Inspection on 16/01/07 for Millard House

This inspection was carried out on 16th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Millard House 07/05/09

Millard House 18/11/08

Millard House 14/05/08

Millard House 19/12/07

Millard House 08/09/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Millard House 364 Church Street Bocking Braintree Essex CM7 5LL Lead Inspector Brian Bailey Key Unannounced Inspection 09:00 16 17 & 26th January 2007 th 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 Millard House DS0000067428.V327397.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. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millard House Address 364 Church Street Bocking Braintree Essex CM7 5LL 01376 325002 01376 324472 surjit@rushcliffecare.co.uk 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) Rushcliffe Care Limited Manager post vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (43) of places Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 43 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 18 persons) The total number of service users accommodated in the home must not exceed 43 persons The 19 service users` bedrooms with an area of less than 10 sq.m., but more than 9 sq.m., will be used only following a written assessment that the facilities in the room are suitable for, and acceptable to, the service user taking into account the service user`s mobility needs. The care plan needs to reflect the assessment findings Service users must not be admitted to the home under the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 8th & 11th September 2006 5. Date of last inspection Brief Description of the Service: Millard House is a purpose built two-storey building situated in the residential area of Bocking, Essex. The larger town of Braintree, with amenities such as banks, shops and a library, is approximately two miles away. The home was owned and managed by Essex County Council until May 2006 when it was taken over by Rushcliffe Care Ltd. The home has an acting manager following the resignation of the registered manager in November 2006. Service users’ accommodation consists of thirty-nine single bedrooms and two shared rooms. Access to the home is good and a passenger lift provides access to the first floor. There are two dining rooms, several lounges and quiet areas. There is a large and comfortable room available with tea making facilities for visitors to meet their relatives in private. Car parking for visitors is available at the front of the property; this area is shared with the older persons day centre that adjoins the main home. There is a fully enclosed courtyard garden in the centre of the building and further gardens at the front and side of the home, but these areas are not secure for some residents to use. As at 16th January 2007, a notice in the main entrance states the fees as ranging from £61.25 to £643.98 per week Items considered to be extra to Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 5 the fees include private chiropody, hairdressing, toiletries and newspapers. CSCI inspection reports are also available from the home, Rushcliffe Care and on our website www.csci.org.uk. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Millard House was carried out on 16th, 17th and 26th January 2007, which was the second unannounced inspection of this home in the inspection year 2006/07. This was necessary as the inspection carried out in September 2006 revealed that there were a number of important key National Minimum Standards that were not being met. This report is based on a range of information that has been accumulated from our inspection records, information from Essex County Council, Approvals and Monitoring Unit that inspected the home in December 2006, five site visits to the home by CSCI inspectors, observations and discussions with service users, staff, visitors, the acting manager and the senior manager from Rushcliffe Care and a check of the records kept at the home. This inspection has revealed that although there remains some standards assessed as only partially met, some improvements have been made, but further action is still required by Rushcliffe Care if the acting manager and staff are to achieve the home’s objectives within an acceptable timeframe. What the service does well: What has improved since the last inspection? The home’s maintenance plan to improve the environment has progressed with the redecoration of twelve bedrooms; carpets replaced in some rooms and corridors; improved odour control; the creation of a larger visitors room; the conversion of the large ground floor dining room into a more homely looking lounge/dining room; improved storage facilities for medication and maintaining the central courtyard to a better standard. Other changes include the introduction of some activities, although only a limited range are available at present, and staff were ensuring that mealtimes and the administration of medication at all times met the needs of residents. Although some training had taken place such as fire training, the acting manager has identified the further training needs of staff and submitted a request to Rushcliffe Care for approval. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millard House DS0000067428.V327397.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 Millard House DS0000067428.V327397.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): 1, 3, 4 & 5. Quality in this outcome area is adequate. Information is available about the facilities and services provided, but the guide for residents needs to be in alternative formats so that all prospective residents have a clear understanding. People who use this service can expect to be able to visit and have an assessment of need completed prior to making a decision to enter the home. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose and service user guide contains a wide range of information about the home, including its aims and objectives and the facilities offered. The acting manager said that these are provided to all prospective residents but there was no evidence on the care records seen that information is provided. The service user guide contains a lot of detail but is in a standard format only, which some people would find difficult to understand. User-friendlier versions should be available, such as in larger print, pictures or an easy read summary version. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 10 Eight sets of care records of residents were checked, five of which were for people that had been admitted during the past two months. These latter records were detailed and clearly showed that assessments had been obtained from the placing authority and that staff from the home had also completed a pre admission assessment form. The assessments completed by the home’s staff covered areas of care such as personal hygiene, continence, mobility, diet and communication. There were also assessments of areas of risk such as tissue viability and manual handling. Assessments obtained for people that that had moved to the home prior to the takeover by Rushcliffe were not readily available as they were not on their current files. Prospective residents are encouraged to visit the home to see whether the home will be suitable, but staff spoken with said that in practice it is generally family members that visit on behalf of their relative. Millard House DS0000067428.V327397.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): 7, 8, 9 and 10. Quality in this outcome area is adequate. Care records were available and up to date, but need to be developed to ensure that residents can be certain that their identified needs will be met in accordance with their wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A larger room has been made available for the storage of medication and records. A separate lockable cupboard contained the controlled drugs (CD). The CD register was inspected and random checks by the acting manager and shift leader in the presence of the inspector confirmed the remaining CDs tallied with the records in the register. The home has changed the supplying pharmacist but still uses a monitored dosage system (MDS) for administering medication, which means that the majority of medication is dispensed from blister packs prepared by the pharmacist. MAR sheets were checked and found to be accurate and up to date. Each MAR sheet had an identification photograph of the resident. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 12 The home has a detailed medication policy available for staff. At the end of each shift a formal handover for the responsibility for the medication is carried out, which was observed on the second day of inspection. The acting manager and the senior shift leader confirmed they and other designated staff had received training to administer medication and had been assessed to ensure they were competent to carryout these duties. The training records of the acting manager were seen but the records for the senior staff were not checked on this occasion. The morning medication round was in progress at 9.00am on both days of the inspection visits to the home. The staff responsible were observed to administer the medication efficiently and within an acceptable timeframe, which meant the lunchtime round proceeded without delays. A resident spoken with in the lounge said about the home, “I like it here, it doesn’t matter what you want they will always try and get it for you”. The home had completed the change over from the previous system for keeping care records to those required by Rushcliffe Care, which had apparently been a rather protracted process. The files and care plans of four residents were inspected on the first day of inspection. All files had basic details listed such as the resident’s GP, photograph, next of kin, contact numbers and social worker. Other information included an inventory of possessions at the time of admission, risk assessments and a daily record. Risk assessment were dated and reviewed at regular intervals. Care plans were available but tended to identify the needs without providing sufficient guidance to staff as to how each need was to be met. At the second visit to the home, a further five care records were checked of people who had been admitted during the past three months. Information was up to date and it was evident that senior staff were beginning to improve the amount of guidance provided to staff although the amount of information available was varied. Senior staff spoken with said their objective was to ensure all care plans were detailed and up to date. Records of health care appointments were available, although for one person, staff confirmed a district nurse had visited but this was not recorded on the persons care file. Observation during the inspection showed that staff had a good awareness of how to protect residents’ privacy and dignity and were seen as kind and patient and to treat residents in a respectful and supportive manner. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. People who use this service can expect to be offered a well-balanced diet, but if the selections offered to residents in each dining room differ, residents are not being treated equally. Residents are consulted on activities that they want and are beginning to benefit from their introduction, but cannot at present rely on a choice of activities being offered on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ an activities co-ordinator, however, the acting manager has taking steps to ensure that staff complete a form “Getting to know you” for each resident. With information gained from residents and relatives about their interests and hobbies, staff are able to direct and focus any activities that can be arranged to meet the needs and wishes of residents. From discussion with the acting manager and staff, this project and method of working is clearly at an early stage, however, staff were observed to provide activities as detailed on the staff roster. The acting manager understood that a more permanent arrangement was likely to be organised. Staff spoken with considered the current system was Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 14 working well and was improving. One staff member spoke enthusiastically about introducing a range of activities that had been identified by residents and expanding the opportunities for residents. This staff member held a meeting for residents on 22/1/07 to discuss their wishes in regards to activities, which is good practice. Minutes of the meeting were not available but were due to be circulated. Although this is clearly an improvement on the situation found at the last inspection, a more permanent arrangement is required to ensure a range of daily activities are provided that doesn’t just rely on care staff providing activities when they have an opportunity. The hairdressing room was observed where the staff member had provided background music, which helped to create a relaxed atmosphere. Two residents spoken with later said they had enjoyed the experience and to have the attention. Facilities for visitors had been improved by providing a larger and more comfortable environment with the opportunity to make drinks. At these inspection visits, residents were observed being enabled to sit in comfortable chairs in the lounges rather than having to spend long periods in their wheelchairs, which was the situation observed at the previous inspection. One resident who was observed to spend a long period sitting in a wheelchair said that it was their wish to remain in the wheelchair. Staff spoken with said that they felt the home was now calmer than during the period following the home’s change of ownership. As a consequence they felt more organised to enable residents to make choices, which from observation, was apparent throughout the time spent at the home. Four residents spoken with said they were able to make choices and could come and go as they pleased. Residents in the first floor lounge area who were more dependent on staff to meet their needs, had staff allocated to care for them and some activities took place. It was not ascertained however, how these residents are encouraged and enabled to take exercise and to access the gardens, which will need to be followed up at the next inspection. A member of staff spoke of exercises as part of the activities that they were planning. On both days of the inspection, there was a choice offered at the lunchtime meal, which was recorded on the menu. Selections made by residents were recorded and the information passed to the cook for preparation and to ensure they receive their chosen meal. The meal on both days was served at approximately 1.00pm, which was well organised and relaxed. There was no indication that staff were wanting to serve and complete the meal by a certain time. Staff were observed as patient, friendly and supportive of residents during the meal and provided assistance to those residents unable to help themselves. The meal selections looked appetising, they were well presented Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 15 and portions were good. Three residents spoken with said they had enjoyed the meal and had no complaints. One person said of the food, “The food is always nice and hot”. On both days, breakfast was observed being served to residents at 9.00am, although some people had already eaten their meal. Residents were offered a choice. One resident spoken with said that they had eaten a fried breakfast of bacon and egg, which is what they generally preferred on most days of the week, another resident spoke of having two bowls of cereal. Tea, coffee, juice and toast were available. Newspapers had been delivered and two people were seen to enjoy their breakfast whilst reading the daily news. At the evening meal on the third visit, a selection of sandwiches and soup were served. It was noted that the selection of sandwiches for people in the first floor dining room provided less choice than for those residents in the main dining room. Care staff had no explanation for this apparent difference. The senior manager who was at the home was informed of this apparent inequality. The acting manager should take the necessary action to ensure that all residents are provided equally with opportunities and support to make choices and selections of food. The food cupboards, fridges and freezers were well stocked. The cook was advised to improve on the method used to file residents meal selection records, as these were important records that provided some evidence of the food provided to each resident. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. People who use this service can expect a complaint to be taken seriously and staff training to protect them from abuse but they cannot be assured that the home maintains an up to date record of complaints made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is printed in both the Statement of Purpose and the Service User Guide. The procedure states that an investigation will be carried out into all complaints; there is a time scale for responding to complainants and contact details of the head office of Rushcliffe Care and the local office of CSCI. Complaints received by the home were kept in a file. This was checked and was found to include five complaints along with a response from Rushcliffe Care. The home did not have a formal system for complaints to be recorded along with records of action taken, the outcomes of the investigation and detail of the complainant’s satisfaction. CSCI had received concerns in 2006 about staffing levels and a lack of disposable gloves, which were checked at the last inspection and at this inspection. Comments regarding these are included in this report under the sections headed “Environment” and “Staffing”. The home has a Protection of Vulnerable Adults (POVA) policy and information on the Essex guidelines. Staff spoken with were clear about their duty of care Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 17 and what they would do if they had any concerns and confirmed they had attended training. The training data available showed that all but one member of the care staff had received POVA training although for some it needed to be updated as it had been done two years ago. This data did not include information relating to the staff employed more recently by Rushcliffe Care. Although the files of these staff were checked and it was evident that some had clearly attended a good range of training, it was not clear as to who required training on POVA. The training plan identifies POVA training sessions that will be held in February, March and April 2007. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 & 26. Quality in this outcome area is adequate. Some improvements to the facilities, the standard of cleanliness, odour control, redecoration and new carpets has made the home a more pleasant place to live for residents. Staff have the necessary protective clothing to minimize the risk of cross infection. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Millard House is a large detached purpose built two-storey property that was designed so that the majority of lounges are on the ground floor and most of the bedrooms are on the first floor. There is a passenger lift that provides access to the first floor, but the long corridors present difficulties for those people that wish to be independent and use the main dining room and lounges on the ground floor. The new owners have started to make some improvements to the layout to improve facilities for both residents and visitors. These include converting the Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 19 large dining room into a lounge/dining room with screens, which has improved its appearance by making it more homely and less institutional. Two residents spoken with said they liked the layout and felt comfortable when sitting in the new lounge area. A larger room on the ground floor with facilities for making refreshments has been made available for visitors to meet their relatives in private. Carpets have been replaced in some bedrooms and corridors and 12 rooms had been redecorated. A larger room has been made available for the storage of medication and records and a room was also being prepared for the use of health care visitors to the home. A maintenance person has been employed on a fulltime basis since the last inspection visit in September 2006. Contractors were present during the inspection cleaning the paving stones and tidying up the central courtyard. A tour of the building was carried out that included the kitchen, laundry, lounges and dining room, bathrooms, toilets and ten bedrooms. All were clean and tidy and odour control was effective, including the rooms identified at the last inspection as having a poor standard of cleanliness. From observation, bathrooms and toilets were kept clean throughout the day. The laundry was very well organised and by the end of the morning, all washes were nearing completion. The bathroom identified at the last inspection as awaiting repairs continues to be out of service, although care staff said the bath was a standard type bath and therefore seldom used as residents generally preferred baths with hoist arrangements. The kitchen is well equipped and the standard of hygiene and cleanliness was good. The hot water washing equipment used in the servery was excessively noisy and could be heard by residents in the dining room. The maintenance person stated that this was due to be repaired and they were awaiting the contractor to attend. A number of the residents’ bedrooms seen were well furnished and decorated although some were looking rather dull in appearance and need brightening up. These are included however in the recording of the planned redecoration and maintenance programme, which was submitted to CSCI as required at the last inspection, and although there has been some slippage in the time schedules, work is progressing. Many of the bedrooms had been personalised with resident’s own possessions. Three residents spoken to said that they were very satisfied with their rooms, they were comfortable and liked being able to have some of their own possessions with them. Radiators were guarded and valves installed on hot water outlets used by residents, which according to the acting manager are checked weekly by the maintenance person, although the records were not checked. Access at the front door is good. There is a small step leading from a corridor to the central courtyard, which is a potential hazard and means that some people would not be able to access the garden independently from this door onto the ramp. A risk assessment must be completed to minimize the risk of an accident to a resident and visitors. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 20 Issues relating to the provision of disposable protective gloves and clothing to staff, which was made a requirement at the last inspection, have from observation and discussion with staff been resolved. All staff spoken with said they had a supply and the shortages experienced during a period in 2006 had been overcome and were now generally available. A delivery is made to the home every two weeks. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Residents benefit from being supported by a team of staff that are experienced and work well together. Staffing levels need to be reassessed so that residents can be confident that they are safe and cared for by a sufficient number of adequately staff at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that for a morning shift there was one team leader supported by six care staff plus the acting manager on duty. The late shift had a team leader with five care staff. At night, the team had been increased to three staff since the last inspection. On the day of inspection there was one cook, one assistant in the ‘servery’, two domestic, a laundry worker and a gardener/maintenance person. The staffing levels at the point of inspection and based on the dependency levels of the current residents, were within the minimum requirement of the Department of Health “Residential Forum” guidelines. The acting manager’s post of care manager has not been replaced and considers the number of staff on duty in the afternoon and evening to be low. According to the acting manager, the procedure for replacing staff that have gone on sick leave is to contact the senior manager at Rushcliffe. The acting manager does not have authority to employ agency staff, which could result in the number of staff on duty being below the required number. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 22 Staff spoken with said they felt rather less pressured than previously and put this down to their determination to work as a team, the support of the acting manager and senior staff and the impression that residents being admitted were a little less dependent than during a few difficult months in 2006. From observation, staff were relaxed, confident and knowledgeable about residents. They were seen to spend time with residents, to acknowledge them and demonstrated warmth and friendship. A staff handover at the end of a shift was observed, which was thorough and efficient providing staff with good information about what was expected of them. Job descriptions were seen for all jobs including the manager. Eight care staff voiced their extreme annoyance at not being provided with a rota for more than one week in advance, which meant they were finding it very difficult to plan their lives outside of work. Rushcliffe Care was organising the work rosters at the time of these site visits. According to the acting manager and from checking the staff roster, twentyfive care staff are employed, twelve of whom have achieved National Vocational Qualification (NVQ) level 2 or above, which is just short of the target of 50 of care staff to obtain the qualifications. The files of five staff employed by Rushcliffe Care were checked. These were up to date and included the correct documentation such as Criminal Record Bureau disclosure information, application forms, contracts, training certificates and references. Only minimal information on induction training was available however and therefore further evidence is required to be available. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. The acting manager has brought a period of stability and has managed to progress some of the issues raised at the last inspection, which benefit residents. There remains however some important matters relating to Health & Safety training and formal staff supervision that need to be addressed, before residents can be assured that the management and administration of the home can be considered as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s registered manager resigned and left the home during November 2006. The existing care manager has taken on the role of acting manager, but Rushcliffe Care has not notified CSCI of how they intend to manage and support the home until a manager is appointed and registered by CSCI. From observation and discussion with staff and the acting manager, it was evident Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 24 that the acting manager has an ability and commitment to manage the home in the interim, but is in need of some on-going direct assistance with the managerial and administrative duties. The last inspection report for this home identified a range of issues that resulted in 21 requirements being imposed. Although a number of these had been addressed or partially addressed, others had not been achieved within the timescales. Rushcliffe Care had produced an action plan dated 30/10/06 for the acting manager to implement these requirements and although a serious attempt has been made, it is not considered feasible for the acting manager to achieve the objectives without additional assistance. The acting manager considers the weekly support from the area manager and other staff from Rushcliffe Care to be good. Staff spoken with considered the acting manager to be very supportive and a good listener. The acting manager explained the system for managing residents’ personal monies and it was safe with a clear audit trail. Three accounts were checked, which showed that the recorded balance tallied with the cash held. Expenditure recorded was in accordance with the items considered to be extra to the fees for accommodation. Evidence was available to show that the provider is carrying out Regulation 26 monthly visits and completing appropriate reports. The acting manager stated that a Quality Assurance survey had been undertaken by Rushcliffe Care in 2006 and a summary of the responses was produced. However, there was no evidence at the home of the survey forms or of those returned. The acting manager confirmed that it had not been possible to organise formal supervision sessions with staff since taking over the role in November 2006. The home’s policies and procedures file was checked, which contained information on a range of matters relating to Health & Safety. A document stated, “The Health and Safety representative will be the key person for their home/unit”. The acting manage stated that no person had been formally designated as the representative since the resignation of the registered manager in 2006. However, from discussion with the acting manager and the maintenance person it was evident that the latter had taken on the responsibility to carryout tests such as checking the temperature of hot water outlets used by residents, fire alarms and fire drills. Records of all tests including the service records of gas and electrical equipment, hoist, lifts and fire detection equipment must be more readily available for checking to ensure they are all up to date. The home’s public liability insurance certificate was up to date. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 25 A training log was available that showed the courses attended by staff, the majority of staff had received training on the health & safety requirements, such as moving and handling, food hygiene, first aid, infection control and basic health and safety. The main gap was the need for fire training, however, a training course on the home’s fire procedures was carried out on 22/1/07 and a further course is planned for those staff that were unable to attend. The acting manager had identified the training requirements of staff in respect of health and safety, which is mainly to update the knowledge of staff. A plan had been submitted to the Rushcliffe training officer for approval. Provisional dates for training are in February and March 2007 and the sessions would be run in conjunction with the adjoining day centre. The most recent fire drills were held 23 & 24/1/07 when a record was kept of the staff in attendance. The maintenance person carries out fire alarm tests at regular intervals. The emergency lighting system was serviced on 24/8/06. The fire extinguishers and the passenger lift were serviced in November 2006. The maintenance person intends to carryout this years safety check on all portable electrical appliances at the home. Large containers (20 litres) of vegetable oil were observed in the kitchen store cupboard. The cook and the acting manager were advised to assess the risk for when staff are required to lift the oil and to take appropriate action to minimise any identified risk. Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X X 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement Care plans must continue to be expanded and developed to ensure that staff are provided with clear guidance to enable them to support residents in a manner that meets their wishes. This is a repeat requirement from the last inspection. A range of stimulating and interesting activities must be developed and residents encouraged to participate and pursue any interests and hobbies. All residents must be provided with equal opportunities to make a selection of a choice of sandwiches regardless of which dining room they use. An improved system for recording the food selections made by residents must be introduced. A record must be kept of all complaints received that include the date received, a brief description of the complaint, the DS0000067428.V327397.R01.S.doc Timescale for action 01/04/07 .2 OP12 16 (2) (m) (n) 01/05/07 3 OP14 OP15 12(2) 17(2) Schedule 4 (13) 01/03/07 4 OP16 22 (8) 01/03/07 Millard House Version 5.2 Page 28 outcome and whether the complainant was satisfied. This is a repeat requirement from the last inspection. 5 OP18 18 (1) a The registered manager must 01/05/07 ensure that all staff receive up to date training in the protection of vulnerable adults from abuse. The small step leading to the central courtyard must be assessed for the risk it presents to people that access the courtyard and action taken to minimise any identified risk. A re-assessment of the staffing levels must be carried out to take into account the day to day support required by the acting manager and the concern that the afternoon shift is short of staff. The home must carryout regular quality assurance surveys of residents, relatives, staff and others, as their feedback will contribute to and influence improvements to services and standards. This is a repeat requirement. Regular supervision must be provided to all staff to guide the way staff work, to reflect on their work practices and as a means to support staff to ensure that residents receive care to a consistently high standard. This is a repeat requirement. All staff must be trained in accordance with the Health & Safety regulations, which include, first aid, fire training, DS0000067428.V327397.R01.S.doc 6 OP20 23 (2) (n) 01/03/07 7 OP27 18 (1) (a) 01/03/07 8 OP33 24 (1) (a) (b)24 (3) 01/05/07 9 OP36 18 (2) 01/06/07 10 OP38 23 (4) (c) (iii) (e) 01/04/07 Millard House Version 5.2 Page 29 food hygiene and moving and handling. This is a repeat requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations People that use the service should be provided with a more user friendly version of the Service User Guide to the home to enable them to have a clear understanding of the services and facilities available. Every effort should be made to increase the number of staff with a National Vocational Qualification in order to ensure that all residents can enjoy the benefits of being cared for by competent and trained staff. A log should be maintained of all matters relating to the servicing of equipment and services. This information would be more readily available than currently available and provide assurance that all the necessary Health & Safety checks have been carried out to safeguard residents. The large containers of vegetable oil in the kitchen should be assessed for the risk they present to staff and action taken to minimise any identified risk. 2 OP28 3 OP38 4 OP38 Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Millard House DS0000067428.V327397.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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