Inspection on 13/07/07 for Millcroft

This inspection was carried out on 13th July 2007.

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

Millcroft 15/04/08

Millcroft 17/12/07

Millcroft 06/07/06

Millcroft 08/11/05

Millcroft 07/05/05

Millcroft 10/10/04

Millcroft 08/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Millcroft Vines Cross Road Horam East Sussex TN21 0HF Lead Inspector Jennie Williams Key Unannounced Inspection 13th July 2007 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 Millcroft DS0000021165.V343125.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. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millcroft Address Vines Cross Road Horam East Sussex TN21 0HF 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) 01435 812170 Millcroft and York Lodge Care Homes Ltd Norma Moore Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-four (24). Service users must be aged sixty-five (65) years and over on admission. 6th July 2006 Date of last inspection Brief Description of the Service: Millcroft is a care home providing care for up to twenty-four (24) residents, of either gender, over the age of sixty-five (65). Nursing care is not provided at this establishment. District nurses will provide nursing input when required. The home is a detached property and is located in a quiet residential area a short distance from Horam village. There is access to public transport in the town. There is a mini bus van available for use at the home. There is a large garden at the rear of the building and parking facilities at the front of the home. Rooms are located over two floors. There is a passenger shaft lift available to assist residents to access all areas of the home. Sixteen rooms are for single occupancy of which 15 have en suite facilities. Two of these are under 10 sq. m in size. There are four double rooms that are provided with an en suite. There are six communal toilets located throughout the home and four bathrooms, of which three have assisted facilities. There is a good-sized combined lounge room and dining area. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Weekly fees range between £375 and £450. There are additional fees; hairdressing (£10), Chiropody (£8), newspapers and for personal dry cleaning (at cost). This information was provided to the CSCI in August 2007. Prospective residents/representatives are provided with a Statement of Purpose and Service User Guide. There are copies of previous inspection reports located at the entrance of the home. Residents/relatives know about the service through social service referrals, word of mouth and from living in the area. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed to the Inspector that people who use this service are called residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced key site visit took place over eight and a quarter hours on the 13th July 2007. Eight residents were spoken with throughout the site visit. One resident did not wish to speak to the Inspector and this was respected. Ten resident surveys were sent to individuals, of which eight were returned. One visitor was spoken with. Ten relative/visitor surveys were sent to the home prior to the site visit and six of these have been returned. One care plan was viewed and specific areas of care were looked at in a further five care plans. There is currently no manager working at the home. The Responsible Individual, another representative of the company, six care staff and the maintenance person were spoken with during the site visit. Four staff files were viewed. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed, complaint and Safeguarding Adult procedures and records were viewed. Copies of the staff rota were provided and menus were looked at. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. There were seventeen residents residing at the home on the day of the inspection. The Inspector would like to thank the staff for their assistance throughout this site visit. What the service does well: Prospective residents are provided with opportunities to visit the home prior to moving in to ensure the home will meet their needs. Visitors are welcomed at the home and residents may receive visitors in private. Residents are happy with their individual rooms and are able to personalise them. Residents were complimentary about the staff working at the home and felt that their personal care needs were being met. Routines of daily living are Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 6 generally to the individual’s choice and preference. Residents confirmed that staff respect their privacy and dignity. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term. The quality assurance and quality monitoring system being developed will ensure that the home is run in the best interest of service users. A written comment from a relative/visitor felt that the care home does well to make the residents feel as if they were still at home. What has improved since the last inspection? What they could do better: That services and facilities advertised in the Statement of Purpose and Service Users Guide need to be complied with and provide current information to ensure living at the home meets the individuals/representatives expectations. Clear information must be given about the current management structure at the home. Further work is required to ensure that pre assessments undertaken on prospective residents evidence that all needs of the resident can be met with the services and facilities provided at the home. This is an outstanding requirement from three inspections. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 7 Care plans and information in use regarding the care of residents must be current and reviewed with the individual/representative to ensure that choice and preferences are reflected in relation to their care and daily routines. This is an outstanding requirement from three inspections. Staff must be provided with guidance/training on how to use any assessment forms that are used pertaining to individuals. Work is required to ensure that there is clear information provided in relation to the administration of medicines to individuals. This will ensure residents and staff are better safeguarded. The provision of meals are slowly improving, however further work is required to ensure residents are provided with a choice of a varied nutritional diet. Clear records must be maintained of food provided in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. Clear information needs to be available for inspection on the number of complaints received about the home and the action taken to resolve these, to evidence that the home deals with these appropriately. The home is currently trying to recruit additional staff. Management must ensure that there are at all times suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of residents and to meet the aims and objectives of the home. This includes ancillary staff. This is an outstanding requirement from three inspections. Robust recruitment procedures must be followed to ensure residents are safeguarded. This is an outstanding requirement from three inspections. Priority must be given to ensure that all staff receive induction and foundation training to ensure the aims and objectives of the home are met and staff are trained and competent to do their jobs, ensuring all peoples health, safety and welfare are promoted and protected. Action is required to make sure that the home is suitably managed to ensure that staff are appropriately supervised and supported and residents benefit from the ethos, leadership and management approach of the home. This is an outstanding requirement. Advice needs to be sought from the appropriate authority regarding the correct disposal of unused equipment and correct storage of food to ensure current legislation is complied with and residents are safeguarded. A written comment from a relative/visitor stated that the home could be improved by ‘better administrative systems in place and ensure regular flow of information’. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 8 Any other shortfalls noted where no requirement or recommendation has been made are highlighted throughout the report. 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. Millcroft DS0000021165.V343125.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 Millcroft DS0000021165.V343125.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): 1, 3, 4, 5 & 6. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The information detailed within the Statement of Purpose and Service Users Guide was not fully being provided as advertised. Lack of information obtained at the pre-admission assessments place some residents at risk of their needs not being met. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that provides the reader with information about the services and facilities provided at the home. These documents do not read as user friendly and does not provide accurate information about the current management arrangements at the home. All services and facilities advertised in these documents are not currently being provided. The Statement of Purpose refers the reader to other Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 11 procedures and documentation and does not read as being user friendly. The home must ensure this additional information is readily available should people wish to read these. The pre admission assessments viewed demonstrated that brief information is obtained on the basic care needs of individuals. Pre admissions assessments need to be expanded to clearly evidence that all needs of the resident can be met with the services and facilities provided at the home. Some residents confirmed that they or a representative visited the home prior to moving in. No information is provided in the Statement of Purpose regarding the admission criteria. Four relative/visitor surveys identifies that they feel the care home usually meets the needs of their friend/relative. It was confirmed at the site visit that there are no residents currently residing at the home from any ethnic minority, social or religious groups with any specific needs. There is no dedicated accommodation provided at the home for providing intermediate care. Respite is available if there is a spare place available. Millcroft DS0000021165.V343125.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): 7, 8, 9 & 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff demonstrated an understanding of individuals needs, however there is a risk of some residents needs not being met due to care plans not being updated to reflect actual current practice and lack of understanding of staff when using assessment tools. EVIDENCE: There has been some improvements in the care plans, however further work is still required. Some staff spoken with confirmed that the care plans are not working documents and that they don’t read care plans on a regular basis. Staff confirmed that they are implementing assessments and risk assessments and other documentation pertaining to an individual’s health needs without any real understanding or guidance provided. One staff member stated that they were required to complete a nutritional risk assessment tool and did not feel competent to do so. No guidance or training had been provided. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 13 Staff confirmed that they will often open a care plan and find that additional paperwork has been placed in the file without any explanation or training on the use of these documents. These forms are being put in place by the current management support being offered to staff. Residents spoken with confirmed that they felt their personal care needs were being met and a resident observed to wearing glasses confirmed that eye checks are arranged whenever required. Other residents confirmed that they have access to sight, hearing and dental checks when required. Four relative/visitor surveys received demonstrated that the care home usually gives the support or care to their relative/friend that they expect or agreed. Care plans viewed were not containing up to date and accurate information on the needs of some individuals. Care plans are not being reviewed with the residents or representatives. It was noted that signatures for two representatives had been obtained with them identifying that they wish to be involved in the reviewing of the care plan, with the residents permission, however this was not happening. Residents spoken with confirmed that they were not familiar with their care plans. Staff confirmed that some residents mental health needs are changing. Some residents who are residing at the home confirmed this to the Inspector. The registered providers must ensure this continues to be monitored and specialist advice obtained when needed. One resident who has very poor eyesight finds it difficult to identify the staff. Staff need to be encouraged to identify themselves to this individual when offering any assistance. There is a key worker system in place, however on speaking with staff not all of them are aware of what this role entails. Medication Administration Records (MAR) charts viewed demonstrated that improvements could be made in the recording and administration of medicines. Where medication is prescribed as one or two tablets, the staff are not regularly recording how many they are administering at the time. Where medication is prescribed as ‘when required’ (PRN) there is no information available to identify when this medicine should be administered eg. creams/eye drops. There is no information available to identify where prescribed creams should be applied and no information was found in the care plan. The supplying pharmacist has recently undertaken an audit at the home. A report was provided to the home identifying issues that need to be addressed. Medication no longer being used for an individual is still being prescribed on the MAR charts with no indication provided to advise that these have been Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 14 ceased. The risk assessments for self-medication could be improved. It identified that this should be reviewed in six months. It has not been reviewed since December 2006. This is not reflected as an outstanding requirement but management must ensure this is reviewed. A senior carer confirmed that there are policies and procedures in place for all aspects of dealing with medication. The content of these were not read. Residents confirmed that they felt their privacy and dignity are respected and that staff knock of room doors before entering. Millcroft DS0000021165.V343125.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): 12, 13, 14 & 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is generally their own choice and further work is being undertaken to ensure that residents are provided with sufficient stimulation that is within their interest and abilities. Residents are not always provided with a choice in meals. EVIDENCE: Residents spoken with confirmed that the lifestyle within the home is generally their own choice. Four of the relative/visitors surveys showed that usually the care service support people to live the life they choose. A written comment from a relative/visitor stated ‘within the practicality of staff levels – generally OK’. Some residents felt that there were not enough activities provided at the home and some commented that they enjoyed going out in the mini bus van that is available at the home. Residents’ surveys demonstrated that two felt there were always activities provided for them to take part in, whilst the other five surveys ranged from usually to never for activities being provided. A staff member commented that they could do with more time to provide activities. It Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 16 was observed on the day of the site visit that a few residents now attend a day centre once a week. No requirement or recommendation has been made in relation to activities as the home is currently obtaining feedback on individual’s preferences in relation to activities and it was confirmed that appropriate action will be taken (See management and administration section for further details). This will continue to be monitored throughout the inspection process. There was a printed menu available in the dining room that demonstrated that there was a choice of meals available. It was evidenced and confirmed throughout the site visit that residents are not made aware of the choices and the menu printed is not followed. It was confirmed by staff that the meal is often dictated by what food provisions are available at the home. Some staff commented that the provision of food has slightly decreased. There was evidence of residents being given a choice at suppertime, however the main lunchtime meal had not been recorded since May 2007. Clear records must be maintained of food provided to residents in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. It was observed that there was bulk meat being frozen, however these were not dated or labelled to identify what it was or when it was frozen for storage. A staff member confirmed that a resident had complained about the quality of the bread provided and the Responsible Individual had confirmed that this would be changed. This has not been addressed to date. There is a cook that works Monday to Friday and an agency cook covers the weekend duties. It is recommended that a list of residents’ likes/dislikes/allergies in relation to food be provided to the cook. Comments from residents about the food ranged from ‘sometimes choice’, ‘plain’ to ‘quite good’. There is a hot house for residents to use and it was noted that fresh tomatoes and cucumbers were being grown in it. A staff member confirmed that there are plans in place to develop a vegetable garden for residents to be involved in. Consideration should be made to have raised garden beds to allow easy access for residents. A visitor spoken with confirmed that they had no concerns regarding the home and there were no restrictions imposed regarding visiting times. The Service Users Guide identifies that normal visiting is encouraged between 10:00am and 8:00pm. A written comment from a relative/visitor wrote that there is ‘always a generous welcome’. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel comfortable to make a complaint, however records are not always maintained and appropriate action is not always taken. The training of staff in Safeguarding Adults procedures ensure residents are safeguarded, however written policies do not provide clear information. EVIDENCE: There is a complaints procedure in place that everyone has access to. Records viewed demonstrated that there has been one complaint raised since the last inspection. Records demonstrated that appropriate action was taken to address the concerns, however the complainants family still chose to find another home for their relative. The AQAA identifies that there have been two complaints received in the last 12 months. Records were not seen for the second complaint. As previously explained, it was confirmed that a resident had complained about the quality of the bread provided. This has not been recorded and no action taken to address it. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 18 Four out of the six surveys received from relatives/visitors demonstrated that they know how to make a complaint about the care provided by the home if they need to. When asked if the care service responded appropriately if concerns have been raised, the responses were: three stated always, one usually and one survey identified never. Six out of the eight resident surveys received demonstrated that they know who to speak to if they are not happy. Of the residents that were asked, the majority stated that they would know who to speak to and would feel comfortable raising any concerns. Staff have access to a copy of the Safeguarding Adults flowchart that identifies procedures to take in the event of an allegation of abuse being made. It was noted on looking through the policies and procedures manual, there are a number of different procedures providing different information. It was discussed with a representative of the organisation that these need to be condensed and provide clear guidance that any allegations must be referred to social services who are the leading authority. This has not been reflected as a requirement or recommendation as the representative confirmed that she will address this. Staff spoken with confirmed that they have received training in Safeguarding Adults procedures. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with suitable facilities. Further redecorating and refurbishments are needed within the home ensure residents reside in a wellmaintained environment. EVIDENCE: There is evidence that the home is working to improve the environment within the home. It was observed that a corridor had been repainted. Management must ensure that this colour is agreeable to the residents residing at the home. Any major changes to the environment should be made in consultation with the residents. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 20 The maintenance person was spoken with who confirmed that he now feels more supervised and supported. He confirmed that there is a maintenance programme in place and this is regularly prioritised. Work has been done to remove metal radiator guards and the maintenance person confirmed that there is a programme in place to ensure that all radiators are suitably guarded prior to the colder weather commencing. This has not been reflected as an outstanding requirement as action is being taken to address this. A written comment from a relative/visitor was happy with the care at the home however commented ‘the only consideration I have is that the furnishings are all a bit tired’. Residents spoken with confirmed that they were happy with their individual rooms. Rooms viewed were seen to be personalised to reflect the individual’s choice and character. Rooms are located over two floors and there is a passenger shaft lift available to assist residents to access all areas of the home. Staff confirmed that the lift has been broken recently, however is able to be used when needed and that the problem is being addressed. Staff confirmed that there is currently only one hoist they are able to use to when bathing residents. This has been an ongoing issue for a period of time. Staff confirmed that residents are not having less baths because of this. A hoist was provided from the providers other home, however confirmed it is not suitable to be used for bathing. Management must ensure that suitable equipment is provided at all times to meet the needs of residents. There was old equipment noted to have been thrown out and was being accumulated beside the garage. This included an old fridge and hoist. Action must be taken to ensure that unused equipment is discarded appropriately. Some carpets were noted to be dirty/very old and worn thin. The maintenance person confirmed that replacement of carpets is included in the refurbishment programme. The cleaner was on holidays at the time of the site visit and staff were undertaking these duties if they had time, as well as providing care to the residents. Two resident surveys demonstrated that the home is always fresh and clean and the other six surveys demonstrated that the home is sometimes to never fresh and clean. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a risk of residents’ needs and the aims and objectives of the home not being met due to insufficient staffing levels. Residents will be better safeguarded if robust recruitment procedures are followed Staff and residents are placed at risk due to no structured induction and foundation training being provided to new staff at the time of employment. EVIDENCE: Residents were very complimentary about the staff working at the home and acknowledge the hard work they are putting in to ensure their needs are met. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term of address. Positive written comments were also received about the staff from relative/visitor surveys. Eg: ‘Nothing is too much trouble’, ‘my mother is very pleased and speaks positively of all the carers’ and ‘the staff are a great bunch of people’. Staff spoken with confirmed that there are usually four care workers for the morning shift, three carers in the afternoon and two working a waking night. The AQAA identifies that seven staff have left employment in the last 12 Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 22 months. It is identified in the AQAA that something they could do better is to have more trained and supervised staff to cater for the needs of the residents. The rota provided to the Inspector identifies that there are not always the same number of staff on duty on all shifts and that there is sometimes only one staff member on at night. One week identifies that there was one staff member for five of the seven nights. The rota was discussed with a senior carer following the site visit who confirmed that only occassionally there is one member of staff on duty at night and the rota provided may not be accurate. Staff confirmed that agency staff are regularly used and this is identified on the rota. The same agency worker is used wherever possible to help promote continuity of care. A written comment from a resident stated ‘ I am well looked after – but find it confusing not having a regular person washing me – often agency staff so they don’t chat or seem in a hurry’. The cleaner was on holidays at the time of the site visit and staff were undertaking these duties if they had time, as well as providing care to the residents. This is reflective of poor management within the home. Arrangements must be made to cover planned absences of staff to ensure there are sufficient staffing numbers working to meet the aims and objectives of the home. Staff are also required to do the supper meals, without additional staff being employed to assist to care for the residents. Some residents spoken with felt that at times there could be more staff. Three of the resident surveys demonstrated that staff are always available when needed, whilst three stated usually and one stating sometimes staff are available when needed. The cook was unable to finish her shift on the day of the site visit and staff were observed to assist in completing the cooking of the lunchtime meal and having to prepare the supper, taking them away from providing care to the residents. Staff drew to the attention of the management support in the home that there were no dishwasher tablets. No action was taken to address this and staff had to hand wash all dishes throughout the day, adding additional pressure to their workload and at the detriment to the care of residents. The AQAA identifies that the home has achieved its 50 ratio of having National Vocation Qualification level 2 or above. Staff files viewed demonstrated that robust recruitment procedures are not being followed. Ensuring application forms are fully completed will assist in addressing shortfalls. Employment histories for individuals were not complete and did not clearly identify employment dates. References were not located for one individual and a staff member had commenced employment prior to a Protection of Vulnerable Adults (POVA) First check being obtained. The home had obtained a copy of the police check done by the country from where this person was recruited. There was no evidence identifying that staff are Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 23 supervised until a full Criminal Record Bureau (CRB) disclosure had been returned. One of them works at night. There were no records available at the home for inspection regarding the temporary person recruited to manage the home in the absence of the Registered Manager. The Registered Person/Responsible Individual confirmed that the previous management company managing the home had recruited this person. He confirmed that poor recruitment practices had been followed. It was reiterated to him as the registered person that he must ensure that people appointed to manage and work at the home are skilled and competent to undertake these duties. Staff spoken with confirmed that they are provided with suitable training relevant to their roles. Recent training included: manual handling, infection control and first aid etc. A representative of the company confirmed that some staff are out of date with some mandatory training and action is being taken to address this. There was evidence that one new staff member has commenced induction, albeit they had been working at the home for nearly one month. A staff member stated that they had no induction into the home and felt that induction for new staff members could be improved. Another staff member confirmed that they have just commenced their induction after being employed at the home for five months. This person confirmed that no one had discussed any fire procedures or other safety measures to take in the event of an emergency. The representative of the company confirmed that a staff member from their other home will be undertaking induction with all new staff. It was confirmed by the representative that the induction programme complies with the Common Induction Standards as set by the Skills for Care. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff, residents and representatives will benefit if there is clear management and leadership within the home. EVIDENCE: The Registered Manager is currently absent from the home and suitable alternative management arrangements have not been implemented. This issue has been ongoing. A management company was employed by the registered providers to manage the home. A meeting was held with the registered providers in February 2007 due to high number of concerns being raised with CSCI regarding the lack of management support at the home. An Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 25 acting manager was appointed as a temporary measure, however this person was present at the home for two weeks and has been absent from the home since March 2007. The planned Christmas party had to be cancelled due to insufficient staffing numbers and lack of management support, this has negatively impacted on the outcomes for residents and is a good example of how the service is not being effectively run. The Registered Providers are offering support to the staff in the mornings during the weekdays and are available to be contacted outside of these hours. Senior care staff have been delegated managerial duties and carry these out to the best of their abilities. Senior staff from the providers other care home are on call if the registered providers are on holidays or not able to be contacted. Staff spoken with confirmed that the registered providers have been more supportive and approachable of late. It has been discussed with the registered providers in the past regarding their legal obligations to ensure the home is appropriately being managed. This will continue to be addressed with them outside of the inspection process. Written comments received from residents and relatives/visitors regarding the management of the home were: ‘Administration systems not strong’, ‘The staff who work at Millcroft at the moment really do there best – I think it is management that’s at fault.’ A written comment on a resident survey stated ‘I can always see staff when I ask or make an arrangement – but it has been confusing in the past year or more to know who is running the home. I’ve received no official letter of who to report to if I have problems … management has been haphazard over the last two years’. The representative from the company confirmed that work is being done on their quality monitoring systems. No structured quality monitoring has taken place in the last 12 months. A survey was viewed that was undertaken in February 2007 asking residents what their preferences are for outings and other activities. The options identified are currently being looked into. The representative confirmed that they are currently doing a questionnaire regarding the menus and the provision of food. It was confirmed that staff and residents meetings are being planned every couple of months. A comment written by a resident identified that they are not informed in advance of when resident meetings are taking place. There is a suggestion box in the dining/lounge area for anyone to write anonymously. No quality monitoring has been undertaken until very recently due to no manager being in place. The AQAA does not provide any information as to the processes that are in Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 26 place to monitor the quality assurance within the service. They have identified that their plans for improvement in the next 12 months is to encourage residents’ relatives to form a committee for monitoring the quality of perceived care. No requirement has been made in relation to quality assurance within the home as action is slowly being taken. This will continue to be monitored throughout the inspection process. The home does not hold any personal allowance for residents. Residents manage their own finances or are assisted by relatives/representatives. Staff have not been receiving any supervision. Staff and the Registered Provider/Responsible Individual confirmed that this has been identified and there are plans in place to address this. No requirement or recommendation has been made in relation to this as action is being taken to address this shortfall. Health and safety records were not viewed. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. The maintenance person confirms that he undertakes regular checks on fire alarms and hot water outlets. A representative of the company has just completed an analysis of the accident records for 2006. A floor plan is being devised for individuals highlighting where falls have occurred and apporopriate action will be taken to address any issues that may be identified. Dorguards were noted to be in place and staff confirmed that they have recently undertaken in house fire training. Any other shortfalls noted in relation to health and safety have been highlighted in the relevant sections of the report. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 27 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 2 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 6 Requirement Timescale for action 30/09/07 2. OP3 14(1) 3. OP7 15 4. OP9 13(2) That services and facilities detailed in the Statement of Purpose and Service Users Guide are complied with and provide current information to ensure living at the home meets the individuals/representatives expectations. That a thorough pre assessment 30/09/07 is undertaken on all prospective service users to evidence that all needs of the resident can be met with the services and facilities provided at the home (Timescale 31.08.06 and 30.11.07 not met) That care plans and information 30/09/07 in use regarding the care of service users is current and reviewed with the individual/representative to ensure that choice and preferences are reflected in relation to their care and daily routines. (Timescale 31.08.06 and 08.12.06 not met) The registered person shall make 30/09/07 arrangements for the recording, handling, safekeeping, safe DS0000021165.V343125.R01.S.doc Version 5.2 Millcroft Page 29 5. OP15 12(2)&(3) 14(1)(a), 15(1) & 16(2)(i) 6. OP16 17(2) Schedule 4 (11) 7. OP27 18(1)(a) 8. OP29 19 Schedule 2 9. OP30 12(1)(a) & 18 (1) 10. OP31 9, 10 & 18(2) administration and disposal of medicines received into the care home to ensure staff and service users are safeguarded. That service users are provided with a choice of a varied nutritional diet and that clear records be maintained of food provided in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. That clear information is available for inspection on the number of complaints received about the home and the action taken to resolve these to evidence that the home deals with these appropriately. To ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users and to meet the aims and objectives of the home. (Timescale 08.07.06 and 08.12.06 not met) That robust recruitment procedures are in place to ensure service users are safeguarded. (Timescale 31.07.06 and 08/12/06 not met) That all staff receive induction and foundation training to ensure the aims and objectives of the home are met and staff are trained and competent to do their jobs, ensuring all peoples health, safety and welfare are promoted and protected. That the home is suitably managed to ensure that staff are appropriately supervised and supported and service users benefit from the ethos, DS0000021165.V343125.R01.S.doc 30/09/07 30/09/07 30/09/07 01/09/07 30/09/07 10/09/07 Millcroft Version 5.2 Page 30 11. OP38 23(5) leadership and management approach of the home. (Timescale 04/12/06 not met) That advice is sought from the appropriate authority regarding the correct disposal of unused equipment and the correct storage of food to ensure current legislation is complied with and service users are safeguarded. 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations That an analysis is done of the quality assurance surveys received and the results are published and shared with prospective residents/relatives and any other interested party. Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millcroft DS0000021165.V343125.R01.S.doc Version 5.2 Page 32 - 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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