Inspection on 04/08/05 for Millfield House

This inspection was carried out on 4th August 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Millfield House 19/11/07

Millfield House 01/08/06

Millfield House 24/11/05

Millfield House 08/03/05

Millfield House 24/06/04

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

CARE HOME ADULTS 18-65 Millfield House 16 Millfield Folkestone Kent CT20 1EU Lead Inspector Julian Graham Unannounced 4 August 2005 9:45 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Millfield House Address 16 Millfield. Folkestone, Kent, CT20 1EU 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) 01303 226446 MNP Complete Care Group Cleo Drury Care home only 8 Category(ies) of Physical Disability x 8 registration, with number of places H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08/03/05 Brief Description of the Service: Millfield House is an 8 bedded Home providing support for people with physical disabilities. The Home is a semi-detached house with bedroom accommodation on the ground, first and second floor. It has disabled access and is situated in a residential street in the centre of Folkestone, a short walk from the amenities within the town. Parking is limited but a few allocated spaces have been made available.Mrs Cleo Drury is the registered manager. She is supported by the assistant group manager and her deputy. Staff are well trained, motivated and supervised. Service users are provided with external and in-house activities.The refurbishment and decorating programme is ongoing. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Millfield House which started at 09.45 and took place over six and a quarter hours. All eight residents were at home at the time of inspection and were spoken with. All the residents were looking well cared for, relaxed and cheerful, and said they like the staff and the home. Much of the inspection was spent talking with the residents, including sharing the lunch time meal with them which was a barbecue. Time was also spent with the manager, and several staff were spoken to, with two being interviewed in private. Staff were also observed both directly and discreetly as they were going about their work with the residents. A visiting relative was also spoken with. A tour of the premises was undertaken, including viewing the communal areas of the home and most of the bedrooms. A small number of records were examined, including a sample of care plans, a pre-admission needs assessment, medication and complaints records and a staff file. The residents, manager and staff are thanked for their welcome and assistance during the inspection. What the service does well: There is a well trained and settled staff team at Millfield House which is being well led by the manager. This is providing continuity and consistency of care which is of benefit to the residents. A visiting relative said the stability of the current staff team “means the world”. A resident said “it is better with settled staff”. Staff communicate well with the residents, including those without speech. Good support is provided to residents to become more independent. Staff have good knowledge of what constitutes good and bad practice. The home is good at providing interesting and fun things for the residents to do, for example, holding regular “theme” evenings. A sports day organised by Millfield House for all the homes within the company was held the day before this inspection, and was much enjoyed by all the residents. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,4 Prospective residents are given the information they need to make an informed choice about whether the home will meet their needs. There is a clear preadmission process which informs the care planning process. EVIDENCE: The manager said that the Statement of Purpose and Service User Guide have recently been updated and that the latter document, along with the complaints procedure, is given to prospective residents to assist them in determining the suitability of the home. The home in turn assesses the needs of prospective residents by completing a comprehensive needs assessment checklist, which covers a wide spectrum of need. The most recent needs assessment form was viewed. The two most recently admitted residents both had the opportunity to visit the home first, with one of them having lunch with the other residents and going on an outing with them. The manager said that prospective residents can stay overnight if one of the bedrooms is vacant. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. 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 The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9, The care planning system is satisfactory, although residents would benefit from having their personal goals reflected in their individual plans. EVIDENCE: A sample of care plans were viewed, and these principally comprise a number of highlighted sections of need relevant to the individual in an easily accessible form. These are supplemented by very detailed guidelines as the support needed in getting up in the mornings and going to bed at night. There are also a number of risks that have been identified and assessed, including moving and handling risk assessments. It is a recommendation of this report that the home consults with residents and identifies one or two personal goals each would like to aim for, and for these to be reflected in the care plans. This will give residents a greater chance of work being done to actually meet the goals. The home encourages residents to participate in some of the routine household chores, and one resident for example, makes her own bed and puts away her clothes. Another resident assists in the cleaning of her room. There is little involvement on the part of residents, however, in the preparation and cooking H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 10 of meals. It is recommended subject to risk assessment, that the home looks at ways greater involvement can be facilitated. There was evidence that residents are being supported to make decisions about their lives. One resident, for example, has made a decision not to consider an alternative placement at the present time, choosing to remain at Millfield House. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 Personal development and active and fulfilling lives are promoted in the home. EVIDENCE: A resident said that the home has supported her in regaining some of her mobility and speech. Another resident was assisted by a staff member through the use of a communication aid to say that she is being supported in becoming more independent. Residents were all looking relaxed in the company of staff, who demonstrated skill in communicating with them. Links with family and friends are encouraged, and two relatives were visiting the home at the time of inspection, with one attending a resident’s review. This person said she is always made welcome and is being given good support from staff. Residents have regular opportunities to go out and access community facilities. One resident was supported by a staff member at the time of inspection in going into town to buy an item of clothing. In-house activities include arts and H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 12 crafts, games and puzzles. One of the residents works in a charity shop as a volunteer a couple of mornings a week. Residents said that routines in the home are flexible, and staff were seen interacting with residents with respect and good humour. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Staff have a very good understanding of residents’ support needs and residents’ healthcare is promoted. EVIDENCE: One resident who needs a lot of help with his personal care needs said that staff are mindful of his need for privacy and dignity. Healthcare specialists are accessed as required. One of the residents said that she attends a hospital out patients for physiotherapy and speech therapy on a weekly basis. Another resident confirmed that staff are assisting her in obtaining a new communication aid with the support of other professionals. There remains the need, however, for the frequency of blood sugar monitoring to be clearly detailed in care plans. The arrangements for the control and administration of medication are satisfactory. All staff who administer medication have received training and there was evidence that their competence has been assessed by the home’s management. The home must ensure however, that an appropriate code is used on the MAR charts when medication is not given for any reason, and for handwritten entries to be checked and signed by a second staff member. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Staff have good knowledge and understanding of adult protection issues which protects residents from abuse. The complaints system is satisfactory, although the written procedure requires amendment. EVIDENCE: Out of the twenty one staff employed in the home, fourteen have attended training on adult abuse issues. The manager said that training is being planned for the remaining staff. Three staff who were spoken with were clear in their understanding of abuse procedures. Residents said that they would feel comfortable raising any concern or complaint with staff and feel that they would be listened to and have their concerns taken seriously. No complaints have been recorded since the last inspection. It is a recommendation of this report that all complaints, however minor are recorded. The written procedure was viewed and needs to be amended to reflect residents’ right to complain to the commission at any stage of their complaint, and for the current name of the commission to be detailed. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26, 27,28,29,30 The standard of the environment is generally good within the home providing residents with an attractive, comfortable and homely place to live. EVIDENCE: The premises has been specially adapted to meet residents’ needs, and is therefore in the main accessible to the residents. The step leading down into the kitchen, however, is restricting residents in making use of this facility. This room is to be upgraded shortly, and hopefully consideration will be given to making it more accessible. The home is being generally well maintained, although the lounge is in need of redecoration. Residents’ rooms are homely and individually personalised. Some do not have comfortable chairs or lockable facilities and it is recommended that these rooms are audited against the standard and residents consulted as to whether they are wanting any additional furniture or furnishings. The premises was generally clean and hygienic, although one of the bedrooms smelt strongly of urine. This must be investigated and suitable action taken to remove the smell. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Staff are well trained and feel valued and supported. EVIDENCE: Staffing levels are satisfactory with three care staff on duty during the day with the manager and deputy manager supernumerary. There are two waking night staff. These numbers are enabling residents’ needs to be met. Staff interviewed were clear as to their roles and responsibilities, and both direct and indirect observations of them working with residents revealed a positive and respectful approach. Thorough induction training is provided and staff said that this equipped them well to carry out their work effectively. All said that the training emphasised how residents must be treated. Over half the care staff have either completed or are currently undertaking NVQ training. Examination of recruitment practice revealed a sound approach, which offers protection for residents. Staff said that they feel supported by the manager who they said is approachable. Formal one to one supervision for staff is not happening H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 17 consistently at the present time however; although the manager said that supervision and appraisal training has been booked for the deputy manager and the three team leaders who in time will be assisting the manager in supervising staff. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 Residents are benefiting from a well run home. EVIDENCE: The manager has shortly completed her RMA training and is in the process of undertaking the NVQ assessors course. The company’s assistant group manager and home’s deputy manager and team leaders support her. Residents, staff and a visiting relative confirmed that the management approach is open and inclusive. The manager is also a moving and handling trainer, and other key training on safe working practices, including food hygiene and infection control are covered in the induction programme. No obvious health and safety hazards were noted during the inspection. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 20 no 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. 2. Standard 30 34 Regulation 23 19 Requirement The strong smell of urine in one residents bedroom to be investigated and removed. Evidence of applying for POVA checks to be available in the home. Timescale for action 11/08/05 11/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 6 6 8 20 22 26 28 Good Practice Recommendations Residents to be consulted with regards any personal goals they may have, and for these to feature in care plans, and to be monitored and recorded. Clarity to be ensured with regards to the frequency of blood sugar monitoring and for this to be clearly detailed in care plans. Access to the kitchen to be improved and residents to have more opportunities to participate in the preparation and cooking of meals. With regards to medication: a) handwritten enties on the MAR chart to be checked and countersigned; b) code to be entered on MAR chart when medication not administered. All complaints to be recorded; procedure to be amended. Bedrooms to be audited against the standard. Lounge to be decorated as planned. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 21 8. 36 Staff to receive formal one to one supervision six times a year. H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU 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 H56-H05 S23493 Millfield House V239644 040805 Stage 4.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!