as manager for the service, but that she had partly completed an application form. We have written to Ms Mackenzie and the provider to remind them of the legal responsibility for a manager to be registered for the service. On the day of our visit, managers and staff told us that they believed that they were beginning to ensure that people’s care needs are being met in a more safe and appropriate way. We found some evidence to support this view – for example staff told us that the new manager, who has been working in the home for four weeks prior to our visit, is approachable and they feel that concerns can be raised more quickly and with an expectation that something will be done. It was our view that this is progress which needs to be maintained and built upon, as there continues to be evidence that the home has not been managed in a way which has ensured people living in the home are safe and receive quality care. For example, as evidenced in the Complaints and Protection section of this report, managers failed to ensure that a safeguarding referral was made and action taken to protect the person, when local safeguarding guidelines clearly indicate that this should have done. The changes of managers and the pressures to improve the quality of care in the home have also had an impact on staff working in the home which managers need to address. For example, one member of staff wrote in their CSCI staff survey form that managers are “moving the goal posts day by day – never know where we stand. Appears to be different rules for each floor, no consistency”. At our visits on the 11th March 2008 and 9th June 2008 a requirement was made that 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. During this visit we found that senior staff are to receive training in providing supervision, and that arrangements are in place for care staff to receive one to one sit down supervision. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 34 There are at present no arrangements for agency staff to receive supervision, and Sandra Panton told us that there were no plans at present to commence supervision with agency staff. Sandra Panton also advised us that regular supervision is not yet in place for team leaders working in the home. One team leader we spoke to told us her most recent supervision session had taken place around April 2008. At our visit on the 17th September 2008 the service was not able to provide supervision records to evidence what supervision had taken place for this member of staff. At this visit we found the following part of the statutory requirement notice had not been met: Ensure that 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 service users. At this visit we did not look in detail at standards concerning quality assurance and health and safety. These standards had been assessed as good during our key inspection on 11th March 2008, and so the judgement above reflects this assessment. Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 35 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 X X 1 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 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 1 X X X X 1 X 3 Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? yes 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 OP18 Regulation 13(4)(c)( 6), 18(1)(c)(i ), and 37(1)(e) Requirement Ensure that a system is in place to report all notifiable and significant incidents and events, which adversely affect the welfare of service users to the Commission without delay. Ensure a system is in place to ensure that you and all staff employed at the care home adhere to the agreed multiagency procedures for safeguarding adults and that all incidents and allegations of abuse are reported and handled in accordance with those procedures in order to protect service users from abuse and harm. 2. OP10 12(1)(a)( Ensure that all staff promote and b)(2)(3)(4 respect the dignity of all the )(a) 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. Ensure that service users are provided with appropriate Mill River Lodge DS0000070879.V372038.R01.S.doc Version 5.2 Page 37 Timescale for action 03/11/08 03/11/08 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. 3. OP7 15(1)(2)( a)(b)(c)(d ) and17(1)( a)(b)(3)(a )(b) Schedule 3 1(b), 3 (k)(m) Ensure that all service users care 03/11/08 needs are fully identified and documented in a care plan, which contains sufficient detailed information on their care needs and guidance necessary for staff to support service users and fully meet their needs. 4. OP12 12(2)(3)1 4(2)(a)(b) 15 (1)(2)(a)( b)(c)(d) and 16 (1)(2)(m) (n) Ensure that a system is in place to fully assess and document the emotional, spiritual, cultural and recreational needs of people who use the service by a suitably qualified and competent person and that the assessment is kept under review and revised as and when necessary. 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. 03/11/08 5. OP36 18(2)(a) Ensure that a system is in place for all staff to receive DS0000070879.V372038.R01.S.doc 03/11/08 Mill River Lodge Version 5.2 Page 38 appropriate and formal supervision at regular intervals and that this is documented in order to meet the needs service users. 6. OP9 OP8 12 (1) The provider must make proper 03/11/08 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. 7. OP27 18 (1) The provider must ensure the 03/11/08 home is adequately managed and staffed to ensure that people receive the assistance they require. 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.V372038.R01.S.doc Version 5.2 Page 39 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.V372038.R01.S.doc Version 5.2 Page 40 - 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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