Inspection on 14/02/07 for Milldene Nursing Home

This inspection was carried out on 14th February 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

Milldene Nursing Home 06/02/09

Milldene Nursing Home 22/01/08

Milldene Nursing Home 22/02/06

Milldene Nursing Home 12/08/05

Milldene Nursing Home 28/02/05

Milldene Nursing Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Milldene Nursing Home 34 Field Street, Off Station Road South Gosforth Newcastle Upon Tyne Tyne & Wear NE3 1RY Lead Inspector Aileen Beatty Key Unannounced Inspection 13:30 7th February 2007 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 Milldene Nursing Home DS0000000426.V319543.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. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milldene Nursing Home Address 34 Field Street, Off Station Road South Gosforth Newcastle Upon Tyne Tyne & Wear NE3 1RY 0191 284 6999 0191 2131521 amanda.bain@anchor.org.uk www.anchor.org.uk Anchor Trust 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) Vacant Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Milldene is a care home with nursing, providing care for 13 adults with enduring mental health problems. The home is owned and managed by Anchor Housing Trust a large national provider of services to vulnerable client groups. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is situated in South Gosforth in the city of Newcastle upon Tyne close to local shops and good public transport links. The building has two floors with single bedrooms all with en-suite facilities. The home has a suitable passenger lift facility. There is a large dining and sitting room on the ground floor and a small room designated for smoking. Residents have access to a communal bathroom and a shower facility. Fees are in the region of £438 per week, although this varies depending on the level of nursing contribution. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, the 7th and 14th February 2007. During the inspection, residents and staff were spoken to, records were read, and inspectors looked around the building including communal rooms and bedrooms. What the service does well: What has improved since the last inspection? What they could do better: Medication procedures must be improved to ensure medicines are given safely and recorded correctly. Staff supervision must be carried out formally on a regular basis to ensure staff know what is expected of them and they receive the support they need. Nurses must be familiar with local adult protection procedures so that they know who to contact in the event of a concern. NVQ training needs to be provided to ensure the home has over 50 of care staff trained in NVQ 2 or above. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 6 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. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 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 Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is some information to help residents decide if Milldene is a suitable place for them to live but some is out of date. The needs of residents are assessed before admission to make sure the home can meet their needs. Prospective residents can visit the home a number of times to see if they like it before they move in. EVIDENCE: The service user guide consists of a brochure, which is personalised to Mildene and the statement of purpose for the Anchor group as a whole. The manager reported that she had not had time to look at these documents in depth. She Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 9 was not sure what information they contained. The documents did not include a description of the staffing for the home. The last inspection report was not included in the package. A requirement is outstanding regarding this. The manager described the admission procedure for the last resident admitted to the home. The care records of this resident were examined. A preadmission assessment had been carried out. It included enough information to enable a care plan to be put into place. A nurse from Mildene carried out the assessment. The manager stated that the resident had visited Mildene for a morning, then several afternoons. This was increased to a full day, followed by an overnight stay then a full weekend stay. This demonstrates good practice. The manager was clear regarding her responsibilities for admitting residents to the home. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s needs are set out in individualised plans of care but these vary in quality and detail. Health care needs are fully met by a range of professionals. Medication procedures are generally good but there are some gaps in records. Residents are treated with respect and their privacy is maintained. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans of three residents were read. Information contained in care plans includes information regarding allergies, personal history, social needs, physical needs and nutritional assessments. Care plans are generally good, one mental health care plan was particularly detailed, but some lack sufficient detail. Some evaluations recorded are very brief and therefore lack meaning. For example one evaluation said that the resident was “in a bad mood today” but there was no attempt to explain why this may be, or how this affected their day. The format of care records is chaotic but this is being resolved when new systems are introduced for care planning and documentation later this year. The manager and regional manager are both aware that care plans are not all well presented and organised in a systematic way. There is evidence of physical health checks for example of blood pressure and nutritional (dietary) needs. Some assessments are out of date but of those checked most are available and have been carried out recently. Residents have access to a range of professionals who might visit the home, or people may be taken to appointments. These include GP, Consultant Psychiatrist (accessed via GP), chiropodist, dentist and optician. All residents currently use the same GP but could use their own if it was practical to do so. A GP surgery is held at the home each Monday. The storage, ordering, administration and disposal of medication were examined. Medicines were properly stored. Storage was tidy and clearly labelled. The system in use is the monitored dose system supplied by Boots chemist. Boots have given training and advice to staff as there were a few errors initially in the ordering process. The administration sheets contained all of the required information. There were several gaps in the administration records. The manager was advised to address these with the individual nurses concerned during formal supervision sessions. Controlled drugs were appropriately stored and recorded. Three amounts of controlled drug were checked and found to be correct. Medication requiring cool storage is kept in a fridge. The temperature of this is monitored daily. Regular audits of the medication system are carried out. Resident’s privacy is respected and staff knock on doors before entering. There is no lockable storage in bedrooms and there is no provision for residents to hold their own room key at present. A review of the care of every resident is held six monthly, and it is recorded whether the resident chose to attend. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s social, cultural, religious and recreational needs are met. Contact with family, friends, and the local community is encouraged. Residents are generally assisted to exercise choice and control over their lives. A wholesome and appealing diet is provided. EVIDENCE: Residents are involved in a variety of individual and group activities. An activities co-ordinator is in post and on the day of the inspection a number of residents were enjoying painting. Care staff also carry out activities and time is allowed for this in staff rosters. An activity plan is displayed on the wall, and a Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 13 record of social activities is kept. Involvement in individual activities is now also going to be recorded in care records. Residents take part in activities in the community. These include attending various clubs in Gosforth and Newcastle. Residents are encouraged to share their views at monthly meetings. Residents say they have a choice of meals and that the chef will make alternatives such as a salad or omelette. The inspector inspected the kitchen, talked to the chef, looked at he menus and ate the same meal as the residents. The kitchen was clean, tidy and well organised. The chef was familiar with all of the residents’ likes and dislikes. He had information about the specific nutritional needs of some residents. The menus offered a choice of meal each mealtime including a healthy option. There were a lot of fresh vegetables in the kitchen and the chef makes everything himself. This includes cakes and puddings. The food was well presented and tasted very nice. The portions were varied according to residents’ requirements. The chef spent some time out of the kitchen chatting to residents. He obviously has a good rapport with them. Menus had been reviewed since the last inspection and were due to be reviewed again to reflect the changing seasons. There was a notice board in the dining area reminding residents what was on the menu that day. Dining tables were clean and attractively set. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints procedures are generally satisfactory but could be made more user friendly. Service users are generally well protected form abuse. EVIDENCE: The complaints procedure was examined. It is a standard procedure produced by Anchor. The procedure was very clear as to what the process would be if the complaint were handled away from the home. The instructions for initially complaining in the home were not clear. The language used was not appropriate for the client group. There have not been any complaints documented since the last inspection. The manager said that residents had been to see her with complaints that were easily resolved. The inspector advised that these should be recorded. A simple, clear, in-house procedure should be written and the manager must ensure that all residents know how to complain. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 15 Staff training files showed that all staff have been trained in Adult Protection. The manager has not yet had that training but is booked on a course. The manager did appear to be clear as to what to do in event of a protection issue but was unable to locate the telephone number needed to contact the adult protection team. The manager reported that there have not been any incidents requiring the intervention of the adult protection team. The adult protection procedure was located in a very large file with all of the other procedures for the home. The manager could not easily find it. The inspector advised that the procedure should include the local guidance and should be summarised for the manager and staff to access immediately. During the inspection, it was identified that one resident may be at risk of financial abuse. There was no risk assessment in the file or care plan to address the concern. It was thought that staff had been made aware of this risk via the communication book, but this is not sufficient. A risk assessment and action plan should be in place to ensure the resident’s interests are protected. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained. The home is clean, pleasant and hygienic. EVIDENCE: The inspector briefly walked around the premises. The laundry, kitchen, sluice, some bedrooms and most bathrooms and toilets were examined. The home was clean and tidy. There were no offensive odours. The home is decorated in a domestic style and bedrooms are nicely personalised. New carpets have been provided in some areas in the home. The remaining redecoration is due to be completed as part of an ongoing plan of refurbishment. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 17 The home is clean and tidy. Light pull cords are clean. Care assistants carry out laundry on a rota basis. The laundry area was clean and tidy. There are hand-washing facilities in the laundry and in all en-suites of bedrooms. The home does not have a sluice machine, however the manager reported that one is not needed as all of the current residents use a toilet. Waste bins in the home are hand operated. They should be replaced with foot-operated bins to prevent cross contamination. Staff have received training in infection control as part of health and safety training. There was not enough evidence of the content of this training and the nurse who used to act as the infection control link has left. Some creams were found in bathrooms that are not named. The domestic on duty was wearing gloves and has had training in COSHH (hazardous substances). Data sheets for chemicals used are available in the home. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet the needs of residents. Recruitment procedures ensure residents are in safe hands at all times. Staff are generally trained and competent to do their jobs. EVIDENCE: There are sufficient staff on duty. There are some vacancies at present but recruitment for these posts is in progress. Staff files were checked and these show evidence of references and criminal records checks. All staff go through an induction programme, which lasts six weeks. This links to a personal development meeting, which is a detailed review of performance, and involves a lengthy discussion resulting in an agreed action plan between manager and staff member. Records relating to staff training were examined. Certificates for training are kept on individuals files. There were overall training plans for Moving and Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 19 Handling which were very good and showed that all staff were up to date. There were records of training for health and safety, which included an infection control module. Certificates were available for Adult Protection training. There was insufficient evidence of any vocational training. There was no overall training plan showing how statutory and vocational training were planned or how staff development was to take place. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is currently going through the fit person process. The home is generally run in the best interests of residents. Resident’s financial interests are safeguarded. Staff are not always appropriately supervised. The health safety and welfare of service users are generally promoted and protected. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is currently going through the “Fit Person” process with CSCI to determine that she is competent to manage the care home. She is an experienced nurse qualified as an RMN (Registered Mental Nurse). The home is run in the best interests of residents who say they are happy with the care provided. Records relating to residents’ monies were examined. Money is held in one central non-interest account. Individual records are kept of each resident’s money. Some money is held in the home for residents to access. Records are clear and well ordered. Two signatures are obtained for every transaction. One of the signatures is usually the resident themselves. Money is independently audited. This has just taken place and was found to be mostly satisfactory. The manager has attempted to produce a plan for formal staff supervision. Some supervisions have taken place but not on a regular basis. One file examined did not hold any supervision record, another file held one. The inspector advised that these are now addressed as priority as many practice issues are currently addressed informally. The manager has delegated the health and safety checks and training to a nurse in the home. This person has been trained to deliver the health and safety training for staff. Good records were kept of the training and safety checks in the home. Fire safety tests and checks were up to date. Internal checks were carried out regularly and these were up to date. They included checks on hot water outlets, window restrictors, glass safety, nurse call bell and security. External checks, tests and certificates were also up to date. These included the gas safety certificate, five year electrical testing, testing of hoists and lifts, water chlorination and legionella checks. The testing of portable electrical appliances was due to be redone and this had been organised. Some risk assessments were up to date and had been reviewed. There were no unsecured hazardous substances in the home. Fire exits were clear. There were no obvious trip hazards. Data sheets were available for all chemicals used within the home. The inspector advised the manager that whilst health and safety did appear to be well managed in the home she should periodically carry out checks herself. This is because whilst the tasks can be delegated, the responsibility for health and safety remains with the manager. She agreed to do this. CSCI were advised of a serious accident to a resident a few days before the inspection. The manager described action she might take following the incident a few days before, and that this may include close supervision at regular intervals. This should have been started much more quickly after the event Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 22 and the manager confirmed that no amended risk assessment or action plan had been put in place. It was agreed that this would be done immediately. Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 23 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 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 24 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 Schedule 1 15 (2) 13 (2) 23 (2) (m) Schedule 1 13 (4) 13 (6) Requirement Include details of staff employed in the statement of purpose and provide a copy of the most recent inspection report. Care plans must be organised and all assessment information brought up to date. Medication procedures must be improved to prevent unexplained gaps in records. Lockable storage must be provided in bedrooms. The complaints procedure must be written in a form easily understood by all residents. All staff must be familiar with the adult protection procedures and location of local contact details. All risks identified must have an up to date detailed risk assessment and action plan. Foot operated bins must be provided. All creams used by residents must be named. Staff supervision must be carried out 6 times per year. DS0000000426.V319543.R01.S.doc Timescale for action 14/05/07 2. 3. 4. 5. 6. OP7 OP9 OP10 OP16 OP18 14/06/07 14/04/07 14/05/07 14/05/07 14/04/07 7. OP26 13 (3) 14/04/07 8. OP36 18 (2) 14/05/07 Milldene Nursing Home Version 5.2 Page 25 9. OP30 18 (1) a NVQ training plan must be put in place. 14/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Milldene Nursing Home DS0000000426.V319543.R01.S.doc Version 5.2 Page 27 - 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. 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