Inspection on 07/05/09 for Millard House

This inspection was carried out on 7th May 2009.

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

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

Other inspections for this house

Millard House 18/11/08

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Millard House 364 Church Street Bocking Braintree Essex CM7 5LL Lead Inspector Pauline Marshall Key Unannounced Inspection 7th May 2009 8:10 DS0000067428.V375250.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Millard House DS0000067428.V375250.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.V375250.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 18th November 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 and it is owned by Rushcliffe Care Ltd. Accommodation consists of thirty-nine single bedrooms and two shared rooms that are not fully occupied at present. 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 people’s 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, The manager provides people interested in using the service with a copy of the home’s Statement of Purpose and Resident’s Guide. Weekly fees range between £452.48 and £648.90 per week and there are additional charges for chiropody, hairdressing, toiletries and newspapers. Millard House DS0000067428.V375250.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 1 star. This means that the people who use this service experience adequate quality outcomes. This was an unannounced key inspection that lasted for eight and a half hours. All of the key standards were inspected; we checked a random sample of policies and procedures and examined some of the records that the home is required to keep. We looked around the building and we spoke to staff, visiting relatives and the manager and a senior manager. We checked the progress of the requirements that were made at the last inspection. The senior manager completed the annual quality assurance assessment (AQAA) and returned it to us within the required timescale; it was detailed and informative and provided us with good information about the service. The AQAA is a self assessment document that the manager is required by law to complete; we have used the information provided in the AQAA throughout this report. We sent surveys to fifteen people using the service, six health and social care professionals, ten relatives, two GP’s, two advocates and fifteen of the homes staff to obtain their views on the service that the home provides. We received nine completed surveys from the people using the service and two from the homes staff; no other completed surveys were received by the due date. Views were mixed and comments from these have been included in the body of this report. What the service does well: The manager provides people with good information about the service and people have a thorough assessment of their needs. Visiting relatives said they are made to feel welcome and that the home offers people good quality meals. Millard House offers a good range of activities to people and staff are working on ways to raise funds to purchase transport that will be used to take people living in the home on outings; a summer fete is planned for July this year. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 6 Millard House is spacious, comfortable, homely and clean and it has good systems in place for the management of health and safety with the responsibility shared between the manager and the handyman. The home has a good system for safeguarding the money that they hold for people using the service. What has improved since the last inspection? What they could do better: To ensure that people get the correct level of assistance, the care plans should include more detailed information on the level of help people need with bathing. There should be clear written protocols explaining why medication for people to have as and when required has been prescribed and it should be clearly identified when to administer it. The home’s medication policy should identify who can and can not administer medication. Maintenance tasks should be carried out in a timely manner to ensure that people living in the home have fully functioning fixtures and fittings and the maintenance records should be stored together to enable ease of tracking any outstanding work. All staff files should contain the documents as required in regulation including the original criminal records bureau check (CRB) and evidence of their fitness to work at the home. Staff should be supervised at least six times each year in line with the National Minimum Standards. The home should obtain the views of other people such as GP’s, social workers, community nurses and advocates when undertaking the home’s annual Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 7 satisfaction survey to ensure that the views and opinions of all people connected to the service are included. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Millard House DS0000067428.V375250.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.V375250.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service would be able to make an informed decision regarding whether the service could meet their needs. EVIDENCE: The Statement of Purpose and Residents Guide were last reviewed in February 2009 and the manager advised us that both documents were due to be amended to show that it is now the Care Quality Commission that regulates Millard House as both documents make reference to the Commission for Social Care Inspection. The Statement of Purpose and the Residents Guide included copies of the most recent Resident’s Satisfaction Survey report and the complaints and fire procedures. There was evidence on the care files that Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 10 people are provided with a copy of both documents prior to their admission and people spoken with and surveyed confirmed this. Five care files were examined and each contained a detailed pre-admission assessment that covered all of the individual’s personal, emotional and social care needs and people spoken with confirmed that they had been visited prior to their admission and that they asked a series of questions. When spoken with, one relative said “my relative was visited by a senior member of staff before they moved in and we discussed her likes and dislikes and social, health and personal care needs”. The manager said in her AQAA “we operate an open door policy that allows potential residents and/or relatives to view the home prior to admission”. People using the service and their relatives confirmed this, when spoken with and the care records showed that trial visits had taken place. Millard House does not provide intermediate care. Millard House DS0000067428.V375250.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive appropriate health and personal care to meet their assessed needs. The home’s medication practice could potentially put people at risk of medication errors. EVIDENCE: We examined five care files, each of which included a photograph of the person, a consent form, personal details, medical history, pre-admission assessment, social services COM5 assessment, dependency level and nutritional screening. Four of the care files included the home’s “getting to know you” form that had been completed by the person using the service together with their relatives; this form provides staff with important background information on a person’s life. The fifth care file examined did not contain a “getting to know you” form but there was a note attached to it Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 12 saying that it had been given to the person’s relative to assist them to complete it. Each of the care files examined included fully completed care plans with an index and a quick reference guide to enable staff to see at a glance the support that a person needs; the care plan broke down the tasks so that staff know the level of support each individual requires. Some areas of care around bathing did not contain sufficient detail on the level of assistance the person actually required such as, was the person able to wash themselves and to what degree were they able to do so? Other areas of care were described in great detail in the care plans such as “give *** flannel and they will wash their face”. The manager said that the care plans are being developed further and that the level of support that people need with bathing will be clearly documented. Each of the care files examined included a care provision diary that charted people’s mobility, bodily functions, sleep, nutrition and hygiene. The entries showed any equipment used, such as hoists and slings and moving and handling belts and they showed the make and size of any continence products that were in use. There were risk assessments in place, together with their management plans for falls, moving and handling, pressure area care, the use of bed rails use of hoists and for the use of buzzers. The manager said in her AQAA “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”. There was evidence on the staff files that the care team leaders had attended a care planning workshop recently and staff spoken with confirmed that the training had given them a better understanding of care planning. The daily notes on all of the care files examined were detailed and informative. Each of the five care files examined contained details of the individual’s healthcare appointments, notes are recorded on the “interagency record sheet” in addition to the daily notes. The care plans showed that medical assistance had been requested within a suitable timeframe and that people’s health care needs were met. When spoken with one person said that if they felt unwell the doctor was called immediately and one relative confirmed that staff reported any health related issues to the relevant people quickly. The AQAA states that the medication policy was last reviewed in July 2007; the current policy does not identify who can and cannot administer medication; the manager said that the policy is in the process of being reviewed to ensure that it does include this information. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 13 Medication is administered by the home’s senior staff only and there was evidence that all senior staff had received recent medication training and there was a fully completed medication assessment checklist on the senior staff file that was examined. Senior staff spoken with said that the home’s medication system was changed on 5/3/09 and that the new provider supplied all senior staff with training on the new system. Staff said that the new system for ordering medication and the new medication administration record sheets (MARS) were clearer than before. We undertook an observation of a senior member of staff administering the medication and her practice was satisfactory, she ensured that the medication was safely removed from its pack and explained her actions to the person taking the medication and recorded the administration appropriately. Two of the medication administration records examined included the use of as and when prescribed (PRN) medication; the MARS included information on the dose, the frequency and the maximum dose to be taken within a twenty four hour period, but it did not identify the reasons why the medication was prescribed. There should be clear protocols in place for the use of all as and when prescribed medication to ensure that staff knows when to administer it. Where medication had been prescribed as either one or two tablets, the staff clearly stated on the MARS whether one or two tablets had been administered. Staff interactions with people living in the home were observed throughout the day and were seen to be sensitive, respectful and appropriate. People spoken with said that they felt staff were nice and treated them well and one relative said when spoken with “staff treat people with dignity and respect, you cannot fault the care, I visit every day so see most of the staff, all of the staff seem happier since the new manager started work and the home seems to have more energy and it is much happier now”. Millard House DS0000067428.V375250.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to access appropriate activities and their meals are healthy and nutritious. EVIDENCE: Millard House staff team have been developing their activities programme and the manager said that she is looking into funding for a mini-bus to allow staff to escort more people to go on outings. People spoken with confirmed that they visit a local garden centre and teashop; they also said that they play dominoes, do drawing, play bingo and have reminiscence sessions. People were observed taking part in a reminiscence session on the afternoon of the inspection and when spoken with people said “I like to keep busy and I always look for something to do, I have been dusting this morning”. A relative said, when spoken with “I feel more involved now and at Easter my relative and I were making hats together; I have been offered the chance to have training Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 15 with the staff to help me to understand my relatives dementia better” and “I feel that the new manager has energised the home, staff seem so much happier and motivated and it is a pleasure to visit as I am now made to feel so welcome”. Records showed that people participate in a range of activities including doing puzzles, watching television, listening to music, sing-a-along, knitting and colouring; external entertainers also make regular visits to the home. The manager said in her AQAA “we verify the actual lifestyle of each resident and make every effort to support these. We have seen significant improvement in the area of resident involvement in their care planning”. People living in the home said when spoken with that they mostly occupied their time and read their newspapers and “did not want loads of activities put upon them”. People surveyed provided mixed view on activities and they ranged from “I enjoy activities, especially knitting” and “I could be doing with more exercise and would like to go out every day”. The home is planning a summer fete in July to raise the money for a mini-bus with a tail lift to enable staff to escort people living in the home on outings to the seaside. One person spoken with said “I am really looking forward to the trips out, especially to the seaside”. People living in the home said when spoken with that they are involved in the running of the home and are asked at meetings if they are happy with the food, the activities and the care that staff supply. People said in their surveys “I am happy with the information I get and happy with my support, staff are helpful and I enjoy my meals, could not wish for anything better”. There were notes of residents meetings that confirmed that the views of people living in the home are sought and they participate in making decisions about their lives. An observation of both breakfast time and lunch time took place and people spoken with said that they were happy with the food offered and that they were able to choose what they wanted to eat; the meals for the day were written up on a large notice board in the dining area. The nutrition records showed that people had chosen their meals from a range of options. Staff interaction with people living in the home was good and people were treated respectfully whilst dining. The kitchen was clean and tidy and the records were well kept; there are two cooks that share the responsibility for the cleaning schedule and for maintaining the kitchen records and they are assisted by two kitchen assistants. Millard House DS0000067428.V375250.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns will be dealt with and that they will be protected from harm and abuse. EVIDENCE: There has been two complaints made in the past twelve months; both complaints had been dealt with appropriately. The complaints folder included detailed information about the complaints, how they were dealt with and the outcomes. The home keeps a record of any compliments received and there were nine written compliments that had been made since the last inspection. One person said in their letter “I visited the home nearly every day and at different times of day and I found during that time all of the staff were happy, dedicated, and hard working and nothing was too much trouble for them when asked”. Another person said in their letter “we can only say how very kind and caring all the staff at Millard House are and we are happy that mum was able to live there, her personal care was good and even her clothes matched nicely so that she always looked the way she would have liked”. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 17 The abuse policy was dated July 2007 and the manager said that this was in the process of being reviewed to include the Southend, Essex and Thurrock guidelines. There was evidence on all of the staff files examined that safeguarding training had taken place and staff spoken with showed a clear understanding of safeguarding adults and the whistle blowing procedure. There has been one safeguarding issue raised since the last inspection and the records showed that it had been dealt with appropriately. Millard House DS0000067428.V375250.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and safe environment. EVIDENCE: The home has two floors; there is a passenger lift that provides people that are not able to climb the stairs with access to the first floor. The manager said that the upstairs lounge area is not currently being used due to the low numbers of people living in the home. All of the bedrooms were decorated reasonably and many contained people’s private and personal belongings such as pictures and photographs. There are plenty of seating areas downstairs including three lounges, an activities room and a large reception area with comfortable seating. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 19 The courtyard garden provides people living in the home with a secure outside space. The handyman has built a raised wooden flowerbed that has provision for wheelchairs to get underneath to enable people to access it from their wheelchairs. The manager said that this is nearing completion and that people will soon be able to use it. The home employs a full time handyman who carries out small repairs, keeps the garden nice, maintains safety records and reports more major jobs to the organisation. We inspected the maintenance records and they showed that minor work had been carried out in a timely manner; however the records of jobs reported to the organisation showed that some essential work such as tap repairs had taken between two to four weeks to be completed. All maintenance work should be carried out in a timely manner to ensure that people living in the home have fully functioning fixtures and fittings. The maintenance records were stored in various places the major jobs are faxed through to the organisation and there was emails confirming receipt of requests; it was agreed that these should be stored together for ease of tracking any outstanding work. People spoken with said that they were happy with their rooms and the communal areas and one person said when spoken with “the home is always clean and fresh; the domestic lady is always vacuuming”. The home was clean and tidy and there was no malodorous smells. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent and well-trained staff team, however, the recruitment process does not fully protect people using the service. EVIDENCE: We looked at the staffing levels on the day of the inspection and they were sufficient to meet the needs of the people living in the home. We also looked at the rotas over a three week period, which included the coming week and they showed that adequate staffing had been maintained and was scheduled for the future. There were three separate rotas, one for the care team leaders, one for the care staff and one for the domestic, catering and maintenance staff. Each of the rotas showed the hours that staff worked and any changes were made clearly; there was a key to any abbreviations that had been used on the rota. The care team leader prepares a daily worksheet that shows which areas staff are deployed in throughout the day; the care team leader said this enables them to ensure that staff are appropriately deployed where needed at different times throughout the day. The care team leaders also prepare a handover sheet that ensures that important information is passed Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 21 over to the incoming shift. Seven of the home’s staff have completed their NVQ level 2 and above in care and ten staff are currently working towards it. Four staff files were examined and there were various shortfalls on each of them which included a lack of induction paperwork; there was evidence that some staff were holding their induction booklets. No new staff has been recruited recently and the manager advised that four new candidates are being processed. There were two different managers checklists on the staff files examined and neither of them had been fully completed. There was evidence of fitness on the newest staff file as it was added to the application form; there was no evidence of fitness on the others. All four staff files examined, contained evidence that a Criminal Records Bureau (CRB) check had been carried out. All of the staff files examined contained evidence of staff training that included medication, infection control, moving and handling, record keeping, health and safety, control of substances hazardous to health (COSHH), fire awareness, communication and challenging behaviour, nutrition and hydration, dementia and abuse. Senior staff had evidence of attending a care planning workshop and training on the mental capacity act. The care team leader said when spoken with “Millard House has provided extra training and I have recently done palliative care”. The manager said that two relatives of people living in the home are doing dementia training and when spoken with one of the relatives said “this training is so helpful and will help me to understand what is happening to my mum, I am so grateful for having the opportunity to do this training”. A senior manager together with the home’s manager is carrying out regular audits to ensure that all staff has regular updates in their training. People spoken with and surveyed said “I get on well with staff” and “I get the support I need from staff” and “staff know what they are doing”. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the homes quality assurance process and the supervision of staff will ensure that people live in a well run home that is run in their best interests. EVIDENCE: The manager has worked at the home since November 2008; she has more than twenty-five years experience in care and has been the registered manager of a learning disability service for the past five years. Prior to this the manager worked in the role of deputy manager for two and a half years at Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 23 a twenty-eight bedded home for people with learning disabilities and challenging behaviour. The manager has previous experience in working with the elderly and has undertaken first aid, fire, moving and handling and food hygiene training in the past year; she is a certified trainer in the protection of vulnerable adults (POVA) and is due to commence her Leadership and Management award at level 4 later this year; she is also enrolled on a dementia training course. There was evidence that regular meetings had been held for people living in the home and for the staff. Staff spoken with confirmed that the meetings were productive and the notes showed that topics discussed included staffs development and any deficits/improvements to the care plans. Staff said when spoken with that through discussions and training they were able to better understand the need for care plans to be more detailed. Notes of residents meetings showed that people were involved in the all areas of running the home including activities, food and staffing. One of the people living in the home said when spoken with “I always have a say in what we do and eat and we have meetings as well to discuss this”. The senior manager completed the homes annual quality assurance assessment (AQAA) fully and it contained all of the required information and was returned by the required date. The organisation carries out an annual satisfaction survey to obtain the views of the people living in the home and their relatives; it does not seek the views of others such as GP’s, social workers, community nurses and advocates; a report is then prepared by a senior manager. The report identifies any issues where actions are necessary and the manager then prepares an action plan to address them; a copy of the most recent report is attached to the residents guide. The cash transaction records together with their corresponding cash for five of the people living in the home was checked, and were all found to be correct. All of the staff files examined contained evidence of some supervisions and appraisals having taken place and two of the files examined contained evidence of observation of staffs practice. We checked a random sample of safety certificates and all were in place and up to date. Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 24 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 (2) Requirement The manager must ensure that there are arrangements in place for the safe administration of all medicines. Timescale for action 01/07/09 This refers to the need for a protocol for all as and when prescribed (PRN) medication to ensure that staff knows when to administer it. 2. OP29 19 (1) (b) Schedule 2 The manager must obtain and keep on the staff files all of the staff records that are required in the regulations; this includes evidence of staff’s fitness to work at the home. To ensure that people using the service are protected. 01/07/09 Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 26 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 OP7 Good Practice Recommendations It is recommended that you continue the development of the care plans to show what level of assistance people require with their bathing to ensure that people get the correct level of help. It is recommended that the homes medication policy includes details of who can and can not administer medication to ensure that staff are clear on their role. It is recommended that all maintenance tasks are carried out in a timely manner to ensure that people living in the home have fully functioning fixtures and fittings. It is recommended that all maintenance records are stored together to enable ease of tracking any outstanding work. It is recommended that the manager obtains the views of other people such as GP’s, social workers, community nurses and advocates when undertaking the homes annual satisfaction survey to ensure that the views and opinions of all people connected to the service are included. It is recommended that all staff receives supervision at least six times each year as required in the National Minimum Standards to ensure that staff feels fully supported to do their work. 2. OP9 3. OP19 4. OP19 5. OP33 6. OP36 Millard House DS0000067428.V375250.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.easatern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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