CARE HOMES FOR OLDER PEOPLE
Millbeck High Street Norton Stockton-on-Tees TS20 1DQ Lead Inspector
Jackie Herring Announced Inspection 3rd November 2005 09:30 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 Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 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. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Millbeck Address High Street Norton Stockton-on-Tees TS20 1DQ 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) 01642 360995 01642 360319 Anchor Trust Mrs Angela McLachlan Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons shall not at any one time exceed 30 elderly frail people 21st June 2005 Date of last inspection Brief Description of the Service: Millbeck is a purpose-built, two storey building situated on the High Street in Norton. The home blends in well with the neighbouring properties and has the advantage of having various amenities within walking distance e.g. Post Office, library, shops, pub, medical centre etc. Accommodation comprises 30 individual flats each with a lockable front door, letterbox, room-number. Each flat has en-suite toilet and hand basin. The home itself is tastefully decorated and has two lounges, the largest being situated on the ground floor. There are two dining rooms - one on each floor. Millbeck is surrounded by wellmaintained gardens, and seating is provided outside the main entrance where residents can sit and overlook the garden or watch the activity along the High Street. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an announced inspection and was completed in one inspection day, six and a half inspection hours in total. Pre inspection documentation was completed and returned prior to the inspection along with a number of residents and relative’s surveys. A number of records were examined, such as resident’s records, fire and maintenance records, a tour of the home took place and six residents, a relative, the manager and five staff were involved in discussions about life at Millbeck. The inspector also enjoyed joining residents for lunch. What the service does well: What has improved since the last inspection?
Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 6 Three of the four areas identified for development from the last inspection have been fully addressed. There has been substantial increase in the number of staff who are now qualified to NVQ Level 2 or above. A registered manager is now in post and the records for CRB disclosures have been updated. The recommendation to increase the accessibility of the garden is in the planning stage and will be addressed next year. 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. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 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 Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The admissions process ensures that resident’s needs are assessed prior to admission, which ensures that their needs can be met. EVIDENCE: Three sets of resident’s records were examined during the inspection and they all contained a pre admission assessment that had been completed prior to admission to the home. Copies of Social Services assessments and care plans were also in place. During discussion with a relative and a resident who is due to move into the home next week, it was confirmed that assessment of need had been completed and it was confirmed that the home could meet the resident’s needs. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 9 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 Whilst there is detailed information about individual residents, the care plans do not fully reflect some of the resident’s current level of needs, as such, there is the potential for resident’s health, personal and social care needs not to be fully promoted. Effective systems are in place for storage and administration of medicines. EVIDENCE: Three sets of resident’s records were examined during the inspection and they contained very detailed personal information about each of the residents and described their individual lifestyles and choices. They were very well written and time had been taken to take account of individual preferences twenty-four hours a day. There was also evidence of resident’s involvement within the assessment and lifestyle documentation. It was good to see assessment records being recorded in the first person, such as “I like to bathe twice a week and have my hair shampooed, my towel and toiletries are taken to the bathroom for me, I like my towel warmed”. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 10 Whilst there was detailed individual and lifestyle information, it was identified that there was the need for further development in regard to the identification of needs and the development of specific care plans. An example of this was in relation to one resident having a life reducing illness and was very low in mood, there was no specific plan of care in place for this although, it was very clear from discussions with the staff and manager that all appropriate care and support was being given. Further examples of this were shared with the manager during the inspection, who agreed that further development was needed. The care plans that were in place were being evaluated on a monthly basis, however the evaluation did not contain a valued based judgement on the effectiveness of the plan of care and tended to state, “no change”. The daily diary tended to be similar in that unless there were specific issues or problems the entry would simply be “settled morning”, “no problems”, “been out this morning”. During discussion with the manager, it was agreed that these could be enhanced further and should describe care and support given. Very well written six monthly reviews were being carried out that involved the residents, relative and keyworker. It was also unclear about the full range of assessment tools that were being use, for examples one of the residents whose records were examined was sat on a pressure relieving cushion, however no pressure risk assessment was documented in the records. Records included detailed information about medical interventions such as GP appointments, hospital appointments and sight tests and residents confirmed that their physical and medical needs were attended to. During discussion with three keyworkers they were able to describe in detail their role as keyworker and the needs of the individual residents they were keyworkers for. They spoke knowledgably and had clearly developed excellent relationships with the residents. Conversely, residents spoke extremely positively about their keyworkers and about the level of support given. They stated that time was spent on a 1:1 basis and they very much valued this time. One resident said, “she does my baths and hair, I can talk to her when I get worried, she has time to sit and chat, she has been my keyworker all the time I have been here, we have a special relationship”. Another resident said, “I am able to talk to my keyworker and I feel supported”. Another residents stated, “If they are treating everyone like me, then that’s alright, they are being well treated”. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 11 The medication system was discussed with two Senior Care Workers and the systems were examined during the inspection. The system for storing, administering and recording medication was well structured and effective. Storage was acceptable, however the plans to re-site the storage facilities to a dedicated area would be advantageous. Controlled drugs records were well maintained, however the manager should recommence the regular audit of controlled drugs within the controlled drug book rather than the supporting documentation. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 12 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): 15 Residents are offered and receive a varied, nutritious and very well present menu in pleasing surroundings. EVIDENCE: Copies of the menu had been submitted along with the pre inspection documentation and contained a rolling menu, which demonstrated choice of meals and beverages. The inspector joined a group of residents for lunch, which was very well presented and delicious. Resident’s had their personal carafes of wine on their tables and said they enjoyed a glass of wine with the lunch. The dining room that the inspector had lunch in was a pleasing environment and the table were nicely set with table cloths, condiments and the vegetables were served in tureens on the tables. Residents spoke highly of the meals and stated, “the food is really nice, you always have a choice, the meat just melts in your mouth”, “I am extremely pleased with the meals”. It was also confirmed through residents lifestyle records and through discussion that residents were able to have their meals in their rooms if they wanted to. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 13 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): None of these standards were examined on this occasion. EVIDENCE: These standards were not examined during this inspection, however the complaints procedure was observed and residents stated that if they had concerns they would not hesitate to raise them and were confidents that any matters would be resolved. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 14 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, 25,26 Millbeck offers residents an attractive, well-maintained and homely environment, with spacious bedrooms and communal spaces, although further development of the garden would be of a further benefit to residents. The home is very clean and in the main safe, however more regular checks are needed in regard to the hot water temperatures to further enhance safety for residents. EVIDENCE: The environment at Millbeck was very clean, fresh and airy if not a little too hot. It was observed to be a very homely and spacious home with pleasant communal areas. There was much evidence of personalisation of individual resident’s bedrooms and residents had also brought some of their own furniture with them. One resident said, “I am happy with my flat, I have been in the same flat since moving in and have my personal mementoes and belongings”. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 15 The home is surrounded by gardens to the front and rear of the home, mostly laid to lawn. The residents if they want to sit outside tend to use the paved areas at the front of the home. It had been identified at the last inspection that the garden could be developed further, making it more accessible to residents. The manager confirmed that an area outside the ground floor dining room was going to have a large patio laid with access from the dining room. Refurbishment was discussed with the manager, who showed the inspector the plan for the next two years. A substantial amount of work is planned, such as the installation of a new fire alarm system and emergency call system. A full redecoration programme is to take place following this work. The small kitchen area in the dining rooms are to be installed over the next few months. There was also discussion about improving the hairdressing salon. Systems were in place to promote a safe and comfortable environment; this included emergency lighting and radiators being guarded to protect residents from hot surfaces. Water temperatures were being recorded, however these were not being recorded at sufficient frequency, particularly where full body immersion was concerned. The frequency did not offer adequate monitoring to ensure the need of adjustment of these devices or protection from the risk of failure. It is acknowledged that each time a resident is bathed, the actual bath water temperature is recorded. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 16 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): 28, 29, 30 Robust procedure are in place for the recruitment and selection of staff. Resident’s needs are met by a well-trained and competent staff team. EVIDENCE: During discussion with the manager and through an examination of the pre inspection documentation, it was identified that currently 66 of care staff have now attained NVQ Level 2 or above and the remaining staff had enrolled or already commenced. This should be noted as commendable as significant progress has been made in regard to this in the past 12 months. Staff confirmed that they had received up to date mandatory training such as fire, health and safety and first aid. They also confirmed that they received client specific training and a number of staff had recently commenced Dementia Care Awareness. The manager produced a training programme which had been completed following a residents needs analysis and included such topics as mobility, mental health, dietary needs, continence care as well as cancer, stroke and epilepsy. These in house courses were being offered from October 2005 to March 2006 and a number of the staff were involved in researching and delivering this information. The pre inspection questionnaire confirmed that all staff receive the appropriate induction and staff receive more that the minimum three days paid training per year. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 17 Staff spoke very positively about the training and believed there was a real commitment to personal growth and development within Millbeck. During discussion with staff, they felt competent in their job roles and well supported by the home manager. They said, “Training is very good and is very much encouraged”. Staff also said that one of the strengths at Millbeck was the staff team, which was described as very dedicated, very friendly with high staff morale and without exception, staff come into the home when they are not on duty to support each other and to increase opportunities for residents recreational activities. Residents said, “The staff are nice, they are respectful and courteous”. “Staff are very helpful, kind, respectful and you can have a laugh with them”. It was noted at the last inspection that the recruitment process was robust however the records for Criminal Records Bureau checks for longer serving staff members did not contain all of the information. It was confirmed through this inspection with the manager and through the previous action plan that the records for Criminal Records were now being appropriately maintained. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 18 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, 38 Residents live in a well run, where robust systems are in place to ensure safeguards to health, safety, welfare and financial interests. EVIDENCE: Millbeck continues to be described as a well-run and well-managed home. Staff said, “it is definitely run for the benefit of the residents, staff come in when not on duty, there is always some-one giving their time”. Staff also said, “it is well organised, well run, you know who to go to and you know you have back up”, “management is approachable, you are encouraged to think and put ideas forward”. Another member of staff said, “I love my job, the whole staff team work together for the benefit of the residents”. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 19 A copy of findings from the last quality assurance questionnaires, which took place Summer 2005, was given to the inspector and was also on display within the reception at Millbeck. It contained an analysis of questionnaires sent to GP’s, District Nurses, residents and relative and identified positive aspects of life and care as well as areas that could be improved upon. The maintenance and service records were made available for examination and a random sample were looked at. This included fire equipment, weekly fire records, gas safety and a log of day-to-day repairs. All were found to be in order. The pre inspection documentation contained details of all other maintenance and service records and details of the policies and procedures. Records for resident’s personal allowances were also examined and the system was observed to be robust. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 20 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 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 3 X X X X 2 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 14 Requirement The assessments must be reviewed to ensure that care and health needs are identified and where necessary, specific care plans are developed, and they demonstrate how these needs are being met. The monthly review must contain more detail to reflect changing need and effectiveness of care plan. 2 OP25 13 The home must ensure that the outlet temperature of hot water to all baths and showers is monitored and recorded weekly as advised by Health and Safety Executive guidance. 03/11/05 Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Millbeck Refer to Good Practice Recommendations
DS0000000014.V261710.R01.S.doc Version 5.0 Page 22 1 2 2 3 Standard OP7 OP8 OP9 OP26 The daily dairy should contain more information about the actual care delivery. The range of assessment tools should be reviewed and in place as per NMS 8. Audit of the control drugs should recommence in the actual controlled drug book. The garden is to be developed further to increase the accessibility for resident use. Millbeck DS0000000014.V261710.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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