CARE HOMES FOR OLDER PEOPLE
Millbrook House 39-41 Birch Street Southport Merseyside PR8 5EU Lead Inspector
Mr Mike Perry Key Unannounced Inspection 30th August 2007 10:00 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 Millbrook House DS0000069263.V350009.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. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Millbrook House Address 39-41 Birch Street Southport Merseyside PR8 5EU 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) 01704546177 01704884110 Mr Mark Jonathan Gilbert Luke Gilbert Janet Elizabeth Hunstone Care Home 33 Category(ies) of Dementia (33) registration, with number of places Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with nursing - code N, to service users of the following gender: - Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 33 Date of last inspection New service Brief Description of the Service: The home has been newly registered to private providers in the last 4 months. Prior to this the home was run by social services as a care home also for elderly people. It accommodates up to 33 residents and is registered as providing services for people with dementia. The building is fairy modern and has day areas on the ground floor and bedrooms on the ground and first floor. The day areas consist of two-day rooms, a spacious dining room and a conservatory. Many of the bedrooms are ensuite. There is good provision of bathing amenities and nursing equipment. There is access to an enclosed garden area. The home is set in a residential area of Southport, which is fairly close to shops and bus routes. The Providers are Mr Mark Gilbert and Mr Luke Gilbert. The registered manager is Janet Hunstone. Fees for the service are currently £496.50 - £539 weekly. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection conducted since the homes registration 4 months ago. All of the key standard the home is expected to meet were assessed. The inspector arrived unannounced and the visit was conducted over 7.5 hours on one day. Prior to the inspection some information had been gathered by the manager completing a self-assessment and review of the service and submitting this to the inspector. On the day of the visit the inspector met with residents and their representatives / relatives, spoke with staff on duty including the nurse and the manager as well as the provider who was also on site. Survey forms were also taken on the visit and these were given to relatives to complete and return. Care records were reviewed and other records such as staff recruitment and training, health and safety and policies and procedures were reviewed. The inspection was very positive. The service is new and the manager is developing the staff team and service with attention to good practice. There are safe procedures and policies in evidence. There was discussion around the need to develop specific quality systems aimed at further developing dementia care practice in the home. What the service does well:
Pre admission assessments are completed for residents. These were comprehensive. Assessments were also seen from health and social care professionals, which included risk assessments covering various aspects of health and social factors. Following admission the in-house assessments are also good. Relatives are involved in the initial assessment process as they are asked to complete a ‘personal care booklet which details life history and preadmission support from family. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 6 Relatives reported that contracts and relevant information was given them as part of the admission process. The care records contain details of health care input from various professionals and this aspect of care is well monitored. All relatives spoken with reported that staff were very prompt at referring residents if needed and kept them informed about any health care input. Residents were observed to be dressed appropriately with good attention paid to cleanliness so that resident’s dignity was protected. One relative said: ‘He [resident] says it’s nice here. He likes the food. I feel the care is good. He can be very aggressive and staff spend a lot of time with him. The other day they spent an hour over teatime trying to get him to settle’. All relatives and some residents commented on the food and were pleased with this. The dining room is bright and the dinnertime meal seen was well presented and sociable. Staff were seen in attendance with those residents that required more assistance and staff were appropriately skilled. Relatives were aware of the complaints process. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. The home offers plenty of day space, which is bright and homely for residents so that residents who like to wander can feel comfortable. Many of the bedrooms have ensuite facilities and there are good provision of amenities such as bathrooms and toilets. The bathrooms offer a number of options in terms of bathing so choice is available. There is access to green space with a garden area accessible from both the conservatory and dining areas. Care has been taken with respect to disability access. Residents able to express an opinion were pleased with the surroundings generally and visitors also commented favourably. Over a short period of time the manager has built up a core team of nursing and care staff who display the abilities to care for residents in the home. There is a good compliment of trained staff that are very experienced. Staff reported that the manager is very keen on training and all spoken with had attended various training courses over the past four months. For example moving and handling, fire training and management of challenging behaviour. The training records available supported this. The comments from relatives regarding the staff were very encouraging: ‘I like the staff. They always spend time to give me update. Mum can get agitated. Care staff sit and talk to her calmly’. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 7 The health and safety checks of the environment are carried out and the certificates of maintenance seen were all up to date including fire safety. Staff interviewed had received basic training in these areas. What has improved since the last inspection? What they could do better:
Care plans seen were easy to read and described the care to be carried out for the individuals concerned in a personalised way. Some of the detail in the care plans could be better developed. For example one resident has a wound, which is being treated but the monitoring of this could be more detailed so that comparison can be made over time. The input that relatives have on the assessment of residents is not yet developed in the care planning, as they had not been consulted on the formulation of the care plan. Medications are administered safely but there are some recommendations listed at the end of the report that the manager should action to ensure standards are maintained. Care staff spoken with gave examples of how to manage various situations although generally felt that there was not always enough staff at times. An example of this was during the morning when all residents needed some personal care and such were the needs that occasionally the care routine could not include a midmorning drink due to lack of time, this impacts upon residents unfavourably. This was discussed with the manager who is aware of the issues around building the staff team and in continuing to recruit necessary staff. to meet the residents needs. There was little evidence during the inspection of time spent by staff in providing planned stimulus or activities for residents. One relative commented ‘staff are very good but there’s not enough of them to spend any quality time’. Another said that ‘there are no real activities for X unless we come’. The manager is aware of the need to develop the social aspects of the home further. Currently there is a lack of any choice on the menu although it was reported that the cook would prepare an alternative meal if requested. A menu board could also be useful to provide information as well as act as orientation aid for residents. There has been no formal training in adult protection and abuse for staff. This means that residents could be at risk if staff are not familiar with the processes
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 8 The manager plans some formal training and this should also be included on induction programmes for staff. There was some discussion around the need to develop the environment with respect to dementia care so that residents with confusion can be assisted to be orientated and find their way around and therefore become more independent. The home has been open for 4 months and the manager is currently developing quality assurance systems so that resident / relative views are sought and the home can therefore best be run in their interests. Quality assurance audits need to be developed so that the home can evidence continued and ongoing improvement following consultation and monitoring. A service development plan should be made available to service users. Management of resident’s monies were reviewed and is satisfactory with records maintained. It is recommended that two signatures be obtained for all entries in the records. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 9 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 Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and admitted to the home appropriately so that their care needs can be met by the staff. EVIDENCE: Two care files were reviewed. Pre admission assessments were completed for both residents. These were comprehensive. Assessments were also seen from health and social care professionals, which included risk assessments covering various aspects of health and social factors. Following admission the in-house assessments are also good. These cover activities of daily living and also include a psychological assessment. Relatives are involved in the initial assessment process as they are asked to complete a
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 11 ‘personal care booklet which details life history and preadmission support from family. Moving and handling, water low [assessment for pressure sore risk] and nutritional assessments are competed. The relative survey forms returned and the relatives spoken with on the inspection all confirmed that contracts and relevant information was given them as part of the assessment process. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s care is planned and managed with good input from other care professionals. There needs to be involvement of relatives in the care planning process so that care needs of residents are met holistically. EVIDENCE: Following admission a care plan is draw up which acts as a communication tool for the carrying out of care. Those seen were easy to read and described the care to be carried out for the individuals concerned in a personalised way. For example one plan detailed the dietary needs of one resident in a personalised way to ensure that staff were aware of the best way to encourage food intake. It was noted that despite difficulties this resident was maintaining weight. Some of the detail in the care plans could be better developed. For example one resident has a wound, which is being treated. There is an accompanying
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 13 wound chart to monitor this but although saying ‘wound improving’ it does not quantify this and it is recommended that more specific measurements be used so that comparison can be made over time. Some care needs are not addressed. For example a resident who has needs around the management of aggression has no detail on how staff should approach this. The ‘divers ional therapy’ plan was not completed for those reviewed and, again, the manager intends to develop these. The input that relatives have on the assessment of residents is not yet developed in the care planning. Relatives interviewed, although pleased with the care in general, had not seen the care plan or been engaged in any formal review. The manager evaluates care plans and these are clearly recorded every month. The manager intends to hold evaluation meetings with relatives and discuss the care plans in the near future. Currently the manager writes all of the care plans although will soon be delegating this work to the nursing staff as named nurses for residents. The care records contain details of health care input from various professionals. During the inspection a psychiatrist who was visiting was reviewing one of the residents. All relatives spoken with reported that staff were very prompt at referring residents if needed and kept them informed about any health care input. Medications are administered safely. There are some recommendations that the manager should action: • One resident is on PRN [give when required] medication for agitation. This is not referenced on the care plan so that there can be consistency with respect to why and when the medication should be given. Given the cognitive impairment of most of the residents in the home it is unlikely that residents will be self-medicating to any degree although a self-medication risk assessment tool should be available in this eventuality. The policy documents cover self-medication. The managers need to carry out in-house audits of the medication stock and systems on a routine basis. There was some discussion around this. • • Residents were observed to be dressed appropriately and there was good attention paid to cleanliness so that resident’s dignity was protected. One relative said: ‘He [resident] says it’s nice here. He likes the food. I feel the care is good. He can be very aggressive and staff spend a lot of time with him. The other day they spent an hour over teatime trying to get him to settle’. Care staff spoken with displayed goodl background knowledge and experience in care. They gave examples of how to manage various situations although
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 14 generally felt that there was not always enough staff at times. An example of this was during the morning when all residents needed some personal care and such were the needs that occasionally the care routine could not include midmorning drink due to lack of time. This was discussed with the manager who is aware of the issues around building the staff ream and in continuing to recruit necessary staff. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social care in the home is provided with emphasis on people’s individuality but this needs to be more consistently maintained in some key areas so that residents can experience increased engagement and improved well-being by the provision of an activities programme. EVIDENCE: The general ambiance of the home is warm and welcoming. Most of the residents were observed to be relaxed and settled. Those that were more agitated have space to wander and are less likely to feel constrained. Relatives are encouraged to visit and those spoken to felt welcome and that staff would spend time talking with them. There was little evidence during the inspection of time spent in providing planned stimulus or activities for residents. Relatives were pleased that they had been asked to contribute towards a social care history but the general feeling was that, although the care was good, more could be done in terms of
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 16 time for diversion and activities. One relative commented ‘staff are very good but there’s not enough of them to spend any quality time’. Another said that ‘there are no real activities for X unless we come’. There is no advertised activities programme although the manager and staff reported that they try and do something during the afternoon. Staff reported a lot of physical care as well as having to observe some residents who need to be kept safe. Time spent monitoring these residents was observed during the inspection. Consequently staff reported that little time was left to socialise. The garden is a useful facility but this was not observed to be in use on the day of the inspection. The manager is aware of the need to develop the social aspects of the home further and was able to give examples of literature that the home has acquired. The provision of an activities coordinator was discussed and would make a big difference in terms of quality input. All relatives and some residents commented on the food and were pleased with this. The dining room is bright and the dinnertime meal seen was well presented and sociable. Staff were seen in attendance with those residents that required more assistance and were appropriately skilled. There was attention paid to nutrition in the care plans seen. Currently there is a lack of any choice on the menu although it was reported that the cook would prepare an alternative meal if requested. A menu board could also be useful to provide information as well as act as orientation aid for residents. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a good complaints process and the home has responded appropriately to concerns raised so that residents are protected but there needs to be some formal training for all staff around abuse awareness including the development of induction standards. EVIDENCE: The complaints file evidenced 2 complaints since the home opened. One was from a visiting GP who could not gain access to the home on one visit due to the doorbell not being linked to the call system. The other complaint was from a relative who was concerned around the care of a resident. Both had been investigated by the manager and letters sent within time scales. Relatives were aware of the complaints process and this is clearly displayed in the homes information guides, which are readily available. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. There has been no formal training around adult protection and abuse for staff although those spoken to were aware of the importance of reporting any allegations or concerns made and were also knowledgeable on the way such
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 18 allegations are investigated. The manager plans some formal training and this should also be included on induction programmes for staff, which still need to be developed. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is newly opened and the bedroom, day areas and facilities are well presented and maintained. There does need to be further development with respect to organising the environment in terms of dementia care so that residents an be more orientated and feel more at home. EVIDENCE: The home offers plenty of day space, which is bright and homely for residents so that those in particular who like to wander can feel comfortable. Many of the bedrooms have ensuite facilities and there are good provision of amenities such as bathrooms and toilets. The bathrooms offer a number of options in terms of bathing so choice is available. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 20 There is access to green space with a garden area accessible from both the conservatory and dining areas. Care has been taken with respect to disability access. The décor is fresh and there are no unpleasant odours. The home was clean and hygienic. Residents able to express an opinion were pleased with the surroundings generally and visitors also commented favourably. There has been some attempt to personalise bedroom areas so that the residents’ individuality was in evidence with photographs and ornaments on display. There was some discussion around the need to develop the environment with respect to dementia care so that residents with confusion can be assisted to be orientated and find their way around and therefore become more independent. Appropriate signage and orientation aids were discussed. The inspector recommended a useful source to get ideas to develop this aspect further. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately to carry out care of residents. There needs to be rationalisation of staff numbers so that care needs can be appropriately met at all times. EVIDENCE: For 27 residents in the home at the time of inspection there was the manager [usually 8 – 5], 1 trained nurse and 5 Care staff. In addition there were 1 domestic and 1 chef working in the kitchen. There was no laundry assistant on the day of the inspection [off work] but the manager was in the process of recruiting another assistant. There is also maintenance cover for 3 days weekly. Nights have 2 staff but extra cover is available till 11 pm [manager states she is soon to put 3 on nights]. Currently the home as still recruiting and building a core of staff and are linking this to need as the home admits more people. Generally there is sufficient staff to cover need although there is some evidence that standards are not consistent in all areas [see comments under
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 22 health and social care sections of the report]. One of the staff summed up the current position: ‘This is the best home I’ve worked in. Purpose built and the equipment is good equipment is good. The staffing levels are OK but its now getting harder [as we fill up]. It’s difficult at present to get around to all the work. It’s very busy in the mornings. Sometimes miss out drinks because we are to busy. After tea a lot of residents get agitated and it is difficult monitoring them’. Another commented: ‘We need more staff for laundry and cleaning duties. Also need extra staff in kitchen. It’s a big home. Residents need constant monitoring. We have to cover for cleaning and laundry absence. [E.g. today for instance]. The manager is aware and is recruiting’. There is a good compliment of trained staff that are very experienced. Some have mental health training and the manager has completed a course in care of the dying. Staff reported that the manager is very keen on training and all spoken with had attended various training courses over the past four months. For example moving and handling, fire training and management of challenging behaviour. The training records available supported this. staff training files did include an induction checklist for those staff reviewed. The checklist covered various housekeeping issues and is completed over a fairly brief period of time. The standards required for induction are listed by ‘skills for care’ and it is recommended that the manager audits the current induction training against these standards. NVQ training is ongoing and currently there are 4 care staff that have an NVQ qualification [although 5 care staff are also undergoing nurse training]. Recruitment files seen for staff were complete and all the necessary pre employment checks had been completed. The comments from relatives regarding the staff were very encouraging: ‘I like the staff. They always spend time to give me update. Mum can get agitated. Care staff sit and talk to her calmly’. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards and 37 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a competent and experienced manager and basic systems are in place to ensure a safe service. There needs to be quality assurance systems developed to access stakeholder views so that the service can be developed in their best interests. EVIDENCE: The manager of the home is Janet Hunstone who is a nurse and has long experience in running care homes and working at senior management level in the private sector. She has a management qualification at NVQ level 5. She is able to communicate well and displayed evidence of continued training and
Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 24 clinical update. Both relatives and staff were supportive of her approach and felt that she had a good understanding of resident and staff needs. The home has been open for 4 months and the manager is currently developing quality assurance systems so that resident / relative views are sought and the home can therefore best be run in their interests. There is already an external quality audit, which has been carried out which accessed relative views. The manager-discussed ideas such as the introduction of care plan reviews and developing various quality audits around care planning and medication for example. Also an example of a relative survey was seen and discussed and the manager intends to circulate this at least twice a year. This could be extended to other stakeholders such as social and health care professionals. The Provider who is regularly onsite supports the manager. Currently the provider is not carrying out regulation 26 visits [audit visits by the provider so that feedback can be given to the manager regarding the overall running of the home]. These must be completed monthly and kept on file and feedback given to the manager. Quality assurance audits need to be developed so that the home can evidence continued and ongoing improvement following consultation and monitoring. A service development plan should be made available to service users. There are a set of policies and procedures available. These are standardised by an external consultant and the manager is currently working through the various policies to ensure suitability for the home. Some policies will need reviewing, for example the restraint policy that does not include any reporting procedures. The policies have signature sheets for staff to sign but none of these have yet been completed. Management of resident’s monies were reviewed this is satisfactory with appropriate records maintained. It is recommended that two signatures be obtained for all entries in the records. The health and safety checks of the environment are carried out and the certificates of maintenance seen were all up to date including fire safety. Staff interviewed had received basic training in these areas. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 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 2 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 3 Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 26 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 15(1) Requirement Timescale for action 01/11/07 2 OP12 16(2) n 3 OP33 24(1) 4 OP33 26 The care planning must continue to be developed with particular need to include relatives in the care planning process so that they can provide consistent input and feel more involved with the care. Planned activities related to 01/12/07 personal preference and need must be provided for residents so that they can be better stimulated and involved. There must be quality assurance 01/01/08 systems developed so that various stakeholder views can be accessed and residents and relatives can have input into the development of the home The provider must complete 01/11/07 monthly regulation 26 audits and reports so that the manager can receive appropriate feedback regarding quality issues in the home. Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 27 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 Refer to Standard OP7 OP9 Good Practice Recommendations The monitoring of wounds should be more measured and use objective descriptions or diagrams / photos if needed. There should be reference to PRN medication on the care plans for residents so that consistency is better maintained. A risk assessment tool for self-medication should be developed. There should be regular auditing of the medicine procedures carried out. Currently there is a lack of any choice on the menu and this should be addressed. A menu board could also be useful to provide information as well as act as orientation aid for residents. There needs to be some formal training for all staff around abuse awareness including the development of induction standards. There was some discussion around the need to develop the environment with respect to dementia care so that residents with confusion can become more independent. The manager should ensure that staff numbers are enough to meet care needs at all times. The current induction programme for staff needs to be developed with regard to the common foundation standards [skills for care]. Two signatures are recommended for all entries involving financial records. All policies and procedures should be reviewed by the manager to ensure suitability and any amendments made. Staff should sign the appropriate form to say they have read and understood. 3 OP15 4 OP18 5 6 7 8 9 OP19 OP27 OP30 OP35 OP37 Millbrook House DS0000069263.V350009.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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