CARE HOMES FOR OLDER PEOPLE
Millcroft Vines Cross Road Horam East Sussex TN21 0HF Lead Inspector
Mike Flint Announced Inspection 8th November 2005 09:45 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.V249792.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 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 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.V249792.R01.S.doc Version 5.0 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. 7th May 2005 Date of last inspection Brief Description of the Service: Millcroft is an extended detached property situated a short distance from Horam village centre. Accommodation is provided on two floors and a shaft lift is fitted to assist access to the first floor. The home has a large rear garden and parking to the front of the building. It is registered to accommodate up to 24 older people. The registered providers are Millcroft and York Lodge Care Homes Ltd. Short-term, respite care is provided, when rooms are available. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out over five and a half hours during a day in November, when there were nineteen (19) residents. The registered manager was present and assisted with the inspection. Each of the duty staff was spoken with, as were four of the residents in the privacy of their own rooms. Comment cards were returned to the Inspector, prior to the visit, from four relatives and during the inspection the Inspector spoke in private to one other relative. The inspection included a tour of the premises and an examination of records. What the service does well: What has improved since the last inspection?
The home has responded with positive actions in addressing recommendations, made following the last inspection in May 2005. Information about the home, the services it offers and previous inspection reports are made readily available to residents and visitors to the home. Residents’ care plans and risk assessments have been brought up to date, including those concerning a resident being accommodated for short-term care. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 People who are referred to the home are fully assessed, enabling decisions to be taken in respect of the home’s ability to meet individual resident’s needs. EVIDENCE: A Statement of Purpose and detailed Service User Guide is available to prospective, or newly admitted residents to inform them about the home and of the services and facilities that are to be provided. The Terms and Conditions of residency are included and a contract is provided if care is to be purchased privately. At the time of the inspection these documents were available on public display. Pre-admission assessments are completed for all potential users of the service, referred to the home. Visits are arranged to assist people in reaching a decision about their choice of home. Short stays can be offered by arrangement. Each of the residents spoken with was able to confirm that they felt their needs were being met. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Personal support in this home is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. EVIDENCE: A satisfactory system of care planning and assessment is in place. Daily progress notes are used and care plans are kept updated. A visiting relative was spoken with, who commented favourably about the general quality of care that the staff at Millcroft provide. The administration of medicines in the home is satisfactorily managed promoting good health. Residents who so wish, and have been assessed as competent, may manage their own medicines. The manager confirmed that only staff, who have been appropriately trained, have the responsibility for dispensing medications. Staff observed in the course of their duties, were courteous and respectful towards residents. Appropriate measures are taken by the home to ensure residents’ privacy. Residents may have a private phone line fitted in their rooms and comments were made to the Inspector about how much this was valued. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The home provides a relaxed and supportive environment that enables residents to pursue their interests and autonomy within a socially orientated setting that is beneficial to their wellbeing. From comments made by residents and from the menu plans produced it was apparent that the quality of meals served could be improved upon. EVIDENCE: The home employs a part-time activities co-ordinator and there is a varied range of activities available, including exercise, outings, games and pastimes and various social events that take place in the home. The activities person said that residents are encouraged to retain their individual interests. It was apparent that the routines of daily living were flexible to suit the residents’ needs. Many of the residents have regular contact with family and friends. Visitors are welcome to the home at any reasonable time. On entering residents’ rooms it was clear that many bring personal items with them on admission, including their own furniture. The manager said that residents, or a next-of-kin on their behalf, would maintain responsibility for personal finances. There is a resident pet dog, which adds to the homely atmosphere at Millcroft, although from comments made it was made clear to the Inspector that not all residents were in favour of this arrangement.
Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 11 Having spoken with one of the cooks and examined the menu plan, the Inspector questioned residents about the meals served and was informed that the quality varied, depending on who was cooking on the day. However, the daily choice of meal was appreciated. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Any matters of concern are handled appropriately, reassuring those involved that they are being listened to and that action will be taken, as necessary. EVIDENCE: There have been six complaints recorded, since the last announced inspection, each of which was dealt with appropriately and satisfactorily resolved. The home has a written procedure that advises residents, or visitors to the home how to make a complaint. Residents and the visitor spoken with said that they felt the manager and staff were approachable and responsive, should issues arise that required action. Residents’ legal rights are protected and their names are included on the electoral register; postal voting forms are available for those who wish to take part in local, or general elections. Those who do not retain responsibility for their own affairs have a next-of-kin, or other person acting for them. There are policies in place relating to adult protection, though it was unclear whether all staff had received training in this area of their work. The manager confirmed that Police checks are carried out for all staff employed in the home. The staff files were not examined during this inspection, though they were available on the premises. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 26 The home provides a comfortable environment that is accessible, safe and satisfactorily maintained, meeting residents’ individual and collective needs in a homely style. EVIDENCE: A physical inspection of the home showed it to be satisfactorily maintained; a full-time maintenance person is employed. Residents’ private rooms are furnished and decorated in a homely style. Residents have the option of bringing their own furniture and belongings with them, which many have done this has resulted in pleasantly personalised rooms. Sufficient assisted bathrooms and WCs are available; these are equipped and maintained to a good standard. Some bedrooms have en suite facilities. Residents have the use of a large lounge/dining room and a spacious conservatory area; these are furnished and decorated to a satisfactory standard. Standards of hygiene and cleanliness throughout the home were good; there were no unpleasant odours. At the last two inspections it has been required that the kitchen floor be replaced. The manager has said that quotes have
Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 14 been obtained for a full refurbishment of the kitchen, during which the flooring will be replaced. The working surfaces and cupboards are chipped and damaged beyond repair. The kitchen is clearly unhygienic and it is required that this food preparation area be inspected by the Environmental Health Department for their advice and guidance on the planned re-fitting. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 The staff have a good understanding of the residents’ support needs, evident from the positive relationships, which have been formed between staff and residents, observed during the inspection. EVIDENCE: The duty rota showed that staffing arrangements during the day shifts are satisfactory. However, the night staffing arrangements of one duty night staff are not acceptable. It is required that a second waking, or sleep-in staff be rostered forthwith. Staff spoken with presented as committed to their work and well motivated, through sound management support; each spoke enthusiastically about their work in the home and said that staff turnover is low. A resident commented that the owner ‘is lucky to have such good staff’. The home provides a home-specific induction to ensure that all new staff are aware of their roles and responsibilities. Additional to this, induction and foundation training that meets the TOPSS specification has been introduced, together with the nationally recognised apprenticeship scheme. The owner and manager are supportive of the NVQ training and several staff already hold these awards, whilst others are working towards them. Staff files and recruitment practices were examined during the last inspection and found to be in order. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 The staff are well supervised, there are regular staff and residents meetings and the good levels of communication, apparent within the home, ensure that continuity of care is maintained. EVIDENCE: The manager presents as experienced, capable and knowledgeable about the needs of older people and of providing suitable levels of staff support. The manager has completed the approved management training for registered managers. When asked, residents commented positively about the management of the home and said that they found both manager and staff very approachable. Records showed that regular staff meetings and meetings for residents take place and that the manager provides regular one to one supervision sessions for staff. A selection of the home’s records were examined, these were of a good quality. Staff receive training in safe working practices.
Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 17 The home’s quality assurance measures include questionnaires for residents and visitors. However, it was noted that there were no up to date copies, available in the home, of the required monthly performance monitoring visits carried out by the provider. Fire alarms and emergency lights are being tested regularly and recorded maintained of these tests. However, there were no records of regular environmental health and safety checks. Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 3 Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 19 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 OP15 Regulation 16(2i) Requirement That professional dietetic advice is sought in a review of the menu planning and that suitable arrangements are made to ensure consistency in the quality of meals served. That the flooring in the kitchen is replaced. (Previous timescale of 07/08/05 unmet) That after consultation with the environmental health authority, suitable actions are taken to ensure that satisfactory standards of hygiene are maintained in respect of food preparation areas. That the current night staffing arrangements are reviewed. (Previous timescale of 07/06/05 unmet) That minimum night time cover is maintained at all times to include two staff rostered on duty i.e. one waking, one sleepin, or two waking, should the situation indicate the need. That a sufficient proportion of staff are qualified to ensure that a minimum of 50 of NVQtrained staff are on duty at any one time.
DS0000021165.V249792.R01.S.doc Timescale for action 01/04/06 2. 3. OP19 OP26 23(2b) 16(2j) 01/04/06 01/04/06 4. OP27 18(1a) 01/04/06 5. OP27 18(1a) 01/04/06 6. OP30 18(1a) 01/04/06 Millcroft Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 01 02 03 04 Refer to Standard OP18 OP22 OP25 OP33 Good Practice Recommendations That all staff receive training in the protection of vulnerable adults and adult abuse. That a lever-type tap, suitable for a person suffering from arthritis, is fitted to assist the resident in room 22. That the level of artificial lighting, provided in some communal areas, including lounge and bathrooms is increased for the safety and welfare of residents. That a copy of the required record of the monthly monitoring visits, made to the home by the responsible individual, are made available to the manager of the home and to the Commission each month. That arrangements are put in place to carry out and record regular environmental health and safety checks in all areas of the home accessed by residents, ensuring as far as possible their health, safety and well being. 05 OP38 Millcroft DS0000021165.V249792.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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