Inspection on 22/05/07 for Millfield

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 15/03/06

Millfield 01/08/05

Millfield 22/03/05

Millfield 21/09/04

Millfield 24/03/04

Millfield 20/10/03

Millfield 31/07/02

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

CARE HOMES FOR OLDER PEOPLE Millfield Huddersfield Road Waterhead Oldham OL4 3NN Lead Inspector Jenny Andrew Unannounced Inspection 22nd May 2007 08:30 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 DS0000005511.V333079.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 DS0000005511.V333079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millfield Address Huddersfield Road Waterhead Oldham OL4 3NN 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) 01616203477 01617850714 lorraine.young@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Mrs Lorraine Young Care Home 37 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (20), of places Sensory Impairment over 65 years of age (8) Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 20 OP up to 9 DE (E) and up to 8 SI (E). Date of last inspection 15th March 2006 Brief Description of the Service: Millfield is a purpose built care home, which is owned by the Anchor Trust. It is located in the Waterhead area of Oldham, and situated on a direct bus route. Accommodation is provided in 37 single bedrooms, all of which have en-suite toilet facilities; one room also has an en-suite shower. Lounges and dining areas are spacious and provide venues for entertainment and recreational activities to take place. The conservatory provides a good view of the garden and surrounding areas and has access to the outside safe enclosed patio area. At the time of this inspection, for those people presently living at the home, the weekly fees ranged from £338 to £398, the higher rate being for those people who were paying privately. However, Anchor had recently reviewed their prices and for anyone now funded by the Local Authority, a £60 top-up fee would be payable by the resident or their relative which would mean all residents were paying the same price. Additional charges are made for private chiropody, hairdressing, newspapers, toiletries and transport. The providers make information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed in the reception area of the home. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection, which included a visit to the home, took place unannounced. This meant the manager was not informed we were coming. The visit lasted a full day with the inspector arriving at 08:30 and leaving at 16:45. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly (care plans) and other records the home needed to keep to make sure the home was safe for those living there. The inspection was conducted with the deputy manager and one of the team leaders, due to the manager being absent due to sickness. In order to obtain as much information as possible about how well the home looked after the residents, the deputy manager, team leader, acting team leader/carer, activity worker, eight residents, five relatives, the housekeeper and cook were spoken with. Comment cards were sent out before the inspection to relatives and residents and of these, two resident and four relative/visitor questionnaires were returned. Their comments, together with information that had been received about the service over the last few months, has also been used as evidence in the report. What the service does well: The residents spoken to felt they were well cared for and that one of the managers or a senior was always there to speak to if they had any problems. Comments made included, “the staff are excellent”, “if you need the staff you only need to buzz and they’re there straight away”, “the carers are always very happy to do anything for you”, “they do their best for you”, “I have my favourites but they’re all pretty good” and “they let me do what I can and help me do things I struggle with”. Relatives/visitors’ feedback about the staff was also good, with comments being made such as “the staff meet the physical needs of my mother and also try to meet her emotional and mental needs”, “the staff have a lot of patience and do their jobs well”, “they all have a nice attitude” “the staff are always pleasant”, “managers and staff are obliging in every way”, “staff have a brilliant attitude with the residents” and, “the staff are lovely and I could live here myself”. The home was good at making sure residents’ health was well taken care of by sending for district nurses and other health care workers whenever they felt they were needed. Residents said they felt safe and well cared for. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 6 The home was exceptionally well maintained, with improvements continually being made to the facilities for the residents. There were no unpleasant smells anywhere in the building and it was spotlessly clean. Residents and relatives spoken to all commented upon how clean the home was kept. They said “it’s kept absolutely spotless”, “its always clean no matter what time you visit”, “the home is always maintained to a high standard of cleanliness” and, “the domestic staff do an excellent job”. The management team took any complaints about the service seriously and did thorough investigations to make sure that the complaint was properly dealt with. They also made sure the staff received training in what to do if they thought a resident may be at risk of abuse. Opportunities for staff to do training courses were good and all new staff did training in how to do their jobs safely. More than half of the staff team had completed recognised training courses known as NVQ training. This meant that the residents were cared for by staff who knew how to meet their needs. The home was good at checking out the quality of care given to the residents. To do this, they asked residents, relatives and other visitors to the home about their opinions and took steps to put what they said into practice. What has improved since the last inspection? What they could do better: Whilst there was a good mix of trained and experienced staff, at times of the day when residents needed more help and support, such as mornings, there were not always enough staff on the floor to make sure their needs were being met, at the times they wanted. The manager needed to review the way staff worked and consider making more of the team leaders time available for them to work on the floor, or provide additional care staff. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 7 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 DS0000005511.V333079.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 Millfield DS0000005511.V333079.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Standard 6 was not assessed, as the home does not provide intermediate care. The admission process was thorough with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. EVIDENCE: Three files were checked, for people who had recently moved into the home. Each contained an assessment of need that had been completed before admission. When residents were assisted with their funding by the Social Services Department, a care manager assessment was also received. The deputy manager said she would visit potential residents in their own homes or hospital and that it would be usual for the relatives to also be present. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 10 Following the assessment, if the resident had not already visited the home, then they would be invited to do so with their relative if this was what they wanted. The deputy manager said this enabled her to gain further insight into the individual’s needs and that often they would stay for a meal and meet other residents and the staff. Two relatives and a resident who were spoken to said they had been involved in the assessment process. The relatives said the reason they had chosen the home was because of the extremely high standards of cleanliness and decor and the fact that all the rooms had en-suite toilets. The housekeeper was spoken to during the visit. Besides overseeing the domestic side of the home, she was also the hospitality manager and responsible for showing residents and their families around the home. At the time of the visit, she was making sure the information, given to new or prospective residents, was up to date. The home was registered to provide care for up to nine people with dementia and eight with sensory impairment and appropriate staff training was provided. From checking the training records, it was identified that the majority of the staff had recently received dementia care training. Staff spoken to confirmed this had been an in-depth full day course from which they had learnt a lot and would count towards any future NVQ training they may do. Staff who had not been able to attend this course were booked on another course in June 2007. The team leader said they accessed information about sensory impairment from the Internet. In addition, an optician visited, usually on an annual basis, to do awareness raising sessions about different eye conditions. According to the records, he was booked to visit the home again on 20 June 2007. Millfield DS0000005511.V333079.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care needs of the residents were being well met by staff who received the right training in how to meet their needs. EVIDENCE: Three individual care plan files were inspected, two for residents who had been recently admitted. The care plans were in the form of “Individual Lifestyle Agreements” which is an Anchor Housing corporate format. The agreements were drawn up in full consultation with the resident and/or their relative to which signatures were obtained. The agreement was then reviewed each month and updates were on all the files that were checked. One of the files for a recently admitted resident contained hand written draft notes which the key worker had compiled. The team leader said that this would form the basis for the lifestyle agreement, which was due to be done with the resident on the day of the visit. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 12 In addition to monthly reviews, the deputy manager also had a system in place for six monthly reviews, which included the resident and/or their relative. A board was seen where different colours highlighted when reviews had taken place and when the next one was due. Whilst the information in the three files contained all the necessary information, there were so many different documents that it was difficult to get an overview of the person’s needs. Anchor was in the process of introducing a new care planning format for their residential homes. The new format was seen and it was user friendly and had sub-divisions so that each section was clearly identified. On the morning of the visit, the deputy manager was at a training course where the new care plans were being introduced, as was one of the acting team leaders. Personal care records relating to bathing and weight were in place and all were up to date. Residents spoken to all said they received sufficient baths, although they did say it was usual to have a bath in the evening, as this was the time when staff were not as busy. Whilst those spoken to did not have a problem with evening baths, residents should be able to have a bath at any time of the day/evening and when the new care plans are being written, key workers should determine preferences from their residents. All the residents spoken to felt their health care needs were being well met, as did the relatives who were spoken to. Feedback from relative comment cards confirmed the home was good at keeping them up to date with important issues, such as accidents, admission to hospital or illness of their relatives. In respect of the question “Does the home give the support to the person you visit that you expect”, three responded with “usually” and one “sometimes”. The visitors spoken to all felt the support needs of their relatives were being well met. The cultural needs of the residents were being met. The majority of people living at the home were white British but there were two people who were not. The deputy manager said these people were able to speak English fluently but that she had done some research into their culture and arranged an evening where the Chef cooked different foods from their country of origin. She said that whilst they had enjoyed the food, they had indicated they wanted to continue to eat the same meals as the other residents. Food/fluid/turn/stand charts were put into place for residents who were being cared for in bed or for those assessed at risk and these were seen for one of the residents. Staff were also vigilant with regard to ensuring that residents received sufficient to drink. Those people who preferred to stay in their rooms were given jugs of juice. At meal times, residents were asked if they wanted more to drink. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 13 Residents had regular access to chiropodists, opticians and district nurses. Referrals through GP’s were made where staff identified problems in other areas such as dietician, consultant, etc. Visits by health care professionals were recorded on the individual resident’s care plan. The residents spoken with said the home would always send for their doctor if they were feeling unwell. Nutritional profiles were completed for each resident, which identified any special dietary needs and preferences and their weight. Records showed that weight was done as part of the admission procedure or very shortly after. Where residents were assessed as at risk due to weight loss, their weight was monitored weekly. Where no concerns were raised, then monthly weight recordings were done. Advice from the GP or dieticians was sought as necessary and those people assessed at high risk were usually prescribed high protein drinks. These were recorded on the person’s medication administration record (MAR). Risk assessments were in place in relation to moving/handling, skin, nutrition and falls. Where other risks had been identified, assessments were in place, for example, self-medication. It was noted that when pressure mats were in use, a risk assessment had not been done. The deputy manager said she would ensure these were written. Whilst risk assessments were said to be reviewed, as and when people’s needs changed, there was no evidence of this on the files seen. Risk assessments should be reviewed and updated at least on a six monthly basis, more often as needed. Where it was identified there was high risk, action plans had been formulated showing how the risk was to be managed in order to lessen it. The arrangements in place in respect of receipt, recording, storage, handling and administration of medication were satisfactory and had been for the last two inspections. The medicine records that were selected for inspection were in order. The Boots monitored dosage system was in place and there were two trolleys in use, one for each floor. As part of the admission process, residents were asked about holding their own medication. If they wanted to do so, a risk assessment was done identifying any risk areas and the action which would be taken to address the risk. One resident only was holding her cream and a risk assessment was in place. The deputy manager or one of the team leaders were responsible for giving out medication. Due to staff having left, two carers were acting up as team leaders. One acting team leader was on duty at the time of the inspection and was responsible for giving out the medication. Whilst she had received basic training in respect of this, she had not done any accredited training. Action had however, been taken to address this and records showed she had been booked on a Boots medication course on 13th June 2007. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 14 Controlled drugs were being dispensed and stored safely and in accordance with the home’s policy. Those checked were seen to be in order. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity were respected by the staff who cared for them. Many of the residents enjoyed staying in their rooms for some of the day and they said this was respected. Relatives also confirmed they were highly satisfied with the staff’s manner and attitude towards the people they visited. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included, explaining to people what you are going to do and why so they didn’t become angry and frustrated, encouraging people to be as independent as possible, especially when bathing/showering, knocking on doors before entering, keeping people covered when assisting with personal care tasks and closing doors and curtains. One relative who was spoken to said this was the only home she had visited where staff always knocked on bedroom doors before entering. Outside each person’s bedroom door, there was a letter box and residents could request post be given to them in this way or arrange for it to be collected by their relative. A private telephone area was available so that residents without a telephone in their rooms could arrange to make or take calls in private. 56 percent of the staff, which included the housekeeper and domestics who sometimes covered care hours, had done NVQ level 2 or above training which included how to treat residents with respect and dignity. A further eight were in the process of doing the training. In addition, the deputy and one of the team leaders had successfully completed their NVQ level 3 and three staff were presently on this course. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ preferred routines were respected by the staff team, resulting in them being able, as far as possible, to continue living their chosen lifestyles. EVIDENCE: Residents were able to make choices in many areas of their daily routines but this did depend on their mental frailty. Residents spoken to gave examples of choices they regularly made: where to sit, there being a variety of lounges both on the ground and first floor levels, what to wear, whether to join in with activities or not, whether to have a bath or shower, when to get up and go to bed, what to eat and where to see their visitors. One resident, with a sensory impairment, said the staff would describe the colour of her clothes so she could decide what she would put on. As previously highlighted, residents’ preferences in respect of bathing times should be obtained and recorded on their new care plan. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 16 When residents first came into the home, a brief social history was recorded, involving the resident and/or their relative so that the home would have some information about what kind of things the person had previously enjoyed taking part in and what sort of routine they preferred. There was a part-time activity worker employed at the home. Feedback about activities was generally positive from the residents with comments made such as “I enjoy armchair exercises”, “the worker does her best to keep us occupied” and “I like playing some of the games”. One person, who stayed in her room all day and had a sensory impairment, said “I’m short of something to do, I get fed up on my own all day but I like my room”. She had some talking tapes but said she couldn’t put them on herself and staff were not always around as they were kept busy looking after residents. One resident comment card said that whilst bingo used to be played, this had stopped and she would like it to start again. The deputy manager said she was aware of shortfalls in activities and that as part of the compiling of the new care plans, would be asking key workers to find out from their residents what other activities they would like to be organised. The activity worker said that whilst she had a programme, which was displayed on the notice boards, she did not always keep to this. She said it depended what people wanted to do. She had recently introduced baking sessions that many of the residents were enjoying. Other activities offered were table games, dominos, arts/crafts, quizzes, memory games, sitting down basketball and carpet bowls. In addition, she assisted one or two residents to pursue their individual hobbies and gave examples of how one resident liked to do flower arranging and another person enjoyed painting. An external worker came in once a week to organise armchair exercises. The majority of the activities were able to be enjoyed by people with dementia. A small corner of the ground floor dining room had been made into a small homely lounge and furnished as a house in the last century. One resident in particular was seen to enjoy spending much of the day there. Whilst some of the activities were suitable for those people with a sensory impairment, it was felt that more time needed to be spent identifying what other activities they could offer to these residents. In-house entertainment was occasionally arranged and outings in the summer were sometimes organised. Staff said the frequency of outings was determined by how much money they had in their amenities fund. They were currently finalising details for their June Summer fair where all proceeds would be put into this account. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 17 The home had excellent hairdressing facilities with a light well-decorated room having been turned into a salon. One resident said she enjoyed the day the hairdresser visited as she liked to sit and wait her turn, chatting to other residents. A beautician also visited the home and some of the residents had their nails done. Entries in the visitors’ book identified that many relatives visited on a regular basis and this was noted during the visit. No restrictions on visiting times were imposed. Feedback from returned questionnaires indicated they were always made welcome by the staff and could always see their relative in the privacy of their bedrooms or anywhere else they liked. Relatives spoken to during the inspection also confirmed they were always made welcome. One relative said “we’re always offered a drink” and another said, “the staff are very welcoming”. One visitor said he liked to sit out on the patio with the person he visited or use the conservatory. He commented that there was always somewhere private to use, rather than having to use the person’s bedroom. The hospitality manager said that if residents wanted to have a private birthday party or celebrate a special occasion with their family, they could arrange to use the conservatory. Residents were encouraged to manage their own financial affairs as far as they were able, although it was generally their relatives who assisted with this. The home was however, aware of advocacy services should a resident need some impartial advice and support. Provision was made for residents to continue to follow their chosen religions, with regular attendance at the home by representatives from both Church of England and Roman Catholic faiths. Feedback from residents about food, both from questionnaires and from interviews, was mixed about the quality of the food served. Several residents commented that the quality depended upon which of the kitchen staff were on duty, as there were three people who were responsible for cooking meals, the main chef, the cook and the kitchen assistant. Comments included: “the food is alright”, “we always get a choice at each meal”, “the food is lovely”, “I enjoy my meals”, “the soup is watery”, “you always get enough to eat” and “the sweet trolley is excellent”. Relative comments were also mixed with these comments being made: “I have had the odd meal and it was very good”, “the food appears to be excellent”, “the meals can be very hit and miss”, “on the whole the food appears good” and, “feel some improvements are needed to the food”. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 18 Resident meetings were being regularly held when food was always part of the agenda. This was seen from checking the minutes of the last two meetings. The good practice of having a comment book for food in the dining rooms was noted. Where residents passed any comments to the staff, be they positive or negative, they were recorded. The deputy manager said these were then collated and fed back to the kitchen staff. She confirmed they were aware of certain problems with some meals and were presently addressing them. From checking the four-weekly menus, it was identified that a good selection of food was offered at each mealtime. The menu was displayed in the dining rooms so that residents could see what was being offered. On the day of the visit, breakfast was observed in the first floor dining room. The more able residents could help themselves to cereal and make their own toast as there were facilities set up in the dining room. This good practice encouraged residents to retain as much independence as possible. The resident meeting minutes recorded that it had again been reinforced to the residents that they could request a cooked breakfast whenever they wanted. Two hot choices were served at lunchtime and at tea there was a choice of soup, assorted sandwiches or a hot snack. Some days, instead of the hot snack, a salad was offered. Desserts were served at both meals with a hot dessert being served at lunch. In addition, a good variety of other cold desserts were offered and displayed in the dining room. These included gateaux, flans and fruit salad. On the day of the inspection, the lunch choices were: cheese and onion pie or sausage casserole with fried potato scallops, broccoli and cauliflower with a hot pudding of chocolate sponge and custard. The inspector sampled both main meal options. The cheese and onion pie was tasty, as was the sausage casserole but the gravy had not been thickened. The individual dietary needs of residents were being well met and dietary and fluid charts were completed as and when needed. The cook used sugar substitutes when cooking, so that any resident following a diabetic diet could enjoy many of the same foods as the other residents. There was a dining room on both ground and first floor levels. They were bright, airy and well furnished and decorated. Cloth tablecloths and napkins were set out with appropriate place settings. Vegetables were served by the staff from individual tureens and gravy boats enabled residents to have as much or as little gravy as they wanted. It was also seen that those residents who needed some assistance or prompting with their meals were sensitively assisted. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents were confident their concerns would be listened to and acted upon and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: The complaints procedure was displayed within the home and was also contained in the home’s information pack. The Commission for Social Care Inspection had not had cause to investigate any complaints at the home within the last 12 months. A complaints folder was in place in which was recorded any complaints made by residents and/or visitors to the home. All complaints/ concerns were logged, no matter how minor they appeared, together with what action had been taken to address them. This good practice is commended. More detailed information was kept on the individual resident’s file. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 20 As described in the section above, a food comment book was in place so that the management team could monitor any problems with the food before they became full-blown complaints. The deputy said they had addressed the issue of the “watery” soup by speaking to the kitchen staff and monitoring whether the quality had improved. There was a comments book kept and many thankyou cards were seen to have been received. The residents spoken with all felt they could speak to the manager, deputy manager or indeed any of the staff about problems and that they would be listened to. Relatives spoken to and feedback on all returned comment cards also confirmed this was so. One relative commented upon the accessibility of the senior management team and said “someone in authority is always available to speak to”. Another relative said “you can go and ask the manager or deputy anything and they’ll get it sorted for you. They’re very obliging”. One returned comment card indicated dissatisfaction about an investigation the home had carried out in respect of an accident sustained by one of the residents. From checking the person’s records, it was identified all the correct information was contained on the person’s file and arrangements had already been made to meet the family and care manager to discuss the problems more fully. It was evident that where problems were identified, the home was clear about the need to include the Local Authority as part of the safeguarding procedures. Staff files showed that two references and Criminal Record Bureau and POVA first checks had been done for the staff employed. If staff had to start work before the full CRB check had been returned, they did not work unsupervised at any time with the residents. The staff spoken to were knowledgeable about what to do if they should have any suspicion that a resident was subject to any form of abuse. A procedure for responding to allegations of abuse was available, as was the Oldham Protection of Vulnerable Adults (POVA) procedure. No protection investigations had taken place over the last year and the majority of the staff employed had done some form of protection training. Some had done a course run by Oldham MBC and others had attended the Anchor “Rights and Responsibilities” training. In addition, 16 staff (including the domestics) had completed NVQ level 2 training (or above), which included a unit on elderly abuse. A booklet about “Rights and Responsibilities” is given to all new staff. The deputy manager said she was currently reviewing staff training and would ensure that any new staff would receive protection training. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The home was clean, safe, well decorated and furnished, providing a bright, attractive and homely environment for the residents. EVIDENCE: There was a maintenance programme in place and from walking around the home it was evident that improvements were continuing to be made on an annual basis. Since the last inspection, two of the bathrooms had been totally refurbished. This had included two new rise and fall baths, new domestic type furniture, attractive tiling to the walls and re-decoration. Pictures and other accessories had been added to give an exceptionally pleasing environment for the residents. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 22 If residents did not wish to have a bath, a large walk-in shower was provided with a shower seat. All bathrooms, toilets and shower room were well equipped with aids and adaptations so that residents could remain as independent as possible. There was also the provision of a therapy room with massage facility, spa bath and piped music. The external beautician used this room when she visited. The high standard of decoration and furnishings throughout the rest of the home had been continued from previous inspections. As bedrooms became vacant, they were being re-decorated and new carpet fitted as necessary. All bedding and curtains were gradually being replaced. Anchor was clearly committed to providing a safe, pleasant environment for the residents. All the bedrooms were of a good size and had the provision of en-suite toilets and wash hand basins. Two residents said they really appreciated this facility. Many of the bedrooms had been personalised. One resident had, by choice, bought all her own furniture so that she could have the room exactly as she would have done had she lived in her own home. Many of the rooms were personalised and residents spoken to were all extremely satisfied with their bedrooms. Outside each bedroom door, there was a shelf where residents could place something personal to them so that they would be able to recognise their bedrooms. Some residents had requested a number on their door and others had their names on. The corridors and communal areas were light and bright so that people with sensory impairments could be as independent as possible. There were two lounges and a conservatory, as well as other different sitting areas around the home. A loop system was available in the conservatory and adjoining lounge to assist people with hearing difficulties. If residents did not have their own telephone in their bedroom, a private telephone booth with a chair was available for them so they could take personal calls without being overheard. The staff could also use this facility. Relatives and residents were very complimentary about the cleanliness within the home and said that the home did not have any malodours. A walk around the building supported this view and the home was spotlessly clean throughout. Comments included; “the home is always spotless and never has smells”, “the home is always maintained to a high standard of cleanliness”, “the domestics are really good and keep my room clean”, “toilets are always fresh and clean” and, “there are never any smells around the home”. One visitor said the clean well-kept building had influenced his choice when looking around the home initially. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 23 Level access to the enclosed safe patio area was via the conservatory or ground floor dining room. This enabled those people reliant on wheelchairs to have easy access. Everyone spoken with thought the home was a safe place to live and work in. An infection control policy was in place and infection control training was provided. The staff interviewed described safe infection control practices. Disposable gloves and aprons were provided for staff use and cloth tabards were used when serving meals to the residents. In order to try and reduce the spread of infection, liquid soap and paper towels were supplied in all bathrooms and toilets. Discussion took place about providing these in ensuites where staff assisted residents with their personal care needs. The deputy manager said she would ensure this was done. The laundry was sited away from the food preparation area and was clean, well decorated and orderly. Sufficient and suitable equipment was provided. There was a sluice on each of the floors so that staff did not have to carry soiled items from the first floor level. Laundry baskets were provided in each of the en-suite toilets. There was a system in place whereby the laundry was collected on certain days from each of the bedrooms. Residents spoken to were all very satisfied with the laundry arrangements in place. All the residents looked smart, wearing clean, well-ironed clothes. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 24 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. The staff team had the skills and expertise to ensure residents were well cared for. EVIDENCE: Inspection of rotas showed that staffing levels, as previously set, were in place. For the 37 people living in the home, some of whom had dementia and sensory impairments, staffing levels were set at four carers in a morning, two upstairs and two downstairs and a team leader or deputy. On the later shift, this could sometimes drop to three carers and a team leader. The team leader role was very much office based, as they dealt with visiting health care professionals, care plan documentation and other general telephone queries. They were also responsible for the administration of medication. Whilst they did work on the floor at certain times, feedback indicated this was limited. In a home where residents are accommodated on two levels, dependency needs of some people are quite high, with many needing two staff for moving/ handling purposes and the added factor of many residents spending time in their rooms, the staff roles needed to be reviewed. If more team leader time cannot be freed up, then additional care staff should be provided. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 25 Comments made by both residents and relatives confirmed that at certain times of the day, they felt insufficient staff were available. These included: “feel there could be more staff on duty first thing in a morning to help with washing and dressing of residents”, “the girls are kept very busy and don’t have much time to sit and chat” and, “staff don’t have time to come and chat to me in my room”. Good feedback was however, given about the staff team and all felt they were well looked after. The home had no vacancies. One newly recruited team leader was working on a supernumerary basis for two weeks so that she could get used to the residents and the way the team operated. During this period she was also undertaking her induction training. There had been quite a few changes in the staff team since the last inspection, for varying reasons. The staff team was multi-cultural, although the majority of the staff were white-British which reflected the majority of the residents living at the home. There was one male team leader on days and a male staff member on the night team. This reflected the gender make-up of the residents, as there were only two males currently living at the home. The male team leader spoken to knew the female residents who preferred female carers to assist them with their personal care needs. Staff feedback indicated staff morale was high, resulting in good teamwork which benefited the residents. The manager made sure that staff had the necessary information to undertake their roles efficiently and effectively. Good communication systems were in place, e.g., staff handovers, communication book, work rotas and diaries. Staff meetings were held on a regular basis and the staff said they were able to put any ideas forward. Minutes of the meetings were seen. In addition to full staff meetings, management meetings also took place. Good training opportunities were provided which enabled staff to strengthen and develop their skills and knowledge. Of the 32 care staff currently employed (which included the housekeeper and two domestics who on occasions covered as carers), 18 had successfully completed NVQ level 2 training or above which meant the home had 56 trained staff. In addition, eight carers were currently doing NVQ level 2 training and a further three were in the process of doing their NVQ Level 3. The manager, deputy manager and one of the acting team leaders were all qualified NVQ assessors. Inspection of records showed that safe recruitment and selection practices were followed in line with the home’s procedure. These included receipt of two satisfactory references, Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 26 Staff were also given copies of the General Social Care Council’s “Codes of Practice” upon appointment. Where staff have left without notice and the manager had to appoint new staff quickly, POVA checks were done and the staff would start work, subject to a satisfactory CRB check being received. However, the staff did not work unsupervised during this period. When new staff started work, they undertook an in-depth induction training programme which met the Skills for Care common induction standards so they learnt how to do their jobs safely. The deputy manager said new staff were not able to work on the floor until they had completed the training. All three files checked contained evidence of the training having been completed. Mandatory training covering moving/handling (back care), first aid, infection control, fire and food hygiene were covered during this initial induction period. Moving/handling training was done by one of the team leaders who was qualified to do so. He had undertaken a three-day training course and received annual update training. The deputy manager had undertaken an indepth health and safety training course which enabled her to pass her knowledge on to the staff team. Where it was felt further mandatory training would be beneficial, this was arranged. Training profiles were in place identifying what training each staff had completed. One training shortfall was identified with regard to equality and diversity and the manager should make this a training priority. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The management team provided clear leadership and guidance to staff, ensuring residents received consistent quality care. EVIDENCE: The manager was absent due to sickness on the day of the visit and the deputy manager and a team leader assisted with the inspection. The deputy manager was competent and clearly understood her role and responsibilities and was extremely helpful during the visit. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 28 Records showed the manager had completed her NVQ level 3 and the Registered Manager’s Award. She was currently undertaking her NVQ level 4 in care. Before becoming manager she had worked as the deputy manager for several years before becoming the home’s manager. She had been approved as the registered manager for the home, by the Commission for Social Care Inspection, on 5th April 2007. The management structure consisted of the registered manager, deputy manager and four team leaders. All had responsibilities for certain tasks. Feedback from both residents and visitors was very positive about the management of the home. Residents said “there’s always someone who will sort things out for you”, “you can go and see someone in the office if you need to” and “I like all the managers”. Feedback from the staff about the manager was positive, with comments made such as “fair” and “offers support”. Relative feedback was excellent about the way the home was run. Comments made included, “It’s the best run home I’ve experienced and I go in a lot of homes”, “the manager makes sure the home is run to a very high standard” and, “attention to detail is excellent”. There was a supervision system in place. From the evidence seen, it was apparent that whilst staff may not have formal supervision six times a year, it was done on a regular basis and management and full staff meetings were also held. Supervision records were seen on staff files. The deputy manager said that performance reviews were due to take place shortly. Anchor had a thorough quality assurance system in place and the manager was in the process of undertaking a full quality audit of the Commission for Social Care Inspection’s National Minimum Standards. Questionnaires were sent out on a regular basis to residents and their relatives and this information was collated and utilised. This indicated that residents’ views were both sought and acted upon. The deputy manager and team leaders worked alongside staff on a regular basis and could monitor care practices. Resident meetings were held where people could air their views and opinions and make suggestions about food, entertainment and any other matters they wished to discuss. The minutes of the meetings showed that quite a lot of residents attended these meetings. The majority of the residents living at the home relied upon their relatives to handle their financial affairs, although the deputy manager said several residents received their personal allowances and managed this themselves. The administrator was in charge of financial arrangements and worked on a part-time basis. Residents’ individual monies were not checked on this visit, as the administrator had the key to the financial records. However, on previous inspections, the financial arrangements had always been found to be in good order. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 29 The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place and that all maintenance checks were up to date. Random record sampling was undertaken of the gas certificate, servicing of lifts/hoists and fire equipment and all were in order. All health and safety training was undertaken by the staff as part of their initial induction training programme and evidence of this was seen on the files inspected. Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 30 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 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 X 3 Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No requirements were made at the last inspection. 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP8 Good Practice Recommendations Key-workers should consult with their residents as to what time of day they would like to take a bath/shower and then make sure enough staff are available for them to accommodate their wishes. Risk assessments should be updated at least on a six monthly basis, more often if people’s needs are changing. Paper towels and liquid soap should be supplied in the ensuite facilities where staff assist residents with personal care tasks, in order to try and reduce the risk of crossinfection. The manager should review the roles of the staff in order to make sure there are enough staff on the floor at peak times to meet the needs of the residents. 2 3 OP8 OP26 4 OP27 Millfield DS0000005511.V333079.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Greater Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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. 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