Inspection on 17/12/07 for Millcroft

This inspection was carried out on 17th December 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 13/07/07

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 Elizabeth Dudley Unannounced Inspection 17th December 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 Millcroft DS0000021165.V357238.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.V357238.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 bozena@millcroft.plus.com Millcroft and York Lodge Care Homes Ltd vacant post Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Millcroft DS0000021165.V357238.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. 13th July 2007 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. Conditions of registration may undergo review by the South East Registration Team as part of the Modernising Registration Agenda. 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 £460 per week, which does not include extra services provided such as chiropody and hairdressing, these charges are available from the home. This information was provided to the CSCI on the 17th December 2007 Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 17th December 2007 over a period of eight and a half hours. It was facilitated by Mrs Bramble, the owner and manager. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and the evening meal, and conversations with residents, staff and visitors to the home. All residents were spoken with during the inspection, and six residents were spoken with in depth and gave their views on life in the home. The inspector sat in on an activities session and spoke to two visitors. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. Prior to the inspection questionnaires were sent out to relatives, residents and staff. Of these one was returned from relatives of residents and two from residents these gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. Residents spoken with said that ‘ Staff answer the bell very quickly’, ‘ The food is variable, one day it’s good, the next day not so good and there is not much variety’. ‘ The supper meal is pretty poor’. ‘ They changed the times of breakfast around, none of us are happy about it’. Following the last inspection the CSCI had concerns about the seriousness of issues found at the inspection and held an internal management review meeting. Following this, the home was required to provide the CSCI with an improvement plan relating to the requirements made. This was not completed to a satisfactory standard and many of the requirements remain outstanding. The CSCI views this very seriously and a further internal management review meeting will be held following this inspection and enforcement action may be commenced. What the service does well: Residents were complimentary about the staff and said that their personal care needs were well met and that they were treated with dignity, they were happy with their rooms, which they are able to personalise with their own possessions. Staff were seen to have a good and professional rapport with the residents and addressing them in their preferred way. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 6 The home provides frequent and varied outings for residents, which include weekly shopping trips, and residents spoken with said that they were kept informed of when these were taking place. Residents also commented on the friendliness of the home and said that it was very much like living in their own homes. What has improved since the last inspection? What they could do better: Some of the requirements made at the last inspection are outstanding. Requirements outstanding included the Statement of Purpose and Service User Guide provided by the home. This does not accurately reflect the status of the home in respect of management, required residents to refer to other documents and is not in a format to be easily used by residents. Whilst the requirement regarding the standard of preadmission assessment of residents has been partially complied with, this requires all areas of residents needs to be assessed to ensure that the home will be able to meet these prior to admitting the resident. Care plans need improvement, both in content and legibility and staff should use these as a working tool. Some areas of the care plans, e.g. daily personal care records had not been filled in daily and other records were not always completed with the required frequency. The storage of drugs was unsatisfactory and lack of an audit trail could lead to misuse of drugs. The manager must ensure that the numbers of staff on duty are sufficient to ensure that the increasing needs of the residents are met. Staff and observation of the residents in the home evidenced that many residents in the Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 7 home were becoming increasingly mentally frail and therefore needing more attention. Recruitment procedures did not fully comply with the regulations, there was evidence that some staff had commenced duty prior to their Protection of vulnerable adults check having being received by the home, which could put residents at risk. There were no disposable gloves in evidence in the bathrooms or in general areas for staff to use. The kitchen is used as a thoroughfare and staff do not wear protective clothing when accessing the kitchen. The manager should ensure that correct procedures are followed in the case of an infection in the home to prevent cross infection. The manager has been in post since September 2007 and during this time has tried to put systems in place to improve the home, however some of this has been done without consultation with staff that have been working at the home for several years and know the residents. Staff are at present, describing the home as being ‘ paper focussed and not resident focussed’. Residents said that a mealtime had been changed without consultation and this has resulted in them being rushed and unsure. There was evidence that recent training undertaken by the manager and staff has not resulted in appropriate changes, such as nutritional value of the supper meals provided in the home. 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.V357238.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. People who use the service experience adequate quality outcomes in this area Documentation produced to provide information about the home to prospective and existing residents do not accurately reflect the situation within the home and do not promote ease of use for residents. Lack of information in preadmission assessments could present problems in ensuring that residents’ needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide do not accurately reflect the current status within the home regarding the management and both require to be produced in a format which would be easily read by residents in the home. Both documents refer the residents to other documents and are not easily Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 10 read. The manager states that all residents have seen the service user guide but it was unclear as to whether they have their own copy. Residents have a copy of the terms and conditions, but this needs amending to reflect the current status in the home and amendments that were discussed with the manager. All residents undergo a preadmission assessment to ensure that the home can meet their needs three of these were examined and some required more detail to enable them to inform the care plan sufficiently, particularly regarding past medical history, current social needs and any special help required. Amendments to the above documents formed part of the improvement plan sent to the home, which has not yet been completed. Most residents spoken with said that they or their representatives had visited the home prior to admission. Written confirmation that the home is able to admit an individual is not being given at present and this should be commenced in line with Regulation 14(1)(c). The home accepts residents for respite care but does not have the facilities for intermediate care. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use the service experience poor quality outcomes in this area The care planning process is not sufficiently detailed to ensure that residents’ needs would be met, and care plans do not generally give sufficient instruction and guidance to staff on how to deliver the care required. The standard of administration of medication safeguards the residents, but the storage and the lack of comprehensive auditing of medication could lead to misuse of the medication kept in the home and could have implications in resident care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A total of four (21 ) care plans were examined in depth, the standard of these were variable. None of the care plans had been signed or dated by the person completing them, and only one showed evidence of consultation with Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 12 the resident or their representative. Care plans had been reviewed on a regular basis. Residents’ needs and the instructions to staff regarding care to be given were not clear, and therefore staff had to rely on their knowledge of the resident to provide care. Discussions were held with the current manager on content and legibility of the care planning. The manager had written in one care plan that a resident had dementia although a General Practitioner or psychiatric consultation had not proved this. Presumed diagnosis of a residents’ condition must not be added to a care plan until confirmed by a medical practitioner. There were Waterlow scoring (a scoring system to indicate risk of pressure damage) charts in the care plans, but these were not always completed and the mobility care plans did not give sufficient instructions or information. The daily records were fully completed and did refer to the care planning process, but relevant sheets such as daily hygiene sheets were not completed in some cases. There was no evidence of a risk assessment for bed rails, although general risk assessments were in place, staff said that at present they are not using bed rails but were not aware of the need for risk assessments in this eventuality. Continence care plans were in place but did not contain any detail of the care to be given or aids to be used. Few nutritional assessments were in place and these did not show evidence of review, staff said that they did not fully understand these. Staff spoken with were unaware of their responsibilities as key workers for residents. Care planning was included in the improvement plan but has not been met in a satisfactory manner Staff informed the inspector that one resident had been diagnosed with an infectious condition, there were no measures in place to prevent cross infection of other residents and staff raised their concerns that medical attention had not been obtained in a timely manner and that the lack of disposable gloves being readily available, both for personal care and in the case of infection would further compromise residents. Staff stated that the mental health of some residents was becoming impaired and that this resulted in them requiring very regular attention and also raised concerns that this was not always being addressed in a timely and appropriate manner. Residents appeared well cared for and said that the staff attended to their needs ‘They do their best’, ‘ Can’t always understand what you want them to do’, but residents spoken with were not aware of their care plans. Staff were seen to be interacting with residents in a manner that respected their dignity and privacy and to be addressing them in their preferred manner. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 13 Medications are kept in a locked room but not in a locked trolley, other items used in the daily life of the home are kept in the room, therefore the security of the medication could be compromised. The manager said that a lockable trolley has been ordered. Medications were signed for on administration, but generally had not been signed in when delivered to the home. A clear audit of drugs, both received and those disposed of was required in the improvement plan. Discontinued medications had not been signed for by two members of staff or the General Practitioner, this is good practice and should be commenced. The controlled drug cupboard contained other items such as cough mixture and money- therefore invalidating the security of the cupboard, and there were 16 Temazepam recorded in 2005 but no evidence of whether these had been returned to either the dispensing pharmacist or the resident. The recording of controlled drugs otherwise met the regulations. The risk assessment for residents that self administer medication was in place but should be more in depth and require checking more frequently with staff signing to say that the residents are still capable of self medication. The manager said that only staff who have medication training give out the medications. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Residents have choices in the routines of daily living, but the scope of activities offered within the home does not accord with residents recorded interests and insufficient time is allocated for these. The type of supper meal available to residents is not substantial or nutritionally balanced and does not allow residents sufficient choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that a member of staff has now been appointed to take charge of the activities. There is no obvious activities programme and it was unclear whether this is done as a matter of course, however there was plenty of evidence of outings taking place. A survey received from a relative of a Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 15 resident said that there were no activities that they could take part in as they remained in their room. Staff spoken with stated that different members of staff are detailed to provide activities each day, that these take place for ‘about 10-20 minutes morning and afternoon’. Social care plans (lifestyle care plans) were not fully completed and it appeared that activities in the home were not related to people’s documented past or present interests. The activities in the home included bingo and board games, and on the day of inspection residents were playing a throwing hoops game in the lounge prior to lunch. Three residents went to the sister home in the afternoon for a Christmas party, but there were no further activities taking place in the home on this day. Lifestyle care plans did not include preferred times of rising and retiring although residents spoken with said that they do have a choice over this. Choices were apparent in other activities of daily living. Residents can have visitors at any time although the home prefers that they ring first if visiting in the early morning or evening for security and residents dignity purposes. Ministers of religion visit the home on a regular basis. The menu is planned on a monthly basis, whilst this showed a choice of one main meal only, an alternative was being offered. The cook keeps records of residents’ likes and dislikes and any alternatives to the main meal ordered. The menu at suppertime does not offer any choice and does not always include a cooked meal. The supper menu provided this day was potato waffles and tinned spaghetti, the nutritional value of this was questioned with the manager. Supper menus in general were poor and did not provide a substantial or nutritious meal for residents. One resident has supplementary liquid food but this was not identified in a nutritional care plan. Menus offered and the choices of food available were part of the improvement plan required by the CSCI. This has only partially been complied with. Care staff are responsible for cooking and serving breakfast and there is a separate cook for suppers. The majority of the staff were in the kitchen at suppertime, few wearing protective clothing and the kitchen was being used as a thoroughfare during the day. Breakfast time has been changed to 7.30 from 8.30 and residents said that they found that this meant they have to rush in the morning and do not always get breakfast when they want it. Residents spoken with said that they had not been consulted over this although the manager said disputed this and said that breakfasts are served until 10am. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience adequate quality outcomes in this area. Any concerns received have been dealt with in a timely manner, residents are not confident about how to make a complaint. Not all staff have received the training on safeguarding those in their care or what action to take if they witnessed an incident requiring a safeguarding alert, and recruitment systems do not fully safeguard the residents in the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been two complaints made to the home since the last inspection, records of these were seen and they had both been addressed within a reasonable time scale. However one of these was from a member of staff who stated that she was not satisfied with the result. Generally recording of the complaints and records of what action has been taken has improved and requirements made in the improvement plan have been complied with. The CSCI received one concern about recruitment practices; this was addressed at the inspection. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 17 Some staff have not yet attended adult safeguarding training and some staff spoken with were not clear on what action to take if they witnessed a safeguarding incident. Recruitment practices within the home do not fully safeguard the residents as some staff had commenced work prior to their Protection of Vulnerable Adults check being received. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24, 25,26 People who use the service experience adequate quality outcomes in this area. The home provides a clean and comfortable environment for residents. Residents would benefit if they were consulted with regards to redecoration. Completion of radiator guards and staff training in infection control would benefit residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of continued redecoration but there was no evidence that this was planned in consultation with residents. Management must ensure that changes to the environment are discussed with the residents living at the home. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 19 There was evidence of carpet tape being used on some carpets and management must ensure that the condition of the carpets is monitored to safeguard residents. Individual rooms are comfortable and clean and personalised with residents own possessions. Radiator covers are in place except for one radiator on the first floor corridor, although this is currently kept switched off, a cover should be put in place in the eventuality of it being switched on, the manager gave assurances that this would be addressed therefore no requirement has been made at this time. All rooms had lockable drawers and window restrictors. Water temperatures to residents’ outlets had been monitored and these were within recommended parameters. Residents spoken with confirmed that their rooms were comfortable, clean and to their taste. Residents’ personal accommodation is over two floors and a shaft lift serves all parts of the homes. There were only two bathrooms available to be used, one bathroom is used solely as storage and staff said that there is one hoist available for use, but that all residents were having baths as required. Lack of detail in personal care plans made this unable to be checked. The National Minimum Standards directs that one bathroom to every eight residents is available and the manager must ensure that this is addressed. There were ramps and grab rails in appropriate place to enable residents’ degree of independence to be maximised. There are concerns about the degree of infection control practised in the home: there are no gloves available in bathrooms or toilets with staff carrying gloves around in their pockets and saying at times gloves are unavailable, staff were seen entering the kitchen without protective clothing and using the kitchen as a thoroughfare. Staff were wearing aprons which only covered them from the waist down to prepare food. Towels and washcloths were in bathrooms and personal toiletries left out in communal bathrooms- this impedes freedom of choice, could lead to residents using toiletries that may cause allergies and pose a risk of ingestion from those residents who are less cognitively able. Precautions have not been put in place to ensure that an infective condition is not passed to other residents or staff. The home was clean and free from odours; staff said that although there is a cleaner employed and a general assistant that they have to assist with cleaning at times. Three surveys were returned and all stated that the home was always clean. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience poor quality outcomes in this area. The number of staff on duty at specific times of day is not always sufficient to meet the varying and changing needs of the residents. The standard of English of some members of staff may prove a barrier in ensuring residents needs are met in a suitable manner. Recruitment procedures are not sufficiently robust to safeguard the residents. A staff training programme has been commenced which will benefit the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota shows that there are between three and four care staff on in the morning, three in the afternoons and two at night, the manager stated that one of the care staff at night was a senior care staff. Staff said that these numbers were not always representative of the numbers actually on duty and that there was not always a senior carer on at night. The manager has intentions of reducing the staff numbers now that a general assistant has been employed. Residents described staff as always busy doing Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 21 care and other associated duties. Staff and residents said that staff had very little time to spend talking with them. Residents and staff also said that standard of English of some overseas staff was not sufficient in either understanding or speech. This was evidenced at the inspection. The manager has now commenced staff on the recognised induction course’ skills for care as well as the local induction course. All existing staff will be required to do this. There is a training matrix in place but this showed that many staff did not have the required mandatory training. The training matrix does not identify past training only what is being done at present and the manager was unclear about the training of some of the staff. Seven staff (33 ) have had Protection of Vulnerable Adults training. Two members of staff have National Vocational Qualification level 3 in care and two have National Vocational Qualification level 2 in care (33 of care staff). Six (33 ) personnel files were examined and showed that two members of staff are employed on student visas, which allows them to work 20 hours and study for 20 hours, the staff gave assurances that this balance was maintained. One member of staff was employed with only one written reference and two were employed prior to the Protection of Vulnerable Adults check being received. A concern had been put to CSCI about a carer employed that had no visa to work in this country; the manager verified this but stated they are no longer employed. Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38. People who use the service experience poor quality outcomes in this area. Management systems are not sufficiently established to ensure the smooth running of the home, staff support or to ensure that residents expectations are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager, since September 2007, is the provider. She intends to apply for registration with the CSCI. She has attended various courses Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 23 including the Registered Managers Award and is a qualified doctor of pathology. Since taking over management of the home she has tried to put systems in place, including routine assessment of new residents, improve care planning and a training matrix. She has improved on the amount of outings offered to residents. However on examination of these records and systems, work and consultation with staff is required to ensure that these meet the needs of the home and the planned outcomes. In some cases the care staff and residents were not adjusting to the new management methods and there has been some staff turnover recently. The management style appears chaotic and haphazard and staff identified that they did not know what was going to happen from one day to the next. Concerns raised with the manager regarding the poor level of English of some of the staff resulted in the manager saying that she would promote these staff to give them more confidence in speaking English. However this will not ensure that residents have their needs met in a satisfactory manner. Residents and visitors spoken with said that ‘ the home is very friendly’, ‘Like a home from home’, ‘ There have been a few problems here and some of the old staff have left’. Following the last inspection, due to the seriousness of the situation in the home, an internal management review meeting was held by the CSCI and an improvement plan sent to the providers detailing what they were required to do to meet the regulations and to improve the quality of life for residents in the home. They were required to return the completed improvement plan to the CSCI. The completed improvement plan returned to the CSCI was of poor quality, it was not comprehensive and did not fully detail what the provider would do to meet the requirements made or who would be responsible for this. This inspection showed that neither the requirements made on the improvement plan or at the previous inspection have been fully complied with, the manager stating that other issues had been a priority. It was evident that issues identified at the last inspection, poor management processes, recruitment systems that fail to safeguard residents, care planning, staff training, nutritional content of meals and lack of staff confidence in the management were still ongoing. During the feedback following the inspection it was made clear to the inspector that the manager would not change some of the issues which caused concern Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 24 during the inspection, including provision of disposable gloves and proposed staffing level changes. An outside company undertook a quality assurance programme, and this combined both the homes together, but it was not possible to differentiate which results related to this home. It was clear that residents’ questionnaires had been sent out and feedback collated but unclear as to which home it related. It is required that the provider differentiates between the two homes in order to set about bringing improvement where required. Residents and relatives meetings take place monthly as do staff meetings but staff say they do not always feel listened to. Staff supervision has commenced and will be undertaken on a regular basis, although not all staff have had this at the required timescales all staff have had at least one supervision. Regulation 26 visits are taking place at the required intervals. The home does not act as appointee for any residents or hold any money for residents. Policies and procedures were not examined at this inspection, but other records were seen including staff records and training records. The registration certificate correctly reflects the management position in the home and there was evidence of suitable insurance policies being in place. Accident records are up to date and the manager is currently analysing the accident reports. There are no records of any regulation 37 reports (reports relating to accidents or incidents affecting residents) having been received by the CSCI. Certificates for the servicing of utilities and equipment were in place apart from the hoist certificate. A fire risk assessment is in place and the home is awaiting a visit from the fire department. Not all staff have had the required mandatory health and safety training. Millcroft DS0000021165.V357238.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 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 3 2 3 3 3 2 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 x x 3 1 2 Millcroft DS0000021165.V357238.R01.S.doc Version 5.2 Page 26 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 Reg 5 (1) (2)(3) Reg (6) Requirement That the information detailed in the Statement of Purpose and Service User’s Guide are amended and provide current information to ensure living at the home meets the individuals/representatives expectations. Both documents should be produced in a format, which is suitable for ease of use by service users, and all service users should be given a copy of the service user guide. This was a previous requirement due 30/9/07 That a thorough pre assessment 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 30.11.06 and 30/09/07 not met) Service users must be informed in writing about whether the home can meet their needs. That care plans and information in use regarding the care of service users is current and DS0000021165.V357238.R01.S.doc Timescale for action 01/03/08 2. OP3 Reg 14(1)(a) (b)(c)(d) 01/03/08 3. OP7 Reg 15(1)(2) 01/03/08 Millcroft Version 5.2 Page 27 reviewed with the individual/representative to ensure that choice and preferences are reflected in relation to their care and daily routines. (This was a requirement on previous inspections with timescales 31.08.06 and 08.12.06 and 30.09.07 not met) 4. OP9 Reg 13(2) The registered person shall make 01/03/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home to ensure staff and service users are safeguarded. This was a previous requirement 30/09/07 timescale not met. That the registered person shall liaise with the dispensing pharmacist regarding the auditing and disposal of those drugs treated as controlled drugs. 5 OP15 Reg 12(2)&(3) Reg 16(2)(i) Reg 13(6) Reg 13(3) That service users are provided with a choice of a varied nutritional diet. This was a previous requirement of the 30/09/07 timescale not met That all staff receive formal training in the safeguarding of the people in their care. The registered person shall liaise with the Environmental Health authority and the Health Protection Agency for advice regarding the reduction of cross infection. The registered person must ensure that staff receive the appropriate training in infection control. Sufficient equipment i.e. disposable gloves DS0000021165.V357238.R01.S.doc 01/03/08 6 7 OP18 OP26 01/04/08 01/03/08 Millcroft Version 5.2 Page 28 8 OP27 Reg 18(1)(a) to protect staff and service users from cross infection shall be readily available at all times. To ensure that at all times 01/03/08 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. (This was a requirement on previous inspections. Timescales 08.07.06 and 08.12.06, and 30/09/07 not met). That the standard of English of the staff employed is sufficient to enable them to meet service users needs and be understood by the service users. That robust recruitment procedures are in place to ensure service users are safeguarded. (This was a requirement on previous inspections. Timescales 31.07.06 and 08/12/06 and 1/09/07 not met) That the home is suitably managed to ensure that staff are appropriately supervised and supported and service users benefit from the ethos, leadership and management approach of the home. (This was a requirement on previous inspections with timescales of the 04/12/06 and 10/09/07 not met) That the registered person shall put in place a system to monitor the quality of the services provided by this home. That the registered person makes reports to the CSCI of DS0000021165.V357238.R01.S.doc 9 OP29 Reg 19 Schedule 2 01/03/08 10 OP31 Reg 9,10 & 18(2) 01/04/08 11 OP33 Reg 24 (1)(2)(3) Reg 37 01/04/08 12 Millcroft OP38 01/03/08 Page 29 Version 5.2 13 OP38 Reg 13(5) Reg 13(6) Reg 23(4)(d) any incidents, accidents or infection which affects the well being of a service user or service users within the home. That the registered person ensures that all staff undertake the mandatory training in health and safety and fire matters. 01/04/08 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 OP9 OP33 Good Practice Recommendations Drugs and medications that are discontinued as treatment should be signed by two members of staff or the General Practitioner discontinuing the treatment. 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.V357238.R01.S.doc Version 5.2 Page 30 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.V357238.R01.S.doc Version 5.2 Page 31 - 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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