Inspection on 13/08/07 for Millfield

This inspection was carried out on 13th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Millfield 23/07/08

Millfield 13/06/06

Millfield 21/10/05

Millfield 03/06/05

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Millfield 9 St Catherine`s Road Littlehampton West Sussex BN17 5HS Lead Inspector Tim Inkson Key Unannounced Inspection 13th August 2007 09:10 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 Millfield DS0000063418.V342830.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. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millfield Address 9 St Catherine`s Road Littlehampton West Sussex BN17 5HS 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) 01903 714992 Mrs Pauline Anne Shanahan Mrs Pauline Ann Shanahan Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 11 service users in the category old age (OP) not falling within any other category. 13th June 2006 Date of last inspection Brief Description of the Service: Millfield is an existing private care home registered to accommodate up to eleven service users in the category of Older People. It is a semi-detached Edwardian house located in the town of Littlehampton. The house overlooks a park and is a few minutes walk from the towns shops, public transport, local amenities and the sea front. The accommodation is provided on three main and two mezzanine floor levels with a lift providing access between the lower floor and the first main floor. The service is privately owned and managed by Mrs Pauline Shanahan. People that are interested in living in Millfield are provided with a copy of the home’s “Service Users Guide” that contains information about the facilities and service provided at the establishment. They are also invited to visit the home and spend some time meeting people and sampling a meal. A copy of a report of the most recent inspection of the home by the Commission for Social Care Inspection (“the Commission”) is readily available in the entrance hall to the home. At the time of this site visit the scale of charges for the home was £331 - £400 per week and this did not include the cost of chiropody, hairdressing and personal items such as toiletries, newspapers and confectionary. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 13th August 2007, starting at 09:10 and finishing at 16:25 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home and staff were spoken to in order to obtain their perceptions of the service that the home provided. Following the site visit some relatives and friends of people living in the home were contacted for their views about the quality of the service provided at Millfield. At the time of the inspection the home was accommodating 11 people. Of these 3 were male and 8 were female and their ages ranged from 69 to 96 years. No person was from a minority ethnic group. The home’s registered manager was available during the visit as she was able to provide assistance and information when required. Other matters that influenced this report included. An Annual Quality Assurance Assessment (AQAA) completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 13th June 2006 such as statutory notices about incidents/accidents that had occurred. What the service does well: The home obtained information about people who wished to move into the home before they did so in order to establish whether they could provide the help that they required. The home’s routines were informal, flexible and individuals were encouraged and supported to make choices for themselves and exercise personal autonomy. The home operated a key worker system and relationships between staff and people living there were relaxed. Staff also said that they had time to sit with people living in the home and encourage them to participate in activities or were available to take them out into the local community. The home also had an electric buggy available to enable people to access local amenities independently. All people living in the home were provided with single bedrooms promoting their right to privacy. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Millfield DS0000063418.V342830.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 Millfield DS0000063418.V342830.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The help that people needed who wished to move into the home was identified before they moved in to ensure that the level of support and care they required could be provided EVIDENCE: The home had written policies and procedures that included one about the admission of people wishing to live there. Details of the procedure were included in the /licence agreement /terms and conditions of residence issued to people ling in the home and it stated among other things: “A care plan or pre-admission assessment will be prepared and agreed with the resident and the resident’s previously nominated carer, relative or advocate before admission to ensure that the resident’s needs will be met in relation to the nature of care required. Where a detailed pre-admission care plan is not available, a care plan will be developed by the care team within the home in conjunction with the resident … “. A sample of the records of 4 individuals accommodated at the home was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. There was evidence from Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 9 the documents and discussion with people living in the home that admissions to the home were always carefully planned and the help that people needed was identified by staff with the appropriate knowledge and skills. Where the admission of a person to the home had been made through care management arrangement i.e. with the support of the adults services department of a local authority. The home had obtained copies of the assessments of the needs of the individual concerned completed by officers of the authority. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. Comments from people spoken to about the process of assessing the needs of people moving into the home included the following: • “ … My doctor recommended two homes. I came here one Saturday to look at he place and was shown around and so on … as far as I am concerned I shall end my days here if I am not chucked out …” (person living in the home). The home does not provide intermediate care. Millfield DS0000063418.V342830.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. Records kept about the personal care needs of people had insufficient detail including; the action staff needed to take to provide the help they needed as well as promote their dignity, privacy and right to exercise choice. This compromises the care and support being provided and could result in the needs of some people being overlooked. The healthcare needs of people living in the home were promoted. The management of the medication of people was living in the home was safe and effective and also where appropriate promoted individuals’ independence. Staff working practice helped to ensure that residents’ privacy and dignity was promoted EVIDENCE: Care plans were examined of the same sample of 4 people living in the home as in the section above (“Choice of Home”). In each case there was basic information about most of the help, assistance and support that that the individual needed. There was not always a plan corresponding to the areas of help that a person might need that were identified as part of the process of assessment e.g. if the need for chiropody was identified at the stage of assessment before someone Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 11 moved into the home there was not always a corresponding plan of care to say how the persons foot care would be provided. The plans did not describe in detail how the help people needed would be provided but were very general e.g. “needs complete support with washing and dressing”. They also did not always indicate how choice and dignity for the person concerned would be promoted. There was little detail the care plans examined setting out how the social and leisure needs of people concerned would be met. The need to include more detail in the plans including reference as to how the fundamental principles that are essential in the provision of good care would be promoted was discussed with the home’s registered manager. There was no care plan in place for one individual who had resided there for over a year because a member of staff was intending to prepare one with him as part of her work towards obtaining a National Vocational Qualification (NVQ) in Care. Where care plans referred to the use of equipment this was observed to be available or, provided e.g. Zimmer frame. Assessments that the home carried out after a person had moved into the home included general risks and some specific risks, such as moving and handling and the danger of falls. There was evidence from documentation and discussion with people living in the home that some individuals and/or their representatives had been involved in developing their plans and agreed with their contents. Records indicated that care plans were reviewed at least every 2 months and daily notes referred to the actions taken by staff to provide the needs set out in those plans. The home had a relatively stable and small staff group. All members of staff team spoken to were familiar with the specific needs of the individuals whose records were sampled. One member of staff with experience of working in a very large care home said, “ … this is a small home and there are not many residents and so we get to know them very well. If someone is not well we know straight away because we know them so well … “. Comments from people living in the home about the help and care they received including that from healthcare professionals and the abilities and competence of the home’s staff included the following: • “I had an angina attack and they called the doctor … The chiropodist comes every few weeks and he comes to my room … the girls are not too bad, the night staff are very good. If you ask them to do anything they will …”. • “I have been to the hospital because I was losing blood. The doctor I see here used to be my old doctor … I have been ill 3 times since I have been here and they have made sure that I was looked after …”. • “The staff are very good we have some good banter … there is a night nurse and I have used the alarm and she came very quickly … “. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 12 • • • “I get some help with washing my back … the girls are mainly alright but some of the people here would try anyone’s patience … I have had my eyes tested here ... I see the chiropodist about every 6 weeks … “. “I get on fine with the staff, I have no fault with them, they are polite…. I have to have my leg lifted in and out of the bath, I feel quite safe when they help me …”. “ … I have had a couple of turns with my breathing and I have had excellent attention …”. Comments from relatives and friends of people living in the home that were spoken to about the care that the home provided included the following: • “It is alright it does its job …”. • “I think that they care about the residents …”. • “We are perfectly happy …” • “The care is very good … she gets looked after and she likes the staff”. Documents examined indicated that individuals weight was recorded regularly, a range of healthcare professionals visited the home and also that arrangements were made for treatment for people when it was necessary. People living in the home said that they saw and received treatment from among others, doctors, podiatrists and opticians. When specialist equipment (pressure reliving aids; continence products) was required the registered manager said that these were provided through the community nursing service. The home had written policies and procedures concerned with the management and administration of medication. They were part of an “off the shelf” collection and did not accurately reflect the actual practice carried out in the home e.g. they referred to the use of a specific refrigerator for storing only medication and the promotion of self-medication. Medication requiring refrigeration was kept in the refrigerator in the home’s kitchen and there was no evidence that the home promoted self-medication apart from one individual who needed inhalers to be readily available. There was some discussion with the home’s registered manager about promoting individuals’ rights concerning medication and the need for accurate procedures. The home used a monitored dosage system for managing medication. A local pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. There was evidence from discussion with the home’s registered manager and the 3 staff on duty at the time of the visit that all staff had received training in the management and administration of medication. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 13 Medicines were stored securely in a locked cupboard and controlled drugs were locked in another metal cupboard that complied with the expectations of the Misuse of Drugs (Safe Custody) Regulations 1973. The dispensing of medication was observed during the site visit and the practice of the staff involved was appropriate. During the site/fieldwork visit staff were observed treating the people living in the home with respect and sensitivity. Individuals spoken with said that staff were polite and promoted their privacy. All people living in the home were accommodated in single rooms, which was another factor that helped maintain these important aspects of life in the home. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and generally according to the choices and preferences of those living in the home. However the quality of meals varied and the safety of people living in the home was compromised because not all staff preparing meals had received necessary food hygiene training. EVIDENCE: Plans of care that were examined (see section above, “Health and Personal Care”) included some details of the social and leisure interests and life style/personal preferences of the individuals concerned. The home organised a variety of social activities for people living in the home and had a programme of these on display but they did not always take place as planned. The home’s registered manager said, “… We bought a buggy for the use of residents and 2 of them like to go out into town and use it … it can be difficult to get everyone motivated … we take people out to the shops or the seafront … Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 15 not all of them necessarily want to sit and paint a picture but we offer it as someone may want to do it that day. We don’t specify a time and so if someone wants to sit and play cards in the morning we will do that”. It was apparent from discussions with people living in the home and staff that some individuals chose not to join in organised activities or mix or socialise with others and some individuals had developed important friendships. People’s individual decisions were respected by the home. Comments from people spoken to including those living in the home and staff about activities organised by the home and individuals’ lifestyle preferences included the following: • “They have a buggy and they keep it charged and I go to town in that … I have got involved with X and we are very close … a lady comes once a fortnight and brings a guitar an sings, but it is not my cup of tea … there are no rules, I get up and go to bed when I want, I go to bed at about 10:30 p.m. … I would rather not look after my medicines so they do that for me …” • “We occasionally have activities here, a women with a guitar comes and sings and we have a game of bingo … I go to bed about 10:00 p.m. and get up at 6:00 a.m. but it is my choice … “. • “I watch television … I go out with my sister … a girl comes with a guitar but it is not my thing, I have my country and western CD … “ • “I knit, read, I am crossword mad and as long as I have a pen and paper I am alright ... I go for a short walk everyday … they have things organised but I don’t join in …”. The home operated a key worker system the success of which was reflected in the informal relationships that had developed between people living in the home and the staff (see also section about “Complaints and Protection” below). Staff spoken to were aware of the particular interests of individuals. One member of staff spoken to who had experience of working in a much larger care home clearly appreciated the fact that there was more time available to spend with people in the home. • “Here it is smaller and we have more time to spend with residents doing activities … we go to the beach take them shopping down the town, X loves animals so we take her to the farm …”. There was evidence from discussion with people living in the home and staff that clergy visited individuals in the home regularly and the manager said that she had on occasions arranged for nuns to visit the home in order to provide communion. The home had a visitors’ policy that encouraged visitors to call at any reasonable time. People spoken to were aware of the policy and said that they could receive visitors whenever they wanted to and that their visitors were made to feel welcome within the home. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 16 There was information in the home’s Service Users Guide that it provided to people wishing to move into the home and those accommodated there, about local organisations that could provide impartial advice, information, guidance and advocacy services. At the time of the site visit no person living in the home was managing their own financial affairs. The responsibility had been delegated to either relatives or representatives. Individuals were able to bring small items into the home with them and it was apparent from observation during a tour of the building that many individuals had taken trouble to personalise their bedroom accommodation. Sensitive information that the home held about people living there was kept securely and the home had written policies and procedures about maintaining confidentiality and the right of individuals to access their personal files and case notes. People spoken to about the food that the home provided indicated that the quality varied depending on who was responsible for preparing and cooking meals. Comments about this included: • “ …The food is good once a fortnight when Pauline cooks it, X is also a good cook …”. • “ … The food has its moments, it depends on who is doing it …”. • “ … The food is not bad and there is enough …”. • “ … It is not bad …”. • “ … You have something different everyday, today it was salad and cold meat … I usually clear my plate …”. People spoken to confirmed that they were provided with 3 meals a day and that there were snacks and drinks available between meals. No one spoken to was aware that they could have a snack if they wished after the last meal in the evening had been provided at 5:00 p.m. The home’s registered manager said that people could have cheese and biscuits or a sandwich and the night staff could prepare snacks for them. The home had a 4 - week repeating menu. It was apparent form the menu that that there was a range and variety of meals provided. It did however also indicate that there was no choice about the main meal of the day. The manager said, “We know what people like, I go round and ask people what their favourites are and it is incorporate into the menu … one meal is prepared for everyone and if they don’t like it they can have whatever they want instead as there is always plenty in the cupboard, but if it is not there I will always go and get it. We ask what they particularly don’t like. Y does not like mushrooms or bananas so we make sure that she does not get them …”. The home was implementing a system of providing details about the menu for people living in the home in large print and on laminated cards. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 17 At the time of the site visit no person living in the home had special dietary needs. A number of staff said that they were undertaking a course in nutrition. This should give them a better understanding of the specific needs of older people, what constitutes a good diet and how it should be prepared. From discussion with staff on duty at the time of the site visit it was apparent that some of those involved in food preparation and handling had not done any basic food hygiene training. It is suggested that the home attempt to obtain some consistency with the quality of the meals prepared in the home and make people living in the home more aware of their ability to have snacks in the evening if they so wish. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to address the concerns of people living in the home and to protect them from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. A copy was also included in the home’s Service Users Guide that was provided to people interested in living in the home and also top those accommodated there. Discussion during the site visit indicated that people living in the home were confident about raising concerns with the registered manager, other members of staff or their relatives. • “ … I would take any petty grievances I had to J my carer …”. • “… I would speak to Pauline if I had a complaint and she would sort it out, if I kept on about it (laughing) …”. • “ … I would talk to my sons but I would also be happy to talk to Pauline …”. The home had a system in place for recording any complaints but there had been none made to the home since the last inspection of the establishment on 13th June 2006. “The Commission” had received no complaints about the home during the same period. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 19 The home had written procedures available concerned with safeguarding vulnerable adults including a copy of the most recent safeguarding vulnerable adults procedures of the local authority. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Staff spoken who were on duty during the site visit were able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The registered manager said that training in safeguarding vulnerable adults had been arranged for a number of staff in September 2007. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 20 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, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable and it was being improved and maintained. Infection control practices in the home compromised the safety of people living and working there. EVIDENCE: It was apparent from discussion with the home’s registered manager, people living in the home and their relatives and friends, that since ownership of the home had changed in 2005 that the building had almost been completely refurbished. There were still some areas of the premises that remained to be done i.e. a bathroom and at least one bedroom. The scale, nature and result of the work was reflected in some comments from relatives about the cleanliness of the building. • “ … I would sometimes think that the staircase was filthy … the building has improved she has decorated throughout and put in a new kitchen …”. • “ … The standard of cleanliness is low you could sometimes write your name in the dust on Mum’s dresser …”. • “ … His room had just been “done out” before he moved in … “ Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 21 Most of the people living in the home that were spoken to were content with the way that the cleanliness of the home was maintained. • “ … They keep it clean, they come and vacuum my room in the morning … te place has really improved since she took over, they have rebuilt downstairs and they did my room right out …”. • “… It is clean, they hoover it every day …”. At the time of the site visit some improvement work was being carried out that involved converting one the home’s 2 bathrooms into a level access shower. A new sluice was also being constructed. It was also apparent that some emergency plumbing was also being completed as the installation of replacement hot water cylinder was also being carried out. The home’s manager said that apart from the planned and on going refurbishment of the premises repairs and replacements were carried out as needed and she was intending to improve the enclosed garden area at the rear of the building by installing a summer house and water feature. The communal areas of the home comprised a bright and airy lounge on the ground floor and a separate dining room on the lower ground floor of the building. The latter had attractive wood strip flooring and matching dining tables and chairs. It was a “thoroughfare” and so it attracted people who wished to take advantage of the activity and several met there to converse and watch the daily “goings on”. One person was seen “happily” reading a paper and talking with staff and other people for most of the day. Frames and raised toilet seats had been installed in WCs to provide assistance for people and the bathroom in use at the time of the site visit had a height adjustable seat in it. Only one bedroom door had been fitted with a lock enabling the individual accommodated to prevent other people entering her “private space” uninvited. The registered manager said that she was intending to install locks on all bedroom doors. She also said that she intending to install a fixture on bedroom doors to enable them to remain open and be released to close automatically if the home’s fire alarm was activated. This would enable people who preferred to stay in their rooms to do so with their door open, to do so, without wedging them open, a practice that compromises the integrity of the home’s fire safety system. The home had a written infection control policy and procedures in place and the ready availability of protective clothing for staff was noted. Access to the home’s laundry facilities that were located in the basement was through the dining room. The importance of ensuring soiled items were managed properly to eliminate the risk of infection was stressed and the manager said that she would implement a system of using dissolvable bags for conveying such material. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 22 The staff toilet facilities were not provided with liquid soap and paper towels were not available initially when it was first seen. The use of such items is recognised as best practice in order to promote good infection control. The report of the local environmental health officer of a visit to the home on 27th November 2006 stated that it was a “very clean premises”. At the time of the site visit the home was clean and free from offensive odours. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 23 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. The home’s level and mix of staff on duty ensured that the basic needs of people living there were met. Lack of training for all staff in some essential subjects and inadequate recruitment practice compromised the heath, safety and welfare of people living and working in the home. EVIDENCE: The staff team working in the home comprised, 10 staff, including the registered manager. Unfortunately at the time of the inspection access could not be obtained to staff records because the only key to a filing cabinet in which they were secured had broken and the home was awaiting delivery of a new one. The home’s registered manager did however confirm the details that she had included in the AQAA dataset about the number of staff working in the home that had a formal and appropriate qualification that indicated that they had the competence to meet the needs of people living in the home. One had a National Vocational Qualification (NVQ) at level 2 in care and another had had a BTEC introductory diploma in Health and Social Care and was working towards an NVQ level 3. The remaining seven staff i.e. 78 , had no relevant qualification, but she said that 2 were working towards NVQ level 2. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 24 The minimum deployment of staff at any time in the home was as follows: 08:00 to 14:00 2 14:00 to 20:00 2 20:00 to 08:00 1 wakeful and 1 sleeping The registered manager also said that all staff working in the home apart from 2 individuals recently recruited had completed training in medication through a college and all were completing a course in nutrition. She said that some training was arranged through the local care homes consortium and that 3 staff were attending a course in safeguarding vulnerable adults in September 2007 i.e. the following month. Staff working in the home carried out cleaning and cooking duties as well as helping people living in the home with their personal care needs. Discussion with people living in the home and staff indicated that their were no concerns about the adequacy of staffing levels. Discussion with staff on duty at the time of the inspection confirmed what the manager had said about training and indicated that staff had opportunities to acquire the knowledge and skills that they required. Also that some individuals had not received training in some essential subjects concerned with health, safety and welfare. • “I have done fire safety we do that twice a year ... I have a certificate for medication training … I have not done moving and handling but I am doing that this month … I am on a nutrition course … and I am doing a course about abuse next month … I am covering rights and choice and so on with my NVQ course … we have to read all the policies and procedures and then sign to say we have read them, they are available for us to read …”. “ … They came here and trained us all in medication … we are doing nutrition … I have not done basic food hygiene … I am involved in preparing food … I have not done moving and handling and there are several people her who need help to mobilise … “. “ … I am doing NVQ at the moment ... I am doing nutrition ... we have fire training every 6 months or so … I have not done moving and handling … I am doing abuse in September … I have not done food hygiene … I was preparing lunch today … I have done training in medication and have a certificate … before I started I had to have a CRB (Criminal Records Bureau) …”. • • It was suggested that as the home was accommodating some people who had developed dementia, that training should include “dementia care” to ensure that staff had a better understanding of the special needs of those individuals. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 25 Two staff had started work in the home since the last inspection of the service on 13th June 2006. Although the records were not available the registered manager openly stated that one individual had started work in the home without all the statutorily required checks having been completed. She said that the individual had worked in another setting where a Criminal Records Bureau enhanced certificate had been required and it had been obtained for that workplace only some 4 weeks before she started work at Millfield. It was stressed that such certificates however recent were not transferable between different places of work. Consequently a requirement was made that in future people must not be allowed to work in the home until all the necessary checks into their suitability to work with vulnerable adults have been completed. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 26 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): 30, 33, 35, and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home was weak in some areas and consequently the welfare of people living and working in the home was compromised. There was no formal method being used in the home to demonstrate that people living there were able to influence the quality of the service that they received. EVIDENCE: The registered manager had been responsible for the day-to-day operation of the establishment for approximately 2 and half years. She owned another care home in the same area for which she had been responsible for some 20 years and she had a City and Guilds qualification in management and was working towards completing and NVQ level 4 in care. From discussion with the staff, people living in the home and their relatives and friends it was apparent that she was perceived as knowledgeable and fair and was well generally well thought of and popular. Observation during the site Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 27 visit indicated that she had a good relationship with most people living in the home and was open about her shortcomings e.g. staff recruitment. It was also apparent from discussion and observation that a lot of work, energy and expense had gone into improving the condition of the premises and its facilities for the benefit of people living there. Comments about the manager’ approach to running the home and her personal qualities included the following: • “We are lucky to have her she is easy going and very fair, if there is a problem you can go to her and talk to her and it will be sorted … she knows what she is talking about …” (member of staff). • “Pauline is alright you can get away with almost anything with her, she is great … “ (person living in the home). • “ … She is a good cook … she cares an awful lot about her patients … “ (person living in the home). • “ … she is brilliant, she works really hard …”(member of staff). • “ … Pauline is very good, very fair, helpful … she is probably a bit set in her ways … ” (member of staff). Despite the positive views about the manager expressed above from the evidence set out elsewhere in this report it is apparent that the home’s management is weak in a few areas i.e. • Care plans • Infection control practice • Staff recruitment procedures • Basic health and safety training for staff • Quality monitoring (see below) At the last inspection of the home on 13th June 2006 it was reported that the home had a system for monitoring the quality of the service that it provided. There was no evidence on this occasion that this had been done. The system included the use of audits to assess whether management information and other systems and practices in the home were working effectively but none had been done. It also included the use of questionnaires to obtain the views of people with an interest in the service the home provided but they had not been used. In the AQAA document provided by the registered manager before the site visit took place she stated: • “We do not hold formal meetings with our residents. The residents can at any time speak to us on an informal basis. If left to designated meetings, residents would either forget the issues they wish to raise or worry themselves over the issues. Informally they speak as they wish and be assured that any issues are dealt with immediately”. The manager reiterated this view during the site visit and said, “They know they can talk to me when they want about what they want”. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 28 The informal approach to quality monitoring does not satisfy the legal obligation imposed on registered persons by Regulation 24 of the Care Homes regulations 2001, to “ … establish and maintain a system for evaluating the quality of the service …”. This system must be based upon among other things, taking into account “ … the views of service users and their representatives …”. The manager was made aware that a requirement would be made to implement a system that takes into account the views of people living in the home. The home had a range of written policies and procedures that informed practice. They were an “off the shelf” package and the manager was advised of the value of having policies and procedures that did not actually accord with the home’s working practices. Among the policies was one that referred to the promotion of equal opportunities and diversity. The home looked after small sums of money for one resident that was provided regularly for purchasing services and personal items for that individual. A record was kept of incomings and outgoings. There was evidence that the person providing that money for the individual concerned checked the record for accuracy. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift; fire safety equipment; etc. The home’s registered manager said that she intended to install thermostatic mixer valves for all wash hand basins to improve safety. There were a range of risk assessments in place concerned with the premises and working practices including a fire risk assessment. Hazardous chemicals were kept locked up and there were product data sheets available with information about each substance used in the home. Staff confirmed that they received regular fire safety training but also indicated that there was some essential heath and safety training that not all of them had received i.e. basic food hygiene and moving and handling. As a consequence a requirement was made that all staff working in the home be provided with the necessary training in order to promote their safety as well as that of the people living there. Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement All persons living in the home must have plans of care prepared and in place that set out in detail the action staff must take to meet their assessed needs. The homes written procedures that inform staff practice about the management and administration of medicines must be amended to accurately reflect the actual practice in the home. No person is to work in the home until all the statutorily required checks have been completed to ensure that the individual is suitable to work with vulnerable adults. Safe systems must be implemented to prevent cross contamination and infection from dirty hands and also laundry items. All staff responsible for preparing food must be provided with suitable training to ensure that it is done so in accordance with food hygiene regulations. All staff who assist people living DS0000063418.V342830.R01.S.doc Timescale for action 30/11/07 2 OP9 13(2) 30/11/07 3 OP29 19(1) 13/08/07 4 OP38 OP26 13 30/11/07 5 OP38 13(3) and 18 30/11/07 6 Millfield OP38 13(5) and 30/11/07 Page 31 Version 5.2 18 in the home must be provided with suitable training to enable them to carry out such task without endangering themselves and /or the persons concerned. 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 Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Millfield DS0000063418.V342830.R01.S.doc Version 5.2 Page 33 - 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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