Inspection on 18/11/08 for Millard House

This inspection was carried out on 18th November 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

Millard House 07/05/09

Millard House 14/05/08

Millard House 19/12/07

Millard House 16/01/07

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Millard House 364 Church Street Bocking Braintree Essex CM7 5LL Lead Inspector Michelle Love Unannounced Inspection 18th November 2008 02:29 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.V373222.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.V373222.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.V373222.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 14th May 2008 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, near Braintree Essex. The home is owned by Rushcliffe Care Ltd. 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. 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 19th December 2007, a notice in the main entrance states the fees as ranging up to a maximum of £643.98 per week Items considered to be extra to the fees include private chiropody, hairdressing, toiletries and newspapers. Millard House DS0000067428.V373222.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. This was an unannounced key inspection. The visit took place over one day, with two inspectors’ and lasted a total of 11.5 hours, with all key standards inspected. The person in charge progress against previous requirements from the last key inspection (May 2008) and random inspection (July 2008) were inspected. As part of this process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents, members of staff and visitors were spoken with and their comments are used throughout the main text of the report. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As a result of continuing concerns relating to care planning/risk assessing, copies of documents were taken by inspectors under Code B of the Police and Criminal Evidence Act 1984. What the service does well: What has improved since the last inspection? Some aspects of staff training have now improved. The registered provider has increased the numbers of staff on duty throughout the night. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 6 Improvement was noted at this site visit in relation to where people require assistance and encouragement to eat their meal, appropriate support by staff was provided. 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.V373222.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect their needs to be assessed to ensure that the home can provide the appropriate level of support and care. EVIDENCE: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective residents needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. As part of this site visit, two care files for the newest people to be admitted to Millard House were examined. These showed that both pre admission assessments were completed prior to the person’s admittance to the care home. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 9 Pre admission assessments were noted to be informative and detailed. It was positive to note that information was recorded to evidence that both prospective residents and their representatives had been invited to visit the care home prior to admission and they had been involved within the pre admission assessment process. The AQAA details under the heading of ‘what we do well’, “we operate an open door policy that allows potential residents and/or their relatives to view the home prior to any admission arrangements”. The home does not currently provide intermediate care. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 10 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 poor. This judgement has been made using available evidence including a visit to this service. Residents can be sure they have an individual plan of care, however significant shortfalls in care planning and risk assessing, mean that residents cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. EVIDENCE: As part of this inspection a random sample of 5 care files were examined. Records show there is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these needs are to be met by care staff. However not all areas of identified need were recorded within each person’s care plan and in some cases there was limited information recorded as to how staff were to proactively manage the person’s specific care needs. In addition to the above, formal assessments are completed in relation to dependency, manual handling falls and pressure area care. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 11 Following the last key inspection to the home (14/5/2008) and as a result of concerns relating to care planning/risk assessing a Statutory Requirement Notice was issued on 10/6/2008. An unannounced random inspection was conducted to the home on 22/7/2008 to assess compliance with the requirements set out in the Statutory Requirement Notice. Evidence showed that efforts were being made by the person in charge and the organisation to address identified shortfalls/deficits and information pertaining to individual’s care needs and how this was to be managed by staff were observed to be much improved, detailed and informative. Whilst we acknowledge the above improvements, records at this inspection show that further development of the care planning and risk assessment process is required as shortfalls identified, potentially place people at risk of not having all of their care needs met and provides staff with inaccurate and not up to date information about individual people who live at Millard House. Risk assessments were not devised for all areas of assessed risk. This has the potential of placing vulnerable people at increased risk, as the staff working within the care home do not have all the information available for them to identify risks and to provide proactive management strategies to minimise the risks. For example, the pre admission assessment and assessment from the person’s placing authority, recorded them as requiring support from staff in relation to all aspects of their personal care. It also stated they could be resistant and on occasions refuse, staff support. No care plan was devised for the above. The placing authority assessment also made reference to the person requiring prompting with their dietary needs. On inspection of their daily care records, records consistently showed the resident as having a small diet and/or refusing meals. Nutritional records were requested for the above person, however we were advised by the care team leader, “we don’t know where they are at the moment”. No care plan and/or risk assessment was devised for the above. In addition to the above records, interagency case notes were also inspected and these showed no evidence that healthcare professionals had been consulted for advice/interventions. The pre admission assessment and placing authority assessment for another person recorded them as being at risk of falls, requiring a soft diet/medium appetite/being on nutritional supplements and a dietician referral being made in June 08 and prone to urinary tract infections. No care plan/risk assessment was completed in relation to the above. Daily care records evidenced on occasions that the person refused meals and interagency case records provided no evidence that the referral to the dietician had been followed up. No formal falls assessment and/or risk assessment had been completed yet accident records showed they were at risk. One accident record recorded, “passed to relevant care team leader to risk assess and care plan”. No evidence was available to confirm this had been undertaken. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 12 The care file for another person showed there was a history of poor dietary intake. The Activities of Daily Living Care Plan recorded, “needs encouragement, takes supplement drinks”. Daily care records consistently recorded the resident as having a very small diet and/or refusing meals. No care plan and/or risk assessment was devised for the above, yet records showed that the person’s poor dietary intake had been prevalent for some considerable time. The resident confirmed to us that they found eating and drinking very difficult and often felt sick. On the day of the site visit the resident was observed to be feeling unwell. Whilst we recognise efforts by the person in charge and staff team to deal with the resident’s poor health/reluctance to eat, records showed that interventions by healthcare professionals had only recently been requested. Records stated that the resident should be weighed weekly, however evidence showed this was not happening in line with their care needs. The above was not an isolated case and the care file for another resident also showed that over a 4 to 5 month period they had lost just under 10KG in weight. On inspection of food intake/fluid balance charts, records showed these were inconsistently completed by staff and did not record all meals/alternatives offered to the resident. No care plan and/or risk assessment was devised for the above. Daily care records were seen to be inconsistently completed, with some staff writing detailed and informative care notes and others providing insufficient evidence of staff interventions. Additionally it was noted on some care files randomly sampled, that daily care records were not always written on a daily basis. The above issues were discussed with the senior manager at the time of the site visit. The senior manager confirmed there were gaps within the care planning processes and that progress highlighted at the random inspection had not been sustained. The AQAA details under the heading of ‘what we do well’, “We believe that with regard to residents’ health and personal care we identify their needs and make every effort to meet these as required”. The AQAA also details under the heading of `how we have improved in the last 12 months`, “We have reviewed all residents care plans and endeavoured to ensure that they are relevant and pertinent to care needs. We have also trained the specific staff to understand the complete process”. On inspection of staff meeting minutes and the home’s communication book, there was evidence to show that the senior manager had highlighted to the person in charge/staff team that deficits and shortfalls relating to the monitoring of individual resident’s healthcare needs and care planning/risk assessing were evident and required addressing. Records included, “daily reports to be completed daily and to reflect care plans in place and efficiency Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 13 of some” and “care plans do not reflect changes of condition, needs urgent update”. As a result of these concerns and from evidence of continued non compliance to meet regulatory requirements relating to care planning and risk assessing, copies of documents were taken by inspectors under Code B of the Police and Criminal Evidence Act 1984. Medication practices and procedures for the safe handling and use of medicines were examined. Administration of medication to residents was observed during the morning and at lunchtime and this was seen to be satisfactory. Medication records were not up to date, with gaps in recording and information. This refers specifically to no record of some medicines having been given to the resident when they were due, as the entries on the MAR record had been left blank and not signed/initialled by staff. Additionally there was evidence to show that medication was not always administered in line with the prescriber’s instructions. This refers specifically to one person who was prescribed amoxicillin capsules, three times daily. Records showed this commenced on 6/11/2008 and 21 tablets were received, however records showed that the above medication was administered/signed for on 25 occasions. Additionally the same records show, there were gaps in the recording and entries on the MAR record were left blank. Requirements made at the last key inspection in relation to the above have not been met. The above issues were discussed with both the care team leader and the senior manager at the time of the inspection. Controlled drug medication and records were audited and these were seen to be satisfactory. Storage temperatures where medication is stored was noted to be adequately controlled and within recommended guidelines. The inspection of the training matrix showed that all but two members of staff who administer medication have up to date training. One of the staff members was noted to have a medication assessment checklist on their file, however this was not fully completed. The care team leader when questioned confirmed that the member of staff was administering medication. Whilst recent further training has been provided for most, there is no assessment that these staff remain competent to administer medication safely. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. People cannot be assured of having their social care needs met. Mealtimes in the home are considered to be an enjoyable event. People can expect to be encouraged to enjoy mealtimes. EVIDENCE: An activities co-ordinator has been in post at Millard House since late October 2008 and the staff rosters evidence they are employed for 3 days a week. The person in charge advised that activities for individuals are recorded on individual activity sheets (within an activity folder), detailing the activity, the date it occurred and any other comments. The person in charge advised that the activity co-ordinator meets with residents so as to establish their personal preferences. Records relating to this could not be produced as the activity coordinator was off sick on the day of the site visit. Records showed the range of activities undertaken by some residents included watching television, puzzles, quizzes, bingo, sing-a-long, colouring, listening to music, going for a short walk, knitting and external entertainers. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 15 Care files examined evidenced basic information pertaining to individual resident’s social care needs and how these were to be met. Activity records for 3 residents were randomly sampled and evidenced the last recorded activity undertaken being on 22/10/08, 3/11/08 and 7/11/08. Residents spoken with said, “not much to do and we would like to go out now and again”, “there’s not a lot going on” and “the staff are busy, what can you do”. Records showed there is a lack of activities for those people who have dementia and/or poor cognitive development. On the day of the site visit no activities were observed throughout the day for residents and there were long periods of time when residents were observed to be seated in the lounge/dining areas with the television on and without any staff support or interaction. The resident meeting of 7/10/2008 recorded the following entry, “not many care staff around during the day/evening as some residents have no way of calling for assistance”. The lack of a call alarm facility was discussed with the maintenance person, who advised that the call alarm facility cannot be extended to the communal areas as this could pose a health and safety risk. This also means that residents have no way of seeking assistance should the need arise. The AQAA details under the heading of ‘what we could do better’, “There is still a need to address the area of social activity; which will be improved through the recent appointment of an activities co-ordinator”. It also states under the heading of ‘our plans for improvement in the next 12 months’, “The production of an activities programme that meets the identified needs of the current residents, that is reviewed and modified to reflect changes in the resident group. To regularly ascertain the views of residents in order to allow these to be taken into consideration in the planning of activities and entertainment. To improve interactions with the general community, as part of the social activity programme”. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. One relative spoken with, stated they visit the home at different times of the day and were always made to feel welcome. The lunchtime and teatime meal was observed. A menu depicting the choices available for the day was displayed on a notice-board within the large dining area. As stated at the previous key inspection, consideration should be given to devising the menu in larger print and/or pictorial format so as to enable the majority of residents to make an informed choice. There continues to be a rolling 4 week menu and this was seen to offer people a varied choice of items. Food served to residents was observed to look appetising and well presented. Actual delivery of the lunchtime meal was observed to be well organised and staff interaction and support provided to individual resident’s during mealtimes, was noted to be respectful and with dignity. People spoken with stated, “the food is lovely” and “its always good”. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 16 Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns and complaints will be listened to and taken seriously. EVIDENCE: Within the home’s policy and procedure file there were two different complaint procedures/policies. One policy was dated 2007 and the other document was dated 2008 and both policies contained incorrect contact details for the Commission for Social Care Inspection and evidenced that people could complain directly to us. This needs to be amended to reflect that we no longer investigate complaints. On inspection of the complaint log, records showed that since the last inspection there have been 2 complaints. Evidence showed that the first complaint had been dealt with appropriately and included the outcome of the complaint, however no outcome was recorded for the second complaint. The senior manager advised us during feedback that the outcome of the complaint had been entered within the complaint file. The AQAA detailed under the heading of ‘how we have improved in the last 12 months’, “Identified areas of concern have been acted upon in a timely and constructive manner, which has alleviated the need to invoke the complaints procedure”. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 18 The complaints folder also contained many letters, cards and notes complimenting the home and its staff. Residents spoken with confirmed that if they had a complaint/area of concern they would discuss this with staff. Since the last inspection there have been no safeguarding issues. Policies and procedures relating to safeguarding are readily available within the home, however they still make reference to the National Care Standards Commission. Staff spoken with demonstrated a basic understanding and awareness of safeguarding procedures. Staff training records showed that safeguarding training has taken place in March, August and September 2008, with 22 members of staff attending. Records also show that since the last key inspection, 5 people have undertaken training relating to dealing with challenging behaviour. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment enables residents to live in a safe, well-maintained and comfortable environment. EVIDENCE: A partial tour of the premises was undertaken as part of this key inspection. A random sample of resident’s bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. A programme of redecoration and refurbishment continues within the home. The premises, were observed to be clean and there were no odours throughout the day. Additionally, no health and safety issues were highlighted on the day of the site visit. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 20 We recognise there is some signage within the home environment, this remains minimal and needs to be improved so as to aid orientation for people residing at the home. The AQAA details under the heading of ‘what we could do better’, “We could look at improving the signage within the home, especially in those areas relating to activities of daily living”. The maintenance person is employed at the home, Monday to Friday. A random sample of safety and maintenance certificates showed that fire systems within the home, fire alarm/emergency lighting testing and fire drills are undertaken regularly. Millard House DS0000067428.V373222.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 poor. This judgement has been made using available evidence including a visit to this service. Whilst staffing levels at the home have improved, staff deployment within the home means that some people’s needs might not be met. Inadequate recruitment procedures and lack of training in some areas means that residents are not safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: Staffing levels at the home are 1 care team leader and 5 care staff (morning), 1 care team leader and 4 care staff (afternoon) and at night there are 3 waking night staff. In addition to the above, there is an activities co-ordinator, a maintenance person, 2 cooks, 1 kitchen assistant and 2 domestic staff. There are 3 separate rosters (senior staff, care staff and ancillary staff) detailing staff hours. The person in charge is supernumerary most days but occasionally covers shifts when there are staff shortages as a result of staff sickness/annual leave. On inspection of 4 weeks’ staff rosters these evidence that staffing levels as detailed above are being maintained and on occasions additional staff are on duty throughout the day. It is positive that since the last key inspection, the numbers of staff on duty throughout the night has been increased from 2 to 3. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 22 It is evident from the inspection that the deployment of staff during the day continues to require improvement. As stated previously, staff spent little time with residents during the day, other than undertaking routines/tasks and there were long periods of time when people were left without staff support. At 12.30 p.m. 4 members of staff were noted to have their break at the same time (staff room) and 4 members of staff were observed within the main kitchen, leaving staff support for residents at a minimum. At this time one resident requested the inspector to take them to the toilet and staff had to be requested to attend to the resident’s needs. The dependency levels of current residents (31) as on the day of inspection, were provided to us and these record 2 residents with low needs, 12 residents with medium needs, 13 residents with high needs and 4 residents with very high needs. A random sample of 6 staff files were examined including those for newly recruited staff. Some shortfalls were identified on all staff files examined and included, no start dates, no application form for one person, incomplete application form for one person, only one written reference for one person, a full employment history not available for one person, no health declaration for one person and no CRB (Criminal Record Bureau) checks. We were advised that Criminal Record Bureau checks have been applied for. Each of the files examined for those people recruited from overseas, included a national bureau of investigation record and police clearance certificate. Four of the new staff files were for those people working on a student visa through international student advisors. There was some evidence of induction on staff files and there was evidence of correspondence from the senior manager requesting that staff return their completed induction books to the office by 26/11/2008. The AQAA details under the heading of ‘our evidence to show that we do it well’, “staff rota, training records and staff files”. The latter did not concur with our findings. The training matrix showed that since the last key inspection, some staff have undertaken training relating to dementia awareness, record keeping/care planning, supervision/appraisal, medication administration, first aid, moving and handling, safeguarding and health and safety. Staff spoken with confirmed that training in the home was good and that a list of training opportunities, are placed within the staff room. Gaps still remain for those conditions associated with the specific needs of older people. We were advised that 5 staff have attained an NVQ qualification and 10 members of staff are due to start this month. Millard House DS0000067428.V373222.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. This judgement has been made using available evidence including a visit to this service. Whilst we acknowledge some improvements, people living at Millard House cannot be confident the home is run in their best interests. EVIDENCE: At the time of the inspection we were made aware that a new manager had been appointed and was due to commence their role, week commencing 24/11/2008. The senior manager advised that a new post of senior care team leader had been newly created with the current person in charge fulfilling this role and it was envisaged that they would support the newly appointed manager. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 24 We were advised that the new manager is currently undertaking the Registered Manager’s Award and has previous experience of managing a care home. We recognise some improvements in some areas e.g. appointment of an activities co-ordinator, increase in staffing levels at night, appointment of a new manager, some staff training undertaken since the last key inspection, however, some aspects of management within the home continue to remain unsatisfactory and provide poor outcomes for people living in Millard House. Areas, which continue to require further development relate to care planning/risk assessments, medication practices and procedures, ensuring that people in the home have their social care needs met (especially for those people who have dementia/poor cognitive development), training and development for those conditions associated with the needs of older people and developing consistent staff supervision. The AQAA details, “Although some deficits have been rectified, it is recognised that further progress is required. This will be achieved through the appointment of a new and experienced manager” and “There are a number of areas where we acknowledge that improvements may be required, but this will be addressed when a manager is available on a regular daily basis”. An Annual Quality Assurance Assessment was completed and returned to us. All sections of the document were completed and this provided us with informative information about the service. A random sample of residents monies/records were inspected and these were found to be satisfactory. Since the last inspection the person in charge has documented staff supervision sessions, appraisals and observation of practice within the training matrix. This record showed some members of staff as having supervision since the last key inspection, however for some members of staff this remains outstanding and not in line with National Minimum Standards recommendations. For example the records for one person showed they received formal supervision on 29/2/08 and 16/8/08. The training matrix recorded that another supervision had taken place on 24/4/08, however the records were unavailable and the person in charge was unable to locate them. There was evidence to show that staff meetings, resident meetings and Regular 26 visits by the registered provider are undertaken. As stated at the last key inspection, there is a health and safety policy within the home. Accident records were inspected and records were noted to be well maintained and included all necessary information. A random sample of safety and maintenance certificates showed that these had been serviced and remain in date until their next examination. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 3 Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1)(2) Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. Previous timescale of 1.4.07, 1.4.08, 14.5.08 and 14.9.08 not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 14.5.08 and 14.9.08 not met. Ensure that the health and welfare of individual residents is promoted and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. DS0000067428.V373222.R01.S.doc Timescale for action 01/04/09 2. OP7 13(4) 01/04/09 3. OP8 12(1)(a) 01/04/09 Millard House Version 5.2 Page 27 4. OP9 13(2) and 12(1)(a) Previous timescale of 22.7.08 not fully met. Ensure that people are protected from harm by having medication administered safely and in accordance with the prescriber’s instructions. 01/04/09 5. OP9 13(2) and 17(1)(a) Previous timescale of 22.7.08 not fully met. Records of medicines 01/04/09 administered to residents must be completed. This will show that residents receive the medicines prescribed for them. Previous timescale of 22.7.08 not fully met. Ensure that all residents receive a varied programme of stimulating and interesting activities both ‘in house’ and within the local community, so as to ensure people have their social care needs met and do not become bored. Previous timescale of 1.5.07, 1.5.08 and 22.7.08 not fully met. Ensure the deployment of staff is appropriate to meet the needs of residents and to ensure their safety and wellbeing. Previous timescale of 1.4.08 and 22.7.08 not met. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Previous timescale of 22.7.08 not fully met. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions DS0000067428.V373222.R01.S.doc 6. OP12 16(2)(m) and (n) 01/04/09 7. OP27 18(1)(a) 01/04/09 8. OP29 19 01/04/09 9. OP30 18(1) 01/03/09 Millard House Version 5.2 Page 28 associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Previous timescale of 1.10.08 not fully met. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. Previous timescale of 1.4.08 and 22.7.08 not met. 10. OP36 18(2) 01/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP12 OP15 OP16 OP27 Good Practice Recommendations Daily care records should be written daily and include sufficient information relating to staff’s interventions. Devise an activity programme that is in large print, simple language and/or pictorial so as to enable people to make an informed choice. Consider devising the menu in larger print and/or pictorial format so as to enable people to make an informed choice. Amend the complaints procedure so as to reflect that the Commission for Social Care Inspection no longer investigates complaints. On the staff duty roster devise a key for the codes utilised e.g. E, L, N, SN etc. Millard House DS0000067428.V373222.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V373222.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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