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Inspection on 27/04/05 for Millfield Care Centre

Also see our care home review for Millfield Care Centre for more information

This inspection was carried out on 27th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a stable staff group offering good continuity of care. There is very little use of agency staff. Residents and relatives felt the staff were caring and committed to providing the best care they could. Relatives spoke of a feeling of confidence in the staff, and felt they had developed a good relationship with them. Observations made during the inspection indicated that there was a relaxed and easy relationship between residents, visitors and members of staff.

What has improved since the last inspection?

In the Young Disabled Unit there has been progress made with the introduction of policies relating to this age group but this needs to be developed further. The Unit managers in the Nursing and Dementia Units have made considerable progress in updating the care plans.

What the care home could do better:

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE MILLFIELD CARE CENTRE Bury New Road Heywood Rochdale 0L10 4RF Lead Inspector Bernard Tracey Announced 27 April 2005 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 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 and Care Homes for Adults 18 – 65*. 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 CARE CENTRE Version 1.10 Page 3 SERVICE INFORMATION Name of service Millfield Care Centre Address Bury New Road Heywood Rochdale Lancashire OL10 4RF 01706 621222 01706 627688 mckinnes@bupa.com Ashbourne K. W. Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sandra Marilyn McKinney CRH Care Home 92 Category(ies) of DE(E) Dementia - over 65 : 24 Places registration, with number LD Learning Disability : 1 Place of places OP Old Age : 52 Places PD Physical Disability : 15 Places MILLFIELD CARE CENTRE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Within the total of 92 places there can be up to a maximum of: 24 DE(E) Places; 15 PD Places; 52 OP - 24 nursing places (Age 60 years and over) and 28 residential places (Age 65 and over); 1 LD Temporary Nursing Place (Aged 55 years) The service should employ a suitably qualified and experienced Manager who is registered by the Commission for Social Care Inspection. Date of last inspection 23 November 2004 Brief Description of the Service: Millfield 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. 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. MILLFIELD CARE CENTRE Version 1.10 Page 5 SUMMARY This is an overview of what the inspectors found during the inspection. The home had been informed that the inspection was to take place on the 27th and 28th April and had been requested to ensure that residents and relatives were aware of the details of the inspection. The inspectors also wrote to General Practitioners, District Nurses and Social Workers involved in the home asking for their comments and also inviting them to meet with the Inspectors during the visit. None of the professionals took up the invitation, though a nurse did send her comments in writing. Two Inspectors spent a total of 16 hours including being in the home during the evening of the first day of the inspection Both inspectors took the opportunity to speak with a total of 8 relatives and 10 residents. A total of 9 members of staff including the manager, were interviewed both individually and as a group. On the whole the care staff said that the home was a good place to work and felt they were given the opportunity to receive training to help them do their job better. Relatives spoken with said they felt they are kept informed of the care provided, but one relative said that staff sometimes did not carry out the instructions given on behalf of her relative. Residents spoke positively of their experience within the home and felt that the staff treated them well. A tour of the facilities was undertaken and the Inspectors also took the opportunity to read through records relating to how the care of residents was planned and carried out. What the service does well: What has improved since the last inspection? In the Young Disabled Unit there has been progress made with the introduction of policies relating to this age group but this needs to be developed further. MILLFIELD CARE CENTRE Version 1.10 Page 6 The Unit managers in the Nursing and Dementia Units have made considerable progress in updating the care plans. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. MILLFIELD CARE CENTRE Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) MILLFIELD CARE CENTRE Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2. 3. Satisfactory systems are in place for introducing new residents to the staff, other residents and the facilities in the home so that the individual can make an informed choice about moving into the home. Assessment of individual need is made before each resident moves into the home to ensure that the home can provide the care needed by the individual. EVIDENCE: All Units. Examination of nine care plans demonstrated that new residents are admitted following an assessment undertaken by members of staff competent to do so before being offered a place in the home. Summaries of the health and social services assessment were seen to be in place as was a copy of the care management care plan. The home develops a care plan based on the assessments made prior to admission to the home, which describes the care needs of the resident and how the needs were to be met. Care plans are shared with residents, signatures on care plans evidenced this including one by MILLFIELD CARE CENTRE Version 1.10 Page 9 a relative. Residents spoken with said they had some knowledge of care plans and how this affected the care being given. Young Disabled Unit Residents spoken with on the Young Disabled Unit said they had the opportunity to build up their introduction to the home over an agreed period of time, commencing with staying at the home for a few hours, and then overnight, before they committed to moving into the home on a full time basis. All residents confirmed that they had the opportunity to make an informed choice in regard to moving into the home through a visit and by looking at written information provided by the home. Contracts and terms of residence are included in the standard company information that is issued by the administrator of the home. MILLFIELD CARE CENTRE Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standards 6, 7, 9, 18,19,20 The care planning system does not always provide staff with adequate information to meet service users needs. The care plans fail to ensure that all health care needs of residents are identified and met. There is a failure to ensure that the care is reviewed regularly, these shortfalls have the potential to place residents at risk. MILLFIELD CARE CENTRE Version 1.10 Page 11 EVIDENCE: An individual care plan was available for each resident, but the information contained within the care plan varied between the different units. Nursing Unit The unit manager informed the inspector that a review of the documentation in respect of the care plans was being undertaken. It was evident from examining care plans that some progress has been made but also that the home is aware of the need for improvement exists. Young Disabled Unit One of the care plans examined indicated a resident to be on a weight reducing diet, however no evidence of this being monitored was found, nor was any communication with the Chef regarding this resident’s diet evident. It was recorded that there was the involvement of the Dietician but again no evidence of advice from the dietician was found nor did the resident feel that ‘my weight reduction is being well managed’. The care plans were reviewed regularly on this Unit. Residents said their own routine is fully respected, supported by information related in conversations with residents, and evidenced through talking to staff and examination of care plans. Staff were seen to act in a manner that promoted individual privacy and dignity, for example always knocking before entering personal accommodation and using the residents preferred form of address. Dementia Unit The Unit manager said that it was policy that the care plans were reviewed on a regular basis but that it was an ongoing problem that certain staff failed to review care plans for residents in line with the policy. One relative spoken with felt that there have been occasions where her relative did not receive the level of care she would expect, particularly in relation to personal hygiene needs. Examination of the medicine administration sheets revealed that verbal prescriptions of medication were accepted by the home but these were not routinely checked and signed by two members of staff which could result in the wrong medication or dosage being written down and therefore putting the residents at risk. MILLFIELD CARE CENTRE Version 1.10 Page 12 MILLFIELD CARE CENTRE Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standards 12, 13, 15, 16, 17 The home has made limited progress in implementing a varied activities programme. Activities provided do not meet the needs of the age and mix of the residents. The menu is traditional and does not offer a variety that allows residents choice and control over what they eat. The arrangements for residents who choose to smoke are inadequate. EVIDENCE: Family and friends of relatives are made to feel welcome, and this was supported in conversations. All relatives felt the staff did a good job, and were friendly and respectful. The Activities Programme is very limited and, in the main focus on group activity taking place within the home generally aimed at meeting the needs of older people. Although staff have identified individual preferences and held a residents’ meeting on the Young Disabled Unit, residents state that ideas and interests expressed have not been acted on, and it has made limited impact on the provision of activities. MILLFIELD CARE CENTRE Version 1.10 Page 14 The recent appointment of an Activity Person for the Young Disabled Unit will allow the home to demonstrate how residents can become less insular and actively engaging with the community, as this is extremely limited at the present time. Organised outings occur irregularly and if cancelled residents stated that they are not replaced with an alternative, and this was seen to be the case on both days of inspection. Use of the home’s mini bus should be improved to allow for 1:1 activity to take place outside of the home. To this end the home should ensure that there is a member of the activities team able to drive the mini bus. Staff do give support to residents wanting to go out, but this is usually occurs on the member of staffs’ day off, rather than provision made in the daily of activity programme of residents. Therefore such support is reliant on staff goodwill rather than as part of the programme of activities. All of the residents and relatives spoken with said the activities programme was the area the home needed to improve upon. The provision of suitable accommodation for residents who choose to smoke remains an outstanding requirement from two previous inspections, and that the home has failed to address adequately. Residents said that the arrangements made by the home were not suitable, particularly in relation to the limited space. Examination of the homes’ menu, discussion with residents and the catering staff identified the need for the home to review the menu in relation to the Younger Adults. The menu whilst varied and nutritious is not particularly suitable for the younger palate. The menu services the entire home, with only 3 meals different for young disabled unit. Residents spoken said generally they would like greater variety of food, with more pasta, salads, fruit platters etc incorporated. Food eaten by Inspector was not served as requested indicative of the catering provision not adequately providing food to meet individual preference. MILLFIELD CARE CENTRE Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standards16 22 23 The home’s complaints procedure is in place to ensure that that residents were able to make their concerns known. The home has not always responded to concerns raised by relatives in relation to improving the standards of care for individual residents. EVIDENCE: Residents and relatives said the staff are approachable and if concerned would speak with them in first instance. Complaints Record books kept on two units did not contain any records of concerns. A Unit manager said she does not get complaints, but felt she was proactive in ensuring any issues are resolved before they develop into a complaint. Staff have a knowledge and understanding of the Protection of Vulnerable Adults Procedure. Relatives spoken with during the inspection and by telephone expressed concern that matters raised in the home are not seen to be acted upon, particularly in relation to basic personal hygiene needs and there was a failure to meet individual preferences. MILLFIELD CARE CENTRE Version 1.10 Page 16 MILLFIELD CARE CENTRE Version 1.10 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standards 19 24 26 30 The standard of accommodation is generally good, providing residents with a homely, clean and attractive environment. EVIDENCE: The home was seen to be clean and free from any offensive odours. Staff were seen to observe good hygienic practices i.e. the use of disposable aprons, disposable gloves, liquid soap, paper towels and bins in all bedrooms, bathrooms and toilets. The home’s facilities are accessible to disabled residents including those in wheelchairs. Power points are accessible from wheelchairs. Individual accommodation is spacious and able to accommodate equipment and personal possessions. MILLFIELD CARE CENTRE Version 1.10 Page 18 The corridors and personal accommodation that have not been re-decorated now require attention. The carpet needs replacing throughout the Residential Unit corridors as it is stained and worn and does not provide residents with a homely environment. Staff did say that the carpet was due to be replaced and this was confirmed during discussion with the manager. The wall in the dining room in the Dementia Unit requires re-plastering as it not only looks unsightly, but debris from the affected area could fall into residents’ food whilst eating. The use of communal lounge accommodation on the Dementia Unit requires reviewing, as all residents were being directed to the small lounge by the dining room whilst the large airy lounge at the far end of the unit was unused. This suggested that the arrangement was for the benefit of the staff rather than the residents though staff spoken with stated that this was not the case. MILLFIELD CARE CENTRE Version 1.10 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standards 27 29 30 34 35 The deployment and numbers of staff are sufficient to meet the needs of the residents. The procedures for the recruitment of staff ensure residents are safeguarded from the appointment of individuals who are unsuitable to care for residents. EVIDENCE: Relatives and residents commented on the caring nature of the care staff. Generally there was not a high turnover of carers and the majority of care staff who had left had done so further their career. There is continuity of care, in that the same members of the care staff on a rota basis deliver it, and residents and relatives alike commented as a positive aspect of the home. During the inspection it was evident that there were enough members of staff on duty to meet the needs of the residents. Relatives and residents said that this was usually the case and no one felt that they had to wait too long before they were given assistance when requested. There is limited use of Agency staff to cover shortfalls. MILLFIELD CARE CENTRE Version 1.10 Page 20 MILLFIELD CARE CENTRE Version 1.10 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – None of the key standards were fully assessed on this inspection The key standards were not inspected on this occasion. at the next inspection. They will be inspected MILLFIELD CARE CENTRE Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 3 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 X X X X 2 X 3 Score Standard No 7 8 9 10 11 Score 2 2 2 x x Standard No 27 28 29 30 3 3 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 2 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X 37 X 38 X MILLFIELD CARE CENTRE Version 1.10 Page 23 Yes Are there any outstanding requirements from 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. 1. Standard 7 Regulation 15 Requirement Residents’ care plans must be in sufficient detail to indicate how their health and welfare needs are to be met. The care plans must be kept under review. (Timescale not met 20 /01/05) Timescale for action 23rd June 2005. 2. 12 16 A suitable programme of activities must be provided, having specific regard to the 23rd June needs and interests of each 2005 resident. (Timescale not met 1st October 2004). A menu is to be devised to take into account the expressed preferences and choices of the Younger Adults, and this to be kept under continuous review. The home must provide a suitable designated smoking area for residents who choose to smoke. (Timescale not met 30th October 2004). When a complaint is made about the home the action taken must be communicated to the complainant. A programme of decoration and refurbishment must be provided within the timescale stated. The Version 1.10 3. 17 16 23rd June 2005 4. 28 23 1st July 2005. 5. 16 22 23rd June 2005 23rd June 2005. Page 24 6. 19 23 MILLFIELD CARE CENTRE carpet on the corridors of the Residential Unit needs replacing. 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 9 Good Practice Recommendations Hand transcriptions of medicines are witnessed by two members of staff, one qualified, to avoid errors. The home should consider renaming the different units to provide a more homely feel to the home. 2. 1 MILLFIELD CARE CENTRE Version 1.10 Page 25 Commission for Social Care Inspection Turton Suite Paragon Business Park Chorley New Road Horwich Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI MILLFIELD CARE CENTRE Version 1.10 Page 26 MILLFIELD CARE CENTRE Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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