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
Deborah Haugh Announced Inspection 10:00 22 February 2006
nd 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.V263240.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. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 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 allison.dewet@anchor.org.uk 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) Anchor Trust Mrs Allison Mercie De Wet Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th August 2005 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 comprises 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. The philosophy of care in the home is to support the residents in their activities of daily living and ensure their mental health treatment needs are being met. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place on 22/02/06 from 10.00 until 3.30pm. The Registered Manager, Allison De Wet was on duty during the visit. There were 13 service users at the time of the visit. Staffing levels were checked. Time was spent looking around the home to check the cleanliness, maintenance and decoration during the visit. Prior to the inspection questionnaires were provided to service users and visitors/relatives. All of the service users completed questionnaires and they also shared their views during the inspection. Time was also spent observing the contact between the service users and staff. 4 relative/friends and 3 professional visitors completed questionnaires. Three care plans were examined. Arrangements fire and health and safety, training, catering and recruitment were also examined. What the service does well:
All of the service users said they felt well cared for and liked the food. Comments from service users included; - ‘Lovely food here.’ - ‘You’ll find this is the cleanest place in Newcastle.’ - ‘I love all the staff.’ ‘Staff give you support, someone to talk to.’ - ‘Staff knock on the door before coming here.’ - ‘I can spend time on my own.’ - ‘I like to help.’ Visitor comments were very positive and included; - ‘ I am always made to feel welcome by the staff and residents. The staff are welcoming and professional.’ - ‘The environment and atmosphere is pleasant and homely.’ - ‘I believe the essence of care is very individually focused with emphasis on enabling and empowering resident choices, self esteem with good community recognition.’ All 7-questionnaire responses said that they felt welcome, could visit in private, kept informed, sufficient staffing, and satisfied with the overall care provided. The inspector shared lunch with the service users and it was relaxed and people were given a range of different choices. Some service users like to help set the table and clear the table after meals. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 6 Staff speak to service users respect and there is a good rapport between the cook and service users. The cook demonstrated his knowledge of dietary needs. Service users were complimentary about the meal and personally thanked the cook and staff. The Registered Manager provides clear leadership and support for staff. Staff are enthusiastic and positive about their roles. The Manager and her team are committed to improving the service provided to people. Staffing levels are appropriate to meet the needs of the service users. The recruitment of staff remains robust. What has improved since the last inspection? 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. Milldene Nursing Home DS0000000426.V263240.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 Milldene Nursing Home DS0000000426.V263240.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 (NMS 3 was assessed and met at the last inspection NMS 6 is not applicable) 1) Service users are able to decide if Milldene will meet their needs but the Statement of Purpose and Service User Guide is being updated. EVIDENCE: 1) Anchor is updating the new Statement of Purpose and Service User Guide and the Registered Manager has agreed to send copies to CSCI. Milldene Nursing Home DS0000000426.V263240.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 & 10 (NMS 9 was assessed and met at the last inspection) 7) Care plans are in place and staff have the information to meet service users needs but one area needs addressing. 8) The health needs of residents are met and multi disciplinary working is taking place. 10) Service users are treated with respect and feel that they are valued. EVIDENCE: 7 & 8) Three care plans were sampled and found to look at a range of service users needs. Service users needs are monitored and reviewed. Risk assessments are identified and action to reduce concerns identified. However one care plan must identify the action to be taken to reduce the risk of community vulnerability and medication compliance. Another needs to identify the social needs. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 10 There is evidence of professional involvement and reviews. 10) Service users commented that staff speak to them appropriately and by their preferred name. Staff were seen to consult with service users and knock on bedroom doors. Service users are able to be alone if they wish and this is respected by staff. Service users are able to have their own telephone (sockets are fitted in all bedrooms.) Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 11 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): 13-15 (NMS 12 was assessed and exceeded the standard at the last visit) 13) Service users are able to maintain relationships which are important to them. 14) Service users are supported to maintain control over their lives where able. 15) Service users receive varied and nutritious meals. EVIDENCE: 13) Service users are able to maintain friendships and relationships with people they care for. Visitors said that they felt welcome and can visit in private. 14) People are supported to be as independent as possible and make choices. Some service users have advocates. People are able to furnish their bedrooms as they wish. 15) The menus have been reviewed since the last inspection and the 4-week menu plan was forwarded to CSCI prior to the visit. All of the service users said that they enjoyed the food provided in the home. An audit of the menus was completed using Masters R (2002) Focus on Food. The Manager was provided with a copy of the audit tool.
Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 12 Service users are offered a nutritiously balanced menu consisting of at least 1 portion of starchy food per meal, 2 portions of fruit, protein, vegetables and dairy food per day. A nourishing snack at supper and a milky drink is offered. A cooked breakfast is available daily and it is recommended that this be recorded on the menu. All members of staff are to complete ‘Dining with Dignity’ training. Service users know the cook very well and spoke very highly of the food provided in the home. The cook has a good knowledge of dietary needs and fortifying food to increase nutritional value. Records are maintained in the kitchen. Service users said that they are trying to eat healthily and the menus reflect this choice. The lunch time meal was shared with service users and it was pleasant and relaxed. The cook ensures that people have enjoyed their meals. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 13 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): 18 (NMS 16 was assessed and met at the last inspection) 18) Residents will be better protected from abuse. EVIDENCE: 18) All staff are completing a 13-week POVA training course. Each week their learning is assessed and credited by the external trainer. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 14 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, 21 & 26 19, 21 & 26) Service users live in a home which is suitable for their needs. Improvements have been made to improve the quality of life for service users but some areas require addressing as a priority. EVIDENCE: 19, 21 & 26) A tour of the home was conducted with the Registered Manager. The home was found to be clean, well maintained and decorated. However the ground floor bathroom requires immediate redecoration and repairs. The shower tiles and grouting are cracked, dirty and worn. The cleanliness of the bathroom is compromised. Two shower chairs are extremely rusty and a potential hazard to service users and staff. A handrail is coming loose off the wall and also very rusty and a potential hazard. The gunmetal coloured radiator cover looks institutional and not homely. The roller blind is stained and could compromise cleanliness. The bath seal is dirty, gaps are visible and bacteria may grow. The tiles have old grouting smeared on them and are difficult to keep clean. The Manager has
Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 15 requested in the 2006 budget for this room to be decorated but this has been rejected by Anchor. However the bathroom must be brought up to the standard required. A new dedicated medicines room has been relocated to good effect. New dining and lounge chairs, tables have been ordered as well as a new television and DVD. In order to avoid and minimise infection the Manager has provided soap and paper towel dispensers in all en-suites. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 16 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, 29 & 30 (NMS 28 exceeded the standard at the last visit inspection) 27) Staffing numbers are appropriate to the assessed needs of the service users, size and layout and purpose of the home at all times. 29) Service users are protected by robust recruitment arrangements. 30) Service users are cared for by staff that are trained and competent but two areas must be addressed. EVIDENCE: 27) The home maintains the level of staffing in accordance with previous agreements and this reflects the size and layout of the building and the needs of the residents currently living in the home. Staff rotas were examined. The current levels of staffing are a minimum of 1 Registered Mental Nurse (RMN) and 2 care staff on duty during the waking day. At night there is 1 RMN and 1 care staff (waking night staff). 29) The records required for recruitment of staff were again examined for newly recruited staff. Criminal Records Bureau and POVA First checks are in place. Staff recruitment has been positive and only one 35 hour RMN post requires filling. The Manager uses a regular Agency nursing staff member to fill the current vacancy. Care assistant hours are complete. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 17 30) Training is in place for infection control and tissue viability (a lead nurse has attended the Infection Control Nurse course at Newcastle General Hospital.) Staff are to attend ‘Dining with Dignity’ training, this will include purred food preparation, feeding, creating atmospheres for good dining and supporting people who require feeding. The Registered Manager has requested Fire Safety training for all staff. Anchor is to train the trainers. Dementia training is to be provided in March 2006 but there are no plans for training in mental health disorders. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 18 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): 36 & 38 (NMS 33 was met, 31 & 35 exceeded the standard at the last visit) 36) Service users benefit from a staff team who are appropriately supervised. 38) Health and safety checks are monitored which protects service users but some areas require addressing. EVIDENCE: 36) Staff supervision is now taking place at the required intervals. Staff spoken with said they felt supported and could approach the manager at any time. 38) A risk assessment is in place for the manual handling of Clinical and Household Waste. This is located in the waste storage area for all staff to read. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 19 One of the bedrooms has a number of suitcases stored on top of the wardrobe. This may be a hazard to the service user and/or staff. A risk assessment must be completed. Maintenance and servicing is in place but an electrical wiring and Legionella certificate was not available for inspection and must be copied to CSCI. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 2 Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP38 Regulation 13(4) & 23(2) Requirement A risk assessment must be completed for LR bedroom where suitcases are on top of the wardrobe. An electrical wiring and Legionella certificate must be copied to CSCI 2 OP26OP21 OP19 23(2) Re-tile/decorate bathroom downstairs. Replace both rusty shower chairs and handrail. Reseal bath and re-tile around the bath. Replace stained blind. Action regarding the identified care plans must be in place to reduce risks of community vulnerability and medication compliance and social needs. Staff must receive training in mental health disorders. Staff must receive fire safety training. 31/03/06 Timescale for action 31/03/06 3 OP7 15 31/03/06 4 5 OP30 OP30 18(1) 23(4) 30/06/06 31/03/06 Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 22 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 3 Refer to Standard OP19 OP15 OP1 Good Practice Recommendations Repaint ground floor bathroom radiator to add to homely feel. Include a statement in menus that a cooked breakfast is available daily. Provide CSCI with an up to date copy of the Service User Guide and Statement of Purpose. Milldene Nursing Home DS0000000426.V263240.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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