Inspection on 18/11/09 for Millfield Care Centre

This inspection was carried out on 18th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Millfield Care Centre 22/02/10

Millfield Care Centre 24/08/09

Millfield Care Centre 14/11/08

Millfield Care Centre 13/11/07

Millfield Care Centre 12/10/06

Millfield Care Centre 20/10/05

Millfield Care Centre 27/04/05

Millfield Care Centre 23/11/04

Millfield Care Centre 23/11/04

Millfield Care Centre 23/11/04

Millfield Care Centre 23/11/04

Millfield Care Centre 28/07/04

Millfield Care Centre 28/07/04

Millfield Care Centre 27/07/04

Millfield Care Centre 27/07/04

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Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lucy Burgess     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF 01706621222 01706627688 mcnallyh@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd care home 92 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 52) Dementia - Code DE (maximum number of places: 24) Physical disability - Code PD (maximum number of places: 15) The maximum number of service users who can be accommodated is: 92 Date of last inspection Brief description of the care home Milfield Care Centre is a two- storey purpose built home situated close to the town centre of Heywood. Access to public transport and the motorway network is good and there is ample parking to the front and rear of the home. Care Homes for Older People Page 4 of 38 Over 65 0 52 0 24 0 15 2 4 0 8 2 0 0 9 Brief description of the care home The home is registered to provide nursing and personal care in four distinct units up to a total of 92 residents. On the ground floor one unit provides nursing care for residents in the dementia category, and in separate accommodation nursing care is provided for up to 15 Physically Disabled residents (18 - 65 years). The upstairs unit provides nursing and personal care for 52 Older People. The home is suitably adapted for disabled access and the majority of rooms have en suite facilities. The previous Commission for Social Care Inspection report is available on request. The home weekly charges range from 370.00 pounds to 515.00 pounds per week. This is dependant on the individuals assessed needs. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection for Millfield Care Home, which included a site visit and took place over two days by 1 inspector and a pharmacy inspector. The service did not know that the inspectors were to visit. As part of the inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned as requested. During the visit time was spent looking at records including care files, recruitment and health and safety. Time was also spent looking at the environment, meal, activities and staffing arrangements for each of the units. A full audit of the medication system was also carried out. Our last key inspection at the home was on the 11 October 2007 however we have since carried out 2 random inspections due to concerns which have been raised. The Care Homes for Older People Page 6 of 38 first random inspection was undertaken on the 14 November 2008 following an Annual Service Review where our opinion of the service had changed. Issues were identified with regards to staffing arrangements and meals. The second random inspection was carried out on the 24 August 2009. This was undertaken by our pharmacist and involved an audit of the medication system. During this visit our pharmacist checked to see that compliance had been met with regards to requirements made during the random inspection. However serious concerns were again noted in relation to the management of medication. We explained to the manager and responsible individual that this information would be considered as part of our management review process to decide what further action would be taken. As part of the inspection process we had sent out feedback surveys to people living at the home and staff. We received comments from 15 people. These have been added to the report along with comments made from people spoken with during the visit. All the key standards were looked at during this inspection visit as well as the action taken to address the requirements and recommendations identified following our previous visits. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose needs to be amended to accurately reflect that the manager is not presently registered with the Commission as well as updating the contact details for us so that people are able to contact us should they wish to. Where concerns have been identified with regards to the nutritional needs of people these should be actioned, so that records clearly show that the health and well being of people are being monitored and relevant intervention are made ensuring their safety. Supplies of medicines must be obtained in a timely fashion to make sure that residents do not go without their prescribed medication. Effective arrangements must be put in place at the home to ensure that all medication is administered to residents in exact accordance with the prescribers directions. Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. This is an outstanding area of compliance. The provider must also put in place effective arrangements at the home to ensure that all medication records regarding receipt, administration and disposal are completed accurately. Risk assessments must be done to assess the safety of residents if medicines are stored in their rooms. So that medicines can be fully accounted for to prevent mishandling and to show that they are being given correctly and service users health is not at risk from harm. This too is an outstanding area of compliance. It is again required that all medicines must be stored safely and securely. Medicines must be stored safely to make sure they can not be mishandled. Effective systems must also be put in place to ensure staff that handle medicines are competent to do so safely. To help make sure that people who live in the home are kept safe. This is an outstanding area of compliance. Care Homes for Older People Page 8 of 38 The provider must also ensure that effective auditing processes are in place to ensure that managers are confident that medicines are being handled safely. In consultation with people more meaningful opportunities should be provided so that they are able to take part in a variety of activities which cater for those people with varying levels of support needs which promotes their emotional and physical well being and prevents boredom. As identified at our previous inspection consideration should also be given for the activity staff to have training to enable them to engage people, particularly those with dementia care needs in meaningful activities. Menus should be provided so that people are able to make a choice about what they would like to eat. The manager must ensure that sufficient food items are made available throughout the day and night so that they are able to have something should they wish too. The manager must ensure that people are aware of the homes complaints procedure and who they can speak with if they have any issues or concerns ensuring they feel listened to. Good quality training needs to be provided for all staff by people trained to do so ensuring staff have the competencies needed to support the specific needs of people living at the home. Without this there is no assurance that peoples needs will be safely met. Training should be provided in the specific health needs of people, such as dementia care and nutrition so the people health and well being is maintained. Sufficient staffing must be provided at all times so that peoples needs are met and they are able to access staff when they need. Adequate arrangements need to be made to ensure that agency and bank staff rotad to cover shifts have received a detailed handover so that they are aware of the particular needs of people and are able to support them safely. Evidence of this should be provided. Other comments made by staff with regards to effective inductions and communication should be explored to ensure that staff are fully informed and able to carry out their duties effectively so that this does not affect the running of the service. The manager must make application to register with us without further delay. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 38 order line 0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs of people are assessed prior to people being admitted to the home ensuring placement are only made where needs can be met. Evidence: The manager provided us with a copy of the homes Statement of Purpose. Information states that the current manager was the registered manager. This is inaccurate as the manager has yet to make application to us. Other information about how to contact us also needed updating providing the new address and contact numbers so that people are able to contact us should they wish to. A random sample of care files were looked at on each of the units. Some of these included an examination of the assessment process undertaken prior to people being admitted to the home. Assessments had been provided by the funding authority as well as being completed by staff from the home. Care Homes for Older People Page 12 of 38 Evidence: Information seen showed that the persons needs had been assessed prior to admission and again on admission to ensure that their identified needs remained unchanged. The homes assessment documentation, Quest, explored all areas of personal, health and social care. Information identifies the level of support required as well as any additional intervention required. Assessment information is then used to inform the development of individual care plans. Of the 9 people who completed the feedback surveys, all but one confirmed that they had received sufficient information about the service prior to them moving into the home. Standard 6 is not applicable as the home does not provide intermediate care services. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records need to clearly evidence that the health and well being of people is being monitored. Serious concerns in relation to the management and administration also need to be addressed to ensure that people are not placed at risk. Evidence: Care Plans were looked at on each of the 4 units. Files were orderly and followed the same format. The care plan explored all areas of daily living, for example, day and night routine, personal care needs, moving and handling, mental and physical health, pressure care, behavioural needs, nutrition and dietary needs and medication. Risk assessment were also completed in moving and handling, falls, nutrition and pressure care in addition to the generic assessments covering the environment and the use of wheelchairs. One area that required attention was in relation to weight monitoring. Individual nutritional needs had been assessed using the MUST screening tool. Assessments completed on the nursing unit showed that the frequency people were being weighed Care Homes for Older People Page 14 of 38 Evidence: was dependent on the outcome of their assessment. However on the other units where individuals had been assessed at a higher level of risk and required additional monitoring this had not been done. One assessment also showed that the person was no longer able to be weighed and that measurements were to be recored however over the last 6 months this had only been done once. The manager must ensure that action identified on the assessments are completed to that people are clearly being monitored. It was also found that weight records were being made on several different documents and therefore not easy to track. This was raised with the manager. Arrangements should be made for one clear record so that the needs of people can easily monitored and records evidence action taken to ensure this does not affect their health and well being. Information recorded in plans was person centered and where possible detailed the specific wishes of the person with regards to their needs and preferences providing a good overview about them and how they wished to be supported. The diary sheets also showed where people had received visits from relevant health and social care professionals however the professional visit sheets had not been kept up to date. Visits had been made by district nurses, chiropody, optician, dietician, GP, continence nurse, tissue viability nurse and social workers. Due to issues identified during the inspection arrangements had been made by the manager for GP reviews to be carried out in relation to medication. Observations between staff and residents showed people were treated with dignity and respect. Staff were seen to knock on doors prior to entering and personal care support was provided in private. Generally people appeared well kempt and were appropriately dressed. People were seen using equipment such as zimmer frames and pressure relieving cushions and these were clean and appeared well maintained. Comments were received in the feedback surveys with regards to the care provided. People said; its very nice and the staff are lovely, staff are very caring and understanding and support you in every way, everyone is very kind to me and the home does their best. Relatives spoken with during the visit felt their relatives were cared for and that staff worked well, however they did feel that at times there were not enough of them to do what was needed. Care Homes for Older People Page 15 of 38 Evidence: During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. This was because at the previous inspection there were concerns that medicines were not always given properly or handled safely. We found that no significant improvements had been made in the way medicines were handled and we found little evidence of good practice that we saw at the last inspection had continued. During this inspection we found that the records about medication were not clear and could not always show that medication had been given as prescribed. A great deal of new paper work had been introduced to help improve the quality of record keeping and to enable audits, checks, to be made to show that medicines had been given as prescribed. However we found that these new documents had not been completed properly. Some records about medication were unavailable in the home during our inspection and as a result we could not tell if people had been given vital doses of their medicines, such as antibiotics. We found that the quantity of medication was not always recorded when it arrived in the home and the returns records were not accurately completed this made it impossible to check that the medication had been given properly. This poor record keeping also meant that medication such as powerful sedatives could not be accounted for. We found several examples of medication being given but no record of the administration was made. Conversely records were made showing that medication had been given however, when we looked at the stocks of medication, it was found that the medication had not been administered. In some instances medication could not have been given because the records showed that there was none available for administration. As at the previous inspection we saw that staff had signed the records to indicate that one medicine had been given twice in one day, despite being only prescribed once. Staff also failed to record the quantity of medication given in each dose when there was a choice of doses to administer. It is important that records can show that all medicines can be accounted for and are given as prescribed to ensure that residents health is not placed at risk from harm and the medicines are not misused. Care Homes for Older People Page 16 of 38 Evidence: At the last inspection we found that mini care plans had been developed to explain how to give medication such as laxatives and analgesics when they were prescribed on an as required basis. These plans were still on file, however some of them were out of date or for medication which was no longer prescribed. We noted that when new as required medication was prescribed information on how to administer it was not always recorded. We also found that staff did not always have enough information available to help them administer prescribed creams correctly. As at the last inspection we found that some residents were not given their medicines as prescribed because nurses failed to follow the directions given by the prescriber carefully. One resident was prescribed a patch which delivered medication each hour for 72 hours, the patch needed to be changed every 72 hours. However over a period of 3 weeks it was applied 24 hours late on 4 occasions. We also found that nurses continued to fail to pay careful attention to special instructions for example we found that two medicines which should not be given with each other were recorded as given at the same time each day. If special instructions are ignored the medication may not work properly and residents health will be placed at risk. Again, other people could not be given some of their medication because there was none available in the home for them because it had run out. It was of serious concern to find, just as at the last inspection, that some residents were given medicines when their health indicated that these medicines should not be given. One resident was prescribed two different laxatives, records for this resident showed that one of the laxatives had been withheld because of loose stools. However the nurse had administered the other laxatives on those days. Records about medication when people came back to the home from a stay in hospital were poor. When people returned to the home from a stay in hospital, we found that they were not given some of the medication which had been prescribed for them whist there. We also found that medication which had been discontinued in hospital and by their own doctor was given to a resident, despite a note being placed on file that had confirmed it had been discontinued. Another resident had been given one of their medicines to control the symptoms of Parkinsons, incorrectly for over 12 months. We found that arrangements which were made to make sure people were able to have their prescribed medicines when out of the home were haphazard. Sometimes people missed doses of their medication due to these poor arrangements Care Homes for Older People Page 17 of 38 Evidence: As at the previous inspection we found that some aspects of storage of medicines was poor, for instance creams were not all stored safely because they were stored in residents rooms without assessing, checking, if it was safe to do so. Again we found that arrangements for checking that people who look after their own medicines, we safe to continue to do so, were poor. There were no records to show that staff made any checks at all and there was no evidence that people were safe to continue to look after their own medications. As at the previous inspection we found that medication was still being given at almost lunch time and as a result lunch time medicines could not be given until later in the day. It is possible that some residents had their doses of medicines either too close together or too far apart. The health of residents who were prescribed regular analgesics or antibiotics may have their health and well being placed at risk. The audits, checks, by the manager had not discovered the poor record keeping and failure to give medicines as prescribed. In light of the findings in this report, the manner in which staff handle medication shows that they do not all do it well and are not all competent to manage medication safely. It is essential that the home ensures that only well trained and competent staff handle medicines, to ensure the health and wellbeing of residents. An action plan was sent to us after our last inspection outlining how the areas of concern and weakness about medication would be addressed and improved. However we found that overall the systems in place for the recording, handling, safe keeping, safe administration and disposal of medication were not effective as the residents health and wellbeing was placed at risk of harm. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More meaningful opportunities should be provided so that they are able to take part in a variety of activities which cater for those people with varying levels of support needs. Evidence: There is currently one activity worker at the home however the manager advised us that she was in the process of recruiting a second. The AQAA also identified that certain staff have been identified as activity champions, which involved them assisting with activities. Arrangements had been made for two of the unused lounge areas on the 1st floor to be used for activities. One has been set out as a cinema room and the other for crafts. An activity list was displayed and showed what was available. These included walks in the garden, crafts and film afternoon. People confirmed that they were offered these activities. Photo albums had also been placed in the reception area showing pictures of parties that had been held including St Georges Day and St Patricks. It was noted on one of the inspection days that the activity worker went out shopping with one person who was on respite. This meant that no activities were offered that afternoon to people at the home. Care Homes for Older People Page 19 of 38 Evidence: The manager should in consultation with people provide more meaningful opportunities so that they are able to take part in a variety of activities which cater for their varying needs and promote their emotional and physical well being, and prevent boredom. As identified at our previous inspection consideration should also be given for the activity staff to have training to enable them to engage people, particularly those with dementia care needs in meaningful activities. Observations confirmed that people could receive visitors throughout the day. People were encouraged to maintain their relationships and spouses were encouraged to spend time in privacy. Two people spoken with had relatives present. They confirmed that they visited regularly and were able to see people in the privacy of their own rooms. In the main staff were respectful and pleasant and referred to people by their preferred name or title. People seemed to enjoy friendly banter with staff and appeared to have a good rapport. Comments received from people included, I like the parties and entertainment, I like watching the film shows and I like going to the hairdressers and making things. Three people spoken with confirmed that some activities were provided however they were not always what they would choose to take part in and therefore stayed in their rooms. With regards to meals we spoke with the chef. We were told that menus were currently being revised and updated. These had been planned following discussions with residents so that consideration was given to what there preferences are. Some people felt that the meals need improving and people also expressed that they would like the menus back. We saw that menus are now displayed on the wall to the dining rooms however on staff member said that these were not always updated and therefore did not show what meals were being served that day. Menus should be provided so that people are able to make a choice about what they would like to eat. Each of the units have a seperate dining area. Tables were nicely set on both days. Staff were sat with people and assisted them with their meals appropriately. Additional dining space has been provided on the 1st floor for those people requiring additional support offering further privacy and space. Care Homes for Older People Page 20 of 38 Evidence: A previous issue raised with the home has been in relation to food available during the evening and through the night should people be awake and hungry. Menus displayed showed that nite bites were available between the hours of 6pm and 6am and included toast, cereal, crumpets, potatoes cakes, horlicks, hot chocolate etc. This was discussed with staff on the units. Staff on one unit said that these items were provided if requested from the kitchen however other staff spoken said that they were not provided. The manager must ensure that staff and residents are aware and make suitable arrangements for such items to be provided so that people are able to have something should they wish too. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place with regard to reporting and responding to complaints ensuring people are protected. Evidence: Policies and procedures are in place with regards to complaints and protection ensuring people are protected. Information provided on the AQAA showed that there had been 3 complaints and 10 safeguarding referrals over the last year. We had been kept informed about events that have occurred within the home. These were discussed with the manager. Information had been referred to the local authority in line with procedure. Where necessary the local authority had carried out reviews to ensure that peoples needs were being met and they were protected. In relation to safe guarding staff training the manager advised us that staff had completed this however this had been almost a year ago. Further training was to be scheduled so that staff are aware of the procedure to follow should an allegation be made. Of the 9 people who responded to the surveys, 7 acknowledged that they were aware of who to speak with and how to make a complaint should they need to. The manager needs to ensure that all residents are familiar with the procedure. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Millfiled provides spacious well maintained accommodation, which meets the physical needs of older poeple. Evidence: People are provided with spacious, comfortable and well maintained accommodation. Suitable aids and adaptations are provided to ensure the physical needs of people are safely met. During our visit we spent time looking round the home. Communal areas, bathrooms and some bedrooms were looked at on each of the four units. The general environment was of a good standard. People were seen to move around the home freely. There are a number of lounge areas throughout the home. People have use of televisions and music centres. Two of the smaller lounges on the first floor have been utilised for activities providing an arts and crafts room and a cinema room. Each of the units have a separate dining room. A kitchen area is provided with a fridge, toaster, kettle and microwave. A new fridge was needed for the dementia unit. This had been ordered however had not been delivered, the manager was to follow this up. The work tops in each room were also heavily stained. During our visit one of the housekeepers had carried out thorough cleaning to address this. Care Homes for Older People Page 23 of 38 Evidence: Single bedrooms are provided throughout each having en-suite facilities. Rooms seen had been personalised with furniture items from home and photographs. People had been provided with lockable spaces, call bells were accessible and staff hand washing provisions were available in each of the rooms. During our visit we did note that the call bell system is connected throughout the home. This meant that when someone pressed the buzzer for assistance on one the ground floor unit it was heard on the first floor units too. We were also made aware by a relative that a door alarm regular sounded on the dementia unit due to people opening a fire door. They felt that this was quite disturbing to some of the residents. During the early evening one person had left by this door (leads to the garden), however as the security light was not working staff had closed the door leaving them outside as they were unaware someone was outside. This was mentioned to the responsible individual and manager. We informed that arrangements had been made for a maintenance worker to look at the system the week following our inspection. Bathroom and toilets were clearly identified and had been fitted with appropriate aids and adaptations such as handrails and specialist bath or shower aids. Specialist equipment such as rise and fall beds had been provided as well as additional aids such as zimmer frames and wheelchairs. Hygiene standards throughout the home were good. Domestic staff are rotad to work each day including weekends. Rooms were found to be clean and tidy and there was no malodour. Suitable arrangements were in place with regards to disposing of soiled waste and protective clothing was available and seen to be worn by staff. The laundry area was also looked at. Laundry staff are available throughout the week. Individual labeled boxes are provided and used to ensure that people receive their own items. The laundry area was clean and well organized, floors and walls are washable and the washing machines have a sluice facility. There were no issues with regards to maintenance. A full time handyman works at the home and ensures that general repairs, redecoration and health and safety checks are carried out. Externally the grounds were also well maintained. The home has a gardener who takes care of gardens. People commented about the standard of accommodation provided. They said; I think Millfield is a nice clean comfortable home to live and the furnishings are old and would benefit from upgrade. Care Homes for Older People Page 24 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are undertaken with a programme of training and development to ensure that staff have the knowledge and skills need to support people safely. Arrangements in relation to staffing levels need to be monitored to ensure sufficient numbers are provided. Evidence: Over the last year we have received 16 notifications advising us of staff shortages. This was discussed with the manager and rotas for day and night staff were examined for each of the units. On examination of the rotas and considering current occupancy levels and support needs of people we found that staff ratios were not always sufficient. The young disabled unit supports 15 people with a high level of support needs. Rotas showed that there were generally 5 staff available in the mornings, 3 in the evening and 2 night staff. On the dementia unit there had been up to 19 people requiring support. Rotas showed that there were 4 morning staff, 4 evening staff however on occasion this was sometimes only 3 staff with 2 or 3 night staff. On the first floor there are two further units providing nursing and residential support. Residential rotas showed that cover for up to 30 people included 5 morning staff, 4 afternoon staff and generally 3 night staff. The nursing unit supported approximately 23 people and staff Care Homes for Older People Page 25 of 38 Evidence: comprised of 5 morning staff (including the nurse), 4 afternoon staff and and 2 night staff. Whilst these units are separate, the night staff allocation is calculated together. Feedback from staff was that at times numbers available were not always sufficient due to the physical needs of people. A number of residents throughout the home required 2-2-1 support. This meant at times staff would be supporting with care or administering medication, which would not always leave staff available to supervise people in communal areas. The providers must ensure that sufficient staff are provided at all times to ensure that people are kept safe. Where possible cover is arranged by utilising BUPA bank staff, offers of overtime and where necessary agency nursing staff. A number of agency nurses had been used over the last few months due to vacancies and staff shortage. Recruitment has taken place with just one vacancy outstanding for a nurse on nights. We advised the manager that staffing arrangements were a cause for concern and would be monitored by us during our inspection process. The manager and responsible individual did agree to follow up on issues discussed in relation to nights. We also discussed the handover arrangements particularly for agency and bank staff. One agency nurse observed during the inspection appeared to be struggling when administering medication as she was not fully aware of the particular needs and behaviours of people. Suitable arrangements need to be made to clearly evidence that all staff have been informed about the needs of people so that they can be supported in a way which fully meets their needs and keeps them safe. At present the shift patterns are 8am to 2pm, 2pm to 8pm and nights 8pm to 8am. However through discussion with the manager and responsible individual we were advised that staff shifts and ratios will be subject to review over the next year. This will be based on the needs of the service ensuring sufficient staffing is provided at core hours throughout the day. The care team are also supported by a number of ancillary staff. The home employs 4 housekeepers plus 3 bank workers, 4 laundry assistants, 3 cooks, 4 kitchen assistants, a handyman, gardener and an activity worker. The manager had also made a new appointment for a second activity worker. Recruitment files were looked. Files were examined for five of the newest members of staff. Information seen included an application form, written referenes, POVAfirst checks, job descriptions, interview records, evidence of identification checked and health information. Criminal records checks (CRBs)are also undertaken and are held separately and securely. Checks are held for six months and then destroyed. Care Homes for Older People Page 26 of 38 Evidence: Procedures followed were thorough and ensured that only those people suitable to work at the home are offered employment. In relation to agency staff we were advised that confirmation of relevant recruitment checks are agreed as part of the service agreement. Information was looked at with regards to staff training. In-house training is provided along with external training provided by Rochdale MBC. Millfield has access to the BUPA development centre, which is based in Rochdale as well as having a number of staff throughout the homes that are trained trainers and will facilitate various inhouse training. Training provided varies in relation to learning styles. This may include video training and completion of questionnaires, workbooks, mentoring as well as more practical training courses. Courses provided over the last year have included fire safety, coshh, personal best and dignity, pressure care and adult protection. Further training in areas specific to the needs of people, such as stroke awareness, introduction to Parkinsons and MS and diabetes had also been sourced from Rochdale and records showed that some staff had attended with arrangements for others to also attend. Records showed that only a small number of staff had received training in dementia care and nutrition. These should be provided to all staff who provide care to residents. Where possible new staff will be scheduled to attend planned training prior to them commencing work ensuring they too have the neccesary skills to carry out their duties. Staff are also offered training in NVQs. Information provided on the AQAA showed that approximately 40 of staff have achieved level 2. Feedback was received from staff during the inspection and within the feedback surveys about the service and support provided. Staff expressed, most staff are totally committed to the unit, we could improve on team work between all units so we work as one and they need staff employed who want to be here not just to make up the numbers. One staff member felt the induction did not cover all the necessary areas. Several staff commented that at times sufficient staffing was not always available nor was communication effective. These concerns need to be explored by the management team to ensure the smooth running of the service so that peoples needs can be safely met. Care Homes for Older People Page 27 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to monitor and review the service provided. The manager must ensure that application to register is completed so that there is clear leadership and direction ensuring a quality service is provided. Evidence: There has been a change in management since our last key inspection. Following the previous registered manager moving from the home, interim arrangements were put in place. The current manager has worked at the home since January 2009 however took up the post of manager in March 2009. We discussed with her the process to follow in making application to register with us. This must be done without further delay. The manager is supported in her role by a clinical service manager, individual unit managers and administration staff. Further support is provided by the responsible individual who visits the home on a regular basis. Care Homes for Older People Page 28 of 38 Evidence: Feedback was given to both the responsible individual and manager at the end of our inspection. Some action had been taken to address initial concerns raised about the medication system. Further arrangements had been made for the following week, which involved an internal quality audit being undertaken on each of the units. All action identified would be action planned with timescales for completion. This information is to be shared with us. There was further discussion about staffing, current levels, vacancies and agency use. Steps were being taken by the manager to address cover issues. Further recruitment had also been undertaken. Staffing arrangements are currently subject to review with the implementation of new rotas/shift patterns being considered. These would commence over the next year and were said to focus on the needs of the service providing flexible staffing arrangements at core times. The manager and responsible individual agreed to follow up on issues identified in relation to night cover. Feedback is to be provided to us once this has been explored. We also looked at arrangements in place for the management of individual finances. BUPA do not act as appointee of people living at the home. People who are not able to manage their own affairs are assisted by family members, a representative or the local authority. Time was spent speaking with the administrator who ensures that personal allowances are managed. All money is held within a residents account and interest is accrued. Individual records are maintained with regards to balances and any transactions, along with receipts. People are able to access money when they need. Systems are in place with regards to quality assurance. Internal audits are undertaken with regards to care planning and medication. The manager also monitors staffing, training, recruitment and attendance. Meetings are held involving staff, residents and relatives so that feedback can be sought from all parties. Additional monitoring is undertaken by the responsible individual who undertakes the Regulation 26 monthly monitoring visits. Reports are held on file. Further auditing is also undertaken by BUPAs quality monitoring team ensuring systems in place are in line with organisational policy and procedure and compliance with good practice guidance and legislation. A random check was carried out with regards to health and safety. Up to date certificates were seen for the 5 year electric circuits, gas safety, fire alarm and equipment, small appliances, passenger lift and hoists. It was noted that action was required in relation to the electric circuit. Information was provided to evidence that these areas had been addressed. Care Homes for Older People Page 29 of 38 Evidence: The home employs a full time handyman, who also carried out internal checks to ensure the premises is kept safe. Care Homes for Older People Page 30 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 All medicines must be stored 03/09/2009 safely, securely and at the correct temperatures. Medicines must be stored safely to make sure they can not be mishandled and at the correct temperatures to ensure that they work properly. 2 9 13 There must be effective systems in place to ensure staff that handle medicines are competent to do so safely. To help make sure that people who live in the home are kept safe. 03/09/2009 3 9 13 Medicines must be given to residents as prescribed. Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 03/09/2009 4 9 13 Clear and accurate records of 03/09/2009 medicines received into, administered and disposed of by the home must be maintained. Risk assessments must be done to assess the safety of residents if medicines are Page 31 of 38 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action stored in their rooms So that medicines can be fully accounted for to prevent mishandling. and to show that they are being given correctly and service users health is not at risk form harm Care Homes for Older People Page 32 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The Provider must ensure that where action has been identified on the nutritional risk assessments that this is addressedensuring the health and well being of people is not affected. 30/01/2010 2 9 13 The Provider must ensure that effective auditing processes are in place to ensure that managers are confident that medicines are being handled safely 30/12/2009 3 9 13 The Provider must put in 30/12/2009 place effective arrangements at the home to ensure that all medication is administered to residents in exact accordance with the prescribers directions. Because receiving medicines at the wrong dose, wrong time or not at all can Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action seriously affect their health and wellbeing. OUTSTANDING 4 9 13 Effective arrangements must 30/12/2009 be put in place at the home to ensure that all medication records regarding receipt, administration and disposal are completed to accurately. Risk assessments must be done to assess the safety of residents if medicines are stored in their rooms. So that medicines can be fully accounted for to prevent mishandling. and to show that they are being given correctly and service users health is not at risk form harm. OUTSTANDING 5 9 13 All medicines must be stored 30/12/2009 safely, securely .Medicines must be stored safely to make sure they can not be mishandled. OUTSTANDING 6 9 13 There must be effective systems in place to ensure staff that handle medicines are competent to do so safely. 30/12/2009 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To help make sure that people who live in the home are kept safe. OUTSTANDING. 7 9 13 The Provider must ensure that supplies of medicines are obtained in a timely fashion to make sure that residents do not go without their prescribed medication. 8 15 15 The manager must ensure that all staff are aware of the nite bite provisions available so that people have something to eat when they want ensuring their nutritional needs are met . 9 27 18 Sufficient staffing must be provided at all times so that peoples needs are met and they are able to access staff when they need. so that peoples needs are met and they are able to access staff when they need. 10 30 18 Training should be provided in the specific health needs of people, such as dementia care and nutrition 30/01/2010 30/01/2010 30/01/2010 30/12/2009 Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action so the people health and well being is maintained. 11 30 18 Effective arrangements need 30/01/2010 to be made to ensure that agency and bank staff rotad to cover shifts have received a detailed handover so that they are aware of the particular needs of people and are able to support them safely. Evidence of this should be provided. so that they are aware of the particular needs of people and are able to support them safely. Evidence of this should be provided. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should be updated to reflect accurate information about the manager being unregistered and the contact details of the Commission so that people are able to contact us should they wish to. Records should be maintained to show that people have received advise and support from all relevant health and social care professionals ensuring their needs are being met. Consideration should also be given for the activity staff to have training to enable them to engage people, particularly those with dementia care needs in meaningful activities. 2 7 3 12 Care Homes for Older People Page 36 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 12 In consultation with people more meaningful opportunities should be provided so that they are able to take part in a variety of activities which cater for those people with varying levels of support needs. Up to date menus should be made available so that people are able to choose what meal they would like. The manager must ensure that people are aware of the homes complaints procedure and wh they can speak with if they have any issues or concerns ensuring they feel that they are being listened to. Other comments made by staff with regards to effective inductions and communication should be explored to ensure that staff are fully informed and able to carry out their duties effectively so that this does not affect the running of the service. Further training should be undertaken by staff with regards to NVQ so that this meets the standard and promote the continuous development of staff. 5 6 15 16 7 27 8 28 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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