Inspection on 08/09/06 for Millard House

This inspection was carried out on 8th September 2006.

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 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 18/11/08

Millard House 14/05/08

Millard House 19/12/07

Millard House 16/01/07

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 Jane Offord Key Unannounced Inspection 10:15 8 and 11 September 2006 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.V306714.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.V306714.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 Mrs Alison Jane Lyon 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.V306714.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. 5. Date of last inspection Brief Description of the Service: Millard House is a purpose built detached building located in the village of Bocking. 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, which is a company owning a number of homes around the country. The home provides accommodation and personal care to up to forty-three older people. The accommodation consists of thirty-nine single bedrooms and two shared rooms. There is a large dining room and several lounges. The building is two storeys and is linked by a passenger lift. The home has a central courtyard accessible from a number of exits and extensive grounds around the home, although these are not secure. A garden centre occupies the adjacent land and there is a small shop and café there that is sometimes used by residents. All beds are on a nomination contract to Essex County Council so a financial assessment is undertaken prior to admission. According to a notice displayed in the entrance hall of the home the resident’s contribution to fees can range between £61.25 and £643.98 per week however Rushcliffe Care say the highest fee is £426.09 Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first key inspection of Millard House under new management. It was unannounced and took place over a day and a half. The registered manager was not present on the first day but was available for the later half-day visit. A member of staff who introduced themselves as the deputy manager, but who Rushcliffe Care call the care manager, assisted with the inspection on the first day. During the time spent at the home several staff, residents and relatives wanted to offer opinions about the service. A visiting health care professional was also spoken with. Four residents’ files, care plans and daily records were seen. Two staff files, the duty rotas, training printout, some maintenance records and a number of other documents were sampled including medication administration records (MAR sheets). A tour of the building was undertaken, part of a medication administration round and the serving of the lunchtime meal were observed. The system for managing residents’ personal monies was explained and the complaints log book was seen. During the inspection it became clear that changes instigated by Rushcliffe Care have had an impact on resident choice and sense of security. The staff were committed and caring but concerned that they could no longer give the level of care to residents they wanted to. Residents and relatives expressed concern about falling standards of cleanliness and that the staff changes have meant daily routines cannot be adhered to in a timely manner. What the service does well: What has improved since the last inspection? Consultation has taken place with residents about meals and new menus have been developed as a result. The new menus have not been started yet but are due to start in a week’s time. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 6 What they could do better: Residents’ care plans and health assessments are poorly completed and were frequently not signed or dated. Food and fluid charts are not filled in fully or indication made that food or a drink has been offered to the resident and refused. A review of the new staffing levels and the impact it has had on residents’ care and daily routines needs to be undertaken. This needs to look at the roles of care staff and ancillary support and take account of residents’ dependency and the need for activities during the day. Some staff said they have not got job descriptions for the role they are performing and do not receive regular supervision sessions. Rushcliffe Care say that all previous job descriptions from the Local Authority are still relevant. Some senior staff spoken with were unable to identify an emergency on-call policy. Staff do not have the equipment required to protect themselves and residents from cross infection in the course of their duties. The system for recording complaints needs to be more consistent as in the complaints log seen recent complaints were not evident. The visitors’ book was full up, on both visits, with no new space for signing in and out. Staff files containing evidence of identification and recruitment checks should be available for inspection. There was no evidence available that staff moved from other parts of the organisation have been suitably trained for the work they are undertaking in Millard House. Medication ordering must be reviewed to ensure that residents have their prescribed medication available. Medication administration practice should also be reviewed so the residents receive their medication in a timely way. Staff training needs should be addressed as a number of staff have not had training such as moving and handling or infection control for over a year. The décor in parts of the building is shabby and dark. A number of carpets are badly stained and some rooms smelt strongly of urine. Although the courtyard has wheelchair ramps from the access doors, the doors have a threshold making it difficult for a wheelchair user to be able to access the outside independently. In the visitors’ room, which is situated upstairs in the secure area, there were cleaning agents left out on the side and the refrigerator contained an undated, open packet of sausage rolls. Lines of communication and authority need to be established between Rushcliffe Care and the registered manager to enable the home to offer an efficient service. Regulation 26 visits and reports should be undertaken. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 7 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. Millard House DS0000067428.V306714.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.V306714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6. Quality for this outcome area was good. People who use this service can expect to be able to visit and have an assessment of need done prior to making a decision to enter the home. The home does not offer intermediate care. This judgement was made using information available including a visit to the home. EVIDENCE: The Statement of Purpose says that the registered manager will undertake a pre-admission assessment. The manager confirmed they do the assessments unless they are on annual leave when the care manager would carry them out. There was documentary evidence in the residents’ files of the assessments done. The assessment covered areas of care such as personal hygiene, continence, mobility, diet and communication. There were also assessments of areas of risk like tissue viability and personal safety. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 10 One relative said they had chosen the home for their spouse two and a half years ago because they had liked the atmosphere. Some relatives of a prospective resident came to look at the home on the day of inspection and were welcomed and given written information and a guided tour of the home. Millard House DS0000067428.V306714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality for this outcome area was poor. People who use this service can expect to have their health needs met but cannot be assured there will be a plan of care for them, that the medication practice will protect them or that there will be sufficient staff to spend time with any resident who is dying. This judgement was made using information available including a visit to the home. EVIDENCE: The files and care plans of four residents were inspected and showed poor completion of records. Two files contained a ‘quick reference care plan’ one of which was not signed or dated; the other two files did not have a care plan except for medication. All files had details of the resident’s GP, next of kin and social worker. Many of the assessments for areas such as falls, tissue viability and nutrition were blank or incompletely filled out and not signed or dated. Daily records seen were written in appropriate language and gave some insight into the residents’ day. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 12 Other records that were poorly completed were food and fluid charts in residents’ bedrooms. Some residents were unwell and confined to bed so monitoring of their intake had been started. One chart seen had not been completed for four days for lunch and tea, with no explanation why. One relative had concerns that their parent had only had six baths in three months. Records for another resident showed they had had twelve baths in eight months in spite of the records being headed ‘weekly baths’. The records showed a gap of up to a month at times without a bath being recorded. On the second day of the inspection a resident became unwell in the dining room during breakfast. The staff called 999 for a paramedic who responded quickly and gave advice. The staff involved acted quickly and remained calm throughout. Staff said that prior to the staffing level changes if they had a resident who was dying they would ensure there was someone with them if there were no relatives to be there. Now they were unable to do that because the needs of the remaining residents meant all staff were constantly busy. It was noted during the day that several residents who were in bed were visited by staff but no one was available to sit with them. The morning medication round was in progress as the inspection started on the first day. The care manager had numerous interruptions from staff, visitors and telephone calls and the round was only completed at 12.15. The lunchtime round was then commenced soon after 13.00 meaning the time lapse for some medication was not as prescribed. The home uses a monitored dose system (MDS) for medication so tablets are dispensed from blister packs prepared by a local pharmacy. Each MAR sheet had an identification photograph of the resident. MAR sheets seen showed that a number of residents had missed doses of prescribed medications because they were out of stock. One resident’s MAR sheet showed Digoxin (a heart drug) prescribed for 8.00 had not been administered, as the resident was not up. The carer said they would give it with the lunchtime medication. When not being used medication trolleys were securely locked in a clinic room. The room also contained the controlled drugs (CD) cupboard. The CD register was inspected and two random checks made on the CDs contained in the cupboard. They both tallied with the records in the register. Millard House DS0000067428.V306714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality for this outcome area was poor. People who use this service can expect to be offered a balanced diet but cannot be assured that daily routines will allow them control over their choice of activities. This judgement was made using information available including a visit to the home. EVIDENCE: The recent change in staffing levels have meant that there are difficulties for staff to meet the needs of all residents in their preferred getting up times. One relative said they were shocked to find their parent still in bed at 11.00 one day. They said the resident had been used to being up early all their life and was not happy about being so late for breakfast. Observation showed residents were still being got up and brought to the dining room for breakfast as late as 11.30. Some residents and relatives said that if people choose to go to bed at 20.00 they are in bed for up to fifteen hours in twenty-four hours. The lateness of breakfast has a knock-on effect as lunch is served from 13.30 and some people will not be ready to eat again so quickly. Some residents are brought to the dining room for lunch at 13.00 and were observed still there after lunch was over, at 14.30, waiting for medication which was being dispensed in the dining room for the convenience of the carers, to save time taking the trolley round the building. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 14 Carers said they used to take residents to the garden centre next to the home sometimes for a cup of tea but they do not have time to do anything in the way of activities lately. Residents are often not transferred from their wheelchairs into a comfortable chair in the lounge any longer. A number of residents were observed sitting for long periods in their wheelchairs in the lounges. Visitors spoken with said they could visit at any reasonable time and were welcomed. Lately there had sometimes been a problem accessing the home, as with reduced staff numbers there was not always someone free to release the front door. On the first day of the inspection the lunchtime meal was fish and chips or cauliflower cheese followed by jam sponge and custard. The meal looked hot and appetising. Residents spoken with said they had enjoyed it. On the second visit an assistant in the ‘servery’ was serving breakfast. Fresh toast was prepared on request and marmalade sandwiches were taken to one resident in their room. A cooked breakfast was available on request and several residents were enjoying bacon and egg. The new menus that had been compiled in consultation with some of the residents were seen and showed that there was going to be a wider choice of options to the two main courses for each day. Meals like jacket potatoes and fillings, salads and omelettes would be available every day. There would also be a choice of two desserts. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality for 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 was made using information available including a visit to the home. EVIDENCE: The home has a robust complaints procedure, which is printed in both the Statement of Purpose and the Resident’s Guide. It offers an investigation and a time scale for responding with the contact details of the head office of Rushcliffe Care and the local office of CSCI. The complaints log was looked at but no entries were seen since before the change of management. One relative spoken with said they had made a written complaint in the last few weeks but did not indicate if they had received a response. CSCI have received concerns from relatives in the last three or four months that the complainants said they were going to raise with Rushcliffe Care. The home has a Protection of Vulnerable Adults (POVA) policy that is crossreferenced with the Essex guidelines. Staff spoken with were clear about their duty of care and what they would do if they had any concerns. The training data seen showed staff had received POVA training although for some it needed to be updated as it had been done two years ago. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 26. Quality for this outcome area was poor. People who use this service cannot be assured that the décor and furnishings are attractive and clean, that the bathrooms are all working properly, that they can independently access outside if they are a wheelchair user or that staff have the protective equipment required to minimise cross infection. This judgement was made using information available including a visit to the home. EVIDENCE: The home no longer has a dedicated maintenance person and has to rely on peripatetic staff from Rushcliffe Care. One bathroom on the first floor has a notice on the door that says, ‘do not use’. The fault was reported on 19/6/06 and partially repaired but the manager said the plumbers are returning later in the week to finish the job. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 17 At the time of inspection the rotas showed that the home had only one domestic who worked five days a week. Some of the carpets were noted to be badly stained, particularly in Willow lounge and room 10. On the second day room 6 smelt strongly of urine. One resident said the carpet in their room had not been hoovered for over a week. One relative said they had entered their parent’s room after a weekend recently and were overwhelmed by the smell. The carpet was wet with urine and there were faeces on the floor under the commode. On the day of inspection faeces were seen under a bed that had been made after the resident had been got up. The décor in some corridor areas is shabby and dark. The central courtyard is a large, secure area that residents can access and on the day of inspection a number of them were outside enjoying the sunshine. There are ramps outside the access doors so wheelchair users can make use of the courtyard, however, the access doors have thresholds so residents in wheelchairs could not go outside without help. The building is designed in a square around the central courtyard. Residents’ bedrooms are on two corridors downstairs and three corridors upstairs. There are long corridors to negotiate to reach different parts of the home. The home has a nurse call system in place. The system does not have an emergency ring to it. Staff said they had to find other staff in an emergency, as the call would only use the normal ring, which would not alert staff to the urgency of the situation. The laundry was seen and was clean. Washing machines have sluicing programmes on them and there is an automated washing agent additive system in place. There are separate hand washing facilities supplied with liquid soap and paper towels. Staff spoken with were aware of the infection control policy and the implications to residents and themselves if it was not followed properly. Several staff and some visitors expressed concern that the home was often left without protective gloves to use in the course of their duties. A number of staff said they had bought boxes of gloves to bring to work. Two staff said they had been told that a restriction of two pairs of gloves per carer per shift was being implemented. The manager said they had calculated an order of gloves based on the number of residents who are incontinent and was told by Rushcliffe Care they would definitely not receive the number they had ordered. Staff also raised concerns that ‘wet wipes’ were no longer available to clean residents. A new policy of using toilet paper initially and flannels had been implemented. Different coloured flannels and towels were to be used for upper and lower body. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality for this outcome area was poor. People who use this service cannot be assured that there are adequate, correctly recruited and trained staff available to meet their needs. This judgement has been made using information available including a visit to the service. EVIDENCE: The duty rotas were seen and showed that for an early shift there was one team leader rostered supported by four or five care staff. The late shift had a team leader with four care staff and night time had two staff. On the day of inspection there was one cook, one assistant in the ‘servery’, one domestic and a laundry worker. The manager said they did not have responsibility for doing the rotas; a more senior person in the organisation did them. The administrator was recently made redundant as Rushcliffe Care was going to centralise all the administrative work. The gardener/maintenance person resigned and has not yet been replaced. It was clear from observation during the day and a half of inspection that to meet basic needs the staff worked constantly and resident choice could not be acknowledged. One resident spoken with said they thought staffing had been reduced too much. When asked if they felt safe in the home they replied, ‘how can you feel safe knowing there are only two people on at night?’ The home’s Statement of Purpose says there will be, ‘a minimum …….. of three waking staff at night …… and administrative support’. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 19 The previous night a resident had become unwell and collapsed falling on the carer who was trying to support them. The needs of the resident were managed but the care manager, the next day, said the carer had had to see their doctor for an injury sustained in the incident and was off sick as a result. When questioned about a potential situation when an injured carer could not have completed their shift staff were unable to identify a recognised on-call policy for senior staff. An immediate requirement was left on the first day of the inspection to increase staffing overnight. A relative and a staff member said the domestic, who had been drafted into Millard House from another part of the Rushcliffe Care organisation, sometimes worked in the ‘servery’ if there was no-one else. The manager said they had asked for confirmation that the member of staff had been correctly recruited and had food hygiene training for the task but had not been given any evidence. CSCI received a number of comment cards and telephone calls before this inspection all raising concerns about the reduced staffing levels. One said they were, ‘disgusted by the lack of staff’, another in response to the question, ‘in your opinion are there always sufficient numbers of staff on duty?’, wrote, ‘definitely not!’. One relative said in their comments that it was often difficult to find a member of staff, particularly in the evenings. Staff said there have been changes made to shift times so the handover period is shorter. An early shift is 7.00 to14.15, a late shift is 14.15 to 21.15 and the night shift is 21.00 to 7.15. Rushcliffe Care has introduced a compulsory, unpaid thirty-minute break for each shift. The implications of that are that for at least an hour each night one member of staff only mans the home. Only two staff files were seen as Rushcliffe Care has removed the majority of them to a central location. This meant staff identification and recruitment checks for new staff were unavailable at this inspection. The two files seen were for staff who commenced work before Rushcliffe Care took over. The files seen contained all the required checks and proof of identity. The training spread sheet was seen and showed staff had received training in moving and handling, POVA, fire awareness, dementia care, infection control, food hygiene, health and safety and medication administration. However a number of staff had not had updates on their training for over a year. Staff spoken with said Rushcliffe Care is starting to provide training but there is an expectation that staff who are rostered will leave their duties to attend, which puts additional pressure on the system. The home employs thirty-four care staff, thirteen of whom have achieved NVQ level 2 or above. This gives a figure of 38 , which does not meet the 50 standard. Some staff with NVQ qualifications have recently left the service. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality for this outcome area is poor. People who use this service can expect to have their personal money handled safely but cannot be assured that the manager has the authority to run the home vested in them by Rushcliffe Care, that their views on the service will be sought or that their welfare is protected. This judgement was made using information available including a visit to the home. EVIDENCE: The registered manager has been in post at Millard House just over a year. They were registered following a fit person’s interview with CSCI and hold an NVQ level 4 in Care and the Registered Manager’s award. They have fifteen years experience working in residential care. Since the change of management they said they have not received a job description or had supervision. Other staff spoken with confirmed they had not received supervision since the change of ownership. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 21 The manager said they do not feel they are being supported to manage the service. One day they came on duty to find the assistant director interviewing to replace the maintenance person and they had no knowledge of the post being advertised. Since Rushcliffe Care has owned Millard House the only consultation with residents has been about the menus. One meeting was held at the beginning of the period of ownership for residents and relatives. A resident and two relatives said that the person who chaired the meeting was unable to answer a lot of the questions and they have remained unanswered. One relative said they had requested to meet with the new directors but it has not happened. CSCI have not received any Regulation 26 reports since the take over by Rushcliffe Care. The manager said they were not aware that any visits for the purpose of compiling such a report had been made to the home. Rushcliffe Care have subsequently supplied CSCI with the Regulation 26 reports completed since they took over Millard House. The manager explained the system for managing residents’ personal monies and it was safe with a clear audit trail. Two wallets were checked against the recorded balance and they tallied. Records were seen that showed regular tests of fire alarms and emergency lighting were undertaken. A fire drill done on 2/9/06 identified some training needs to ensure resident safety. Staff left the kitchen without turning off the gas mains. The visitors’ book was not checked so some visitors with a resident were not identified or given any instructions. However on the two days of inspection, which were either side of a weekend, the visitors’ book was full with no space for any visitor to sign in. This meant that for four days there was no record of who had been in the home. The manager said there was a visit due later in the week from the fire officer. As noted earlier in this report the equipment to meet the infection control policy properly is often not available to staff. In the visitors room that is located upstairs within the secure area it was noted that there were cleaning materials left on the side by the sink that were accessible to anyone. The refrigerator, which is primarily for milk so a visitor can make a resident a hot drink, contained an open packet of sausage rolls that did not have anyone’s name on and was not dated. A relative said they had found, in the past, milk in the refrigerator that had gone off. On the day of inspection the milk was within its using date. Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 22 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 X X X X 1 STAFFING Standard No Score 27 1 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 2 X 1 Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 23 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) Requirement Each resident must have a care plan developed from their assessed needs. This is a repeat requirement from the last inspection. Medication ordering must ensure that prescribed medication is available for the residents and that prescriptions times are adhered to or they are altered after consultation with a doctor. A programme of activities must be developed for the residents’ participation. This is a repeat requirement from the last inspection. Daily routines must be reviewed to ensure residents have the choice of how they spend their time. This is a repeat requirement from the last inspection. A complaints log must be maintained to show complaints received by the service and the action taken. Timescale for action 31/10/06 2. OP9 13 (2) 11/09/06 3. OP12 16 (2) (m) (n) 30/11/06 4. OP14 12 (3) 31/10/06 5. OP16 22 (8) 11/09/06 Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 24 6. OP18 18 7. OP19 23 (2) (b) 8. OP20 23 (2) (n) 9. OP21 23 (2) (c) 10. OP26 16 (2) (k) 11. OP26 13 (3) 13 (4) (c) 12. OP27 18 (1) (a) 13. OP29 19 (1) (b) (i) 18 (1) (a) 18 (1) (c) (i) 14. OP30 The registered manager must ensure that staff receive up to date training in protection of vulnerable adults. An action plan must be submitted to CSCI of how the redecoration of the home and maintenance of the gardens are to be managed. Adaptations must be made to the thresholds leading to the courtyard to enable wheelchair users the facility to access outside independently. The registered person must ensure that there are adequate and appropriate bathing facilities. This specifically relates to ensuring that the bath on the first floor has been repaired and is available for use. Action must be taken to ensure residents’ rooms are properly cleaned and unpleasant odours eradicated. Protective equipment must be available for staff to perform their duties in safety. This relates specifically to the need for protective gloves and aprons. The registered person must ensure that a review of residents’ dependency levels and a calculation of the care hours needed to meet the needs must be undertaken urgently and the information supplied to CSCI together with an action plan of how the service will manage this. Documentary evidence of recruitment and identification checks on staff must be available in the home for inspection. The registered person must ensure that all staff who handle food have undergone the appropriate training. DS0000067428.V306714.R01.S.doc 01/11/06 31/10/06 30/11/06 30/09/06 11/09/06 11/09/06 31/10/06 31/10/06 31/10/06 Millard House Version 5.2 Page 25 15. OP31 12 (5) (a) The registered manager must have a job description for the post and clarity about lines of accountability and responsibility. Quality assurance surveys of residents and relatives must be undertaken annually. Regulation 26 visits must be established and reports made available to CSCI on request. The registered person must ensure that all staff receive appropriate supervision. The control of substances hazardous to health (COSHH) regulations must be enforced to protect residents. The registered person must ensure that there is a record of all visitors to the home. Staff must undergo fire training to ensure they know their responsibilities in the event of a fire. 31/10/06 16. 17. 18. 19. OP33 OP33 OP36 OP38 24 (1) (a) (b) 24 (3) 26 (2) 26 (3) 18 (2) 13 (4) (a) (c) 17 Schedule 4 23 (4) (c) (iii) (e) 31/12/06 31/10/06 30/11/06 11/09/06 20. 21. OP38 OP38 11/09/06 31/10/06 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. Refer to Standard OP11 OP22 Good Practice Recommendations A review of staff routines and staffing levels should be undertaken to allow staff to give the level of care appropriate to residents who are dying. The present nurse call system should be replaced or adapted to allow for an emergency alarm to be available as well as the standard call. The registered manager should ensure that 50 of care staff achieve NVQ qualifications. OP28 Millard House DS0000067428.V306714.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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.V306714.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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