Inspection on 06/02/09 for Milldene Nursing Home

This inspection was carried out on 6th February 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 22/01/08

Milldene Nursing Home 14/02/07

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 19/06/2009.

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 Karena M. Reed Key Unannounced Inspection 6th February 2009 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 Milldene Nursing Home DS0000000426.V373959.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.V373959.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 213 1521 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.V373959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd January 2008 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. A Statement of Purpose and Service User Guide are available at the home to help people when selecting a home. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit: We looked at: · Information we have received since the last visit. · How the service dealt with any complaints & concerns since the last visit. · Any changes to how the home is run. · The provider’s view of how well they care for people. · The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on date 6/02/09. During the visit we: · Talked with people who use the service, relatives, staff, the manager & visitors. · Looked at information about the people who use the service & how well their needs are met, · Looked at other records which must be kept, · Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, · Looked around the building/parts of the building to make sure it was clean, safe & comfortable, · Checked what improvements had been made since the last visit. We told the person in charge what we found. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A regular system of reviewing the residents care plans has been introduced to ensure their care and support needs are met appropriately. All physical assessments in residents care plans are up- to-date. Lockable storage facilities have been provided for all residents. A system has been introduced to ensure staff supervisions are carried out regularly. The maintenance person’s hours are to be increased to ensure the home is properly maintained. A vacant bedroom has been decorated and new furniture purchased. There is a good level of staff training, carers pursuing National Vocational Qualifications at different levels. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Milldene Nursing Home DS0000000426.V373959.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 Milldene Nursing Home DS0000000426.V373959.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 1,3,4,5 were assessed. There are good arrangements in place to ensure that the home can meet the needs of residents. EVIDENCE: The Statement of Purpose and service user guide for the home were examined. They were interesting and informative and contained the necessary information as required by the Care Homes Regulations 2001. The Statement of Purpose and service user guide had been reviewed and updated. The information is available in other languages, formats such as and large print for people who may require this. Anchor homes also has a DVD for new residents to tell them about the Organization. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 10 Records for three residents showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. A copy of the external assessment and care plan for each person had been obtained before they moved into the home. The person living at the home and relevant people who knew them were involved in the initial assessment. The records contained a range of information. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender, culture, religion and spirituality, educational and social histories, preferred daily routine and preferences. It also looks at mood, speech, behaviour, mental health, risks, sexuality and living skills. This information and the care managers assessment of the residents care needs were used to ensure all the needs of the resident could be met by staff. Residents have the opportunity to visit the home as often as they need in order to decide if they want to live there. A resident may come for meals, have overnight stays and be introduced to other residents at the home at a pace suitable to the individual. Milldene Nursing Home DS0000000426.V373959.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 7,8,9 and 10 were assessed. There are good arrangements in place to ensure the health and social care needs of residents are met by staff. EVIDENCE: After a resident has moved to the home a care plan is designed around their assessed needs so that staff know how to provide the right amount of support. The sample of care plans examined outlined the needs of each resident and how these should be supported. Care plans are written in a respectful way that promotes the individuality and dignity of each resident. The sample showed that all care plans had been evaluated regularly. Records were in place to show how the medical and nutritional needs of residents were being met. Residents’ care plans recorded information about their social and leisure needs. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 12 A personal life history of each resident was not available on their files to give more information about their likes and dislikes and to give staff more understanding of their care and support needs and the life of the resident before they came into the home. Health care records were available on the files of residents to show that residents are supported to have access to health care services such as GPs, dentists, psychiatric services and district nurses. Risk assessments are in place for residents covering areas such as health care smoking, going out, continence and nutrition. Moving and handling assessments have also been carried out to show the moving and assisting needs of more dependent residents. Technical aids and equipment are available for residents who are unable to move independently. The home has a medication policy that is available for all staff to read. All staff administering medication have received training, this training is not accreditted. Care records, conversation with staff and observation showed the privacy and dignity of residents is respected. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12,13,14 and 15 were assessed. Overall, residents have opportunities to make choices about activities, daily routines so that they may lead a lifestyle that matches their social care needs. EVIDENCE: There is a welcoming atmosphere in the home. Staff take turns on a monthly basis to be responsible for organizing activities and outings for residents. Activities include: baking, arts and crafts, bingo, quizzes, massage, knitting, board games, WII Nintendo electronic game, karaoke, percussion instruments, exercise, cards, song and dance, movies, family visits and gardening. Residents are encouraged to pursue their own interests and hobbies supported by staff as necessary. Various seasonal and birthday parties are arranged within the home. Entertainers also visit the home. Church services take place within the home and ministers of different religions may visit when requested. Staff ask each resident about their wishes, interests and choices. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 14 Residents have the opportunity to visit the local community with relatives and staff. Residents enjoy trips to the coast, to the country and to the shopping centres. Staff support residents to keep in touch with relatives and friends. The homes menus were reviewed and new menus introduced in December 2008. Menus run on a four weekly basis and are changed seasonally. The cook attends residents meetings and receives comments about the food and the popularity of items on the menu. Residents are asked daily what they wish to eat from the menu selection. A menu displays the daily choices available. Cooked breakfast is available daily. Lunch on the day of inspection was leek and potato soup, selection of sandwiches or cheese omelette. People have access to snacks and drinks in between meals. Residents have nutritional risk assessments and special diets are catered for. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 16 and 18 were assessed. The home has a clear, complaints and protection system, to help protect residents. EVIDENCE: Information about how to make a complaint is provided in the Service Users Guide. There is a complaints procedure on display within the home. The home keeps a record of complaints. There has been one complaint received since the last inspection, this has been investigated and any necessary action taken. The home has a copy of the Local Authorities Vulnerable Adults procedures. This provides staff with clear guidance on how to deal with adult protection concerns. Staff receive training about Protection of Vulnerable adults. Milldene Nursing Home DS0000000426.V373959.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 19,20,23,24,25,26. The home provides a comfortable and safe environment for those living there. EVIDENCE: The home is accessible and placed in a residential area in South Gosforth. A maintenance person works at the home five hours per week, these hours are to be increased to ten hours per week from April. There is an ongoing programme of decoration and refurbishment around the home. Since the last inspection lockable facilities have been provided in all residents bedrooms, a bedroom has been decorated and new furniture purchased. The home has an appropriate amount of sitting, recreational and dining space. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 17 Furnishings and fittings were domestic in design. Room sizes meet the minimum required. Residents all enjoy their own bedrooms and they are personalized with some of their own belongings. There was emergency lighting around the home. The washing machines have the specified programme to meet disinfection standards. The home was comfortable and there was a good standard of hygiene apart from the carpet by the kitchen door was soiled and a wall and cabinet in bedroom 7 required cleaning. Milldene Nursing Home DS0000000426.V373959.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 27,28,29 and 30 were assessed. There are enough staff for the occupancy levels of the home, they are appropriately recruited and trained to meet the needs of the residents. EVIDENCE: Examination of staff rosters and discussion with the person in charge and members of the staff team showed that staff numbers are as follows 1 nurse and 2 carers 1 nurse and 2 carers 1 nurse and 1 carer 8 00am - 3 00pm 3 00pm- 10 00pm 10 00pm - 8 00am These numbers do not include the manager. Other members of staff are employed for duties such as food preparation and cleaning. Since the last inspection a part time post for a carer has been filled ,there is a vacancy for a part time RMN for day time working. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 19 A sample of staff records were examined and it was evident all the necessary checks are being carried prior to workers being appointed or starting work at the home. Two written references were available on staff files examined. An application form had been completed for each staff member. Employment histories were available. CRB checks are carried out before a person is appointed. Staff photographs were not available on staff files examined. There is a good level of staff training. There are seven carers, all are studying or have achieved National Vocational Qualifications at levels 2 and one has completed level 3. As the home provides nursing care for people with enduring mental health problems, specialist nurses with mental health qualifications are employed. Staff have received the necessary statutory training and developmental training is planned to ensure all staff are up to date with recent mental health legislation about mental capacity, some mental health awareness training is also planned. Training carried out includes health and safety, moving and handling, risk assessment, food hygiene, fire training, first aid, venapuncture, challenging behaviour, care planning, dying with dignity, dementia awareness, employment law, equality and diversity, diabetes, infection control and back care. Milldene Nursing Home DS0000000426.V373959.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 31,32,33,35,36,37,38 Residents live in a home that is well run and run in their interests and where the welfare of all is promoted. EVIDENCE: All of the previous requirements and recommendations have been addressed apart from the manager becoming registered for the day- to- day running of the home and the manager providing evidence of the regular audits of the health and safety systems and records. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 21 There is currently no registered manager in the home. Mary-Jane McKuur, who has yet to be approved as manager by the Commission for Social Care Inspection is running the home. The manager has the relevant qualifications for managing the home. The home is well run and there is an ethos of involving residents and staff in the running of the home. Residents are also involved in decision making in their daily living. Regular staff and resident meetings take place within the home. There was a very good standard of record keeping and documents detailing fire safety, financial records and other statutory records were all up to date apart from the fire log did not record an up to date fire check. Cascading staff supervisions take place, the manager is responsible for supervising the nurses, this is carried out monthly and the nurses carry out monthly supervisions of the carers. Lockable facilities are available for residents to keep their own money if they wish. When a resident does not keep control of their own money, the home is able to provide the facility to hold a small amount on behalf of the resident for everyday living. Individual records show the home has a suitable system for accounting for any monies on behalf of a resident. Staff training relating to health and safety was up to date. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 22 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 x 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 3 3 2 Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 24 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 OP31 Regulation 19(5) Requirement The manager must be registered with CSCI as a matter of urgency. This requirement remains outstanding. All fire checks must be carried out within the prescribed timescale. Staff photographs must be held on staff files. Timescale for action 30/05/09 1 OP38 23(4)(v) 10/03/09 2 OP38 Schedule 2 (1) 30/03/09 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 OP7 OP9 OP19 Good Practice Recommendations A life history should be completed for each resident to ensure staff are providing as individualized care as possible and to record residents likes and dislikes. Staff should receive accreditted medication training to ensure the health and safety of residents. Bedroom 7 walls and the hall carpet by the kitchen should be cleaned in the interests of health and safety and residents comfort. Milldene Nursing Home DS0000000426.V373959.R01.S.doc Version 5.2 Page 25 Care Quality Commission North Eastern Region Citygate Gallogate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 61 61 61 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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