Inspection on 20/08/05 for Millfield Lodge

This inspection was carried out on 20th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Millfield Lodge 22/07/08

Millfield Lodge 04/10/07

Millfield Lodge 15/02/07

Millfield Lodge 02/10/06

Millfield Lodge 29/11/05

Millfield Lodge 10/08/04

Millfield Lodge 05/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Millfield Lodge Potton Road Gamlingay Bedfordshire SG19 3LW Lead Inspector Nicky Hone Cathryn Bramham Unannounced 20th August 2005 at 09:15 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. 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 Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Millfield Lodge Address Potton Road Gamlingay Bedfordshire SG19 3LW 01767 650734 01767 651434 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) Ms Anita Ram To be appointed Care Home 16 Category(ies) of Older People not falling within any other registration, with number category (OP) 16 of places Dementia - over 65 years of age (DEE) 16 Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21 March 2005 Brief Description of the Service: Millfield Lodge is situated on the edge of the village of Gamlingay. It is within walking distance of the shops, doctor’s surgery and village centre. Gamlingay is on the Cambridgeshire-Bedfordshire border and is approximately a 30 minute drive from Cambridge city and a 15 minute drive from Sandy. The home is a single storey building comprising of twelve single and two double bedrooms. Five of the single bedrooms have ensuite facilities consisting of a washbasin and toilet: all other bedrooms have washbasins. The home has five additional toilets, three bathrooms, a lounge, dining room, sun lounge, kitchen, laundry room and staff office. At the time of this inspection, building work had begun on a large extension to the rear of the home. The office had been demolished and moved to a portable building at the front of the home and the back gardens were no longer accessible. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of Millfield Lodge in the 2005/6 inspection year. It was carried out by two inspectors who spent two and a half hours at the home. They made a tour of the communal areas of the building, and saw some of the bedrooms; spoke to service users and staff; and checked some of the records kept at the home. One of the deputy managers was on duty. This report is a reflection of what was found at the home on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: It was disappointing to note that three of the seven requirements made at the last inspection have not been met (see requirements numbered 8, 9 and 12 at the end of this report). Records and discussion indicate that there are not sufficient staff on duty, and they have not received appropriate training, to meet the needs of the residents. Care plans must be followed to ensure residents’ needs are met and their health and well-being are maintained, and activities must be provided to keep people occupied. Medication must be dealt with correctly, records must be maintained as required, and much greater priority must be given to issues of health and safety, specifically issues around fire safety. An immediate requirement notice was left at the home regarding five matters that the inspectors considered put residents at immediate risk: Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 6 1. Medications were not stored securely (see Health and Personal Care) 2. Medication records were not completed correctly (see Health and Personal Care) 3. Tests of the fire alarm system were not carried out as required (see Management and Administration) 4. Fire exits were not clearly signposted (see Management and Administration) 5. One person’s weight loss had not been investigated (see Health and Personal Care). The provider responded to the immediate requirement notice: the response is available at the local office of the CSCI. 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. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Assessments are received by the home before new residents are admitted. Standard 6 is not relevant to this home. EVIDENCE: The file of one service user was checked: this contained an adequate assessment of the person’s needs and was completed before s/he was admitted to Millfield Lodge. This home does not offer an intermediate care service. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 The information on care plans is adequate but there is no evidence that the plans are followed by staff so that residents’ needs are satisfactorily met. The home’s practices regarding medication are poor and potentially place service users at risk. EVIDENCE: The care plan for the resident most recently admitted to the home was seen and was satisfactory, with adequate information for staff to be able to meet the resident’s needs, and evidence that the plan had been reviewed. However, daily diary notes did not contain any information to show that the care plan was being followed. For example, one care plan stated that the resident should ‘walk escorted in the garden or lane each day’ but there was no record of this happening in the daily notes: the activities record on this care plan showed one entry of ‘walked in the garden’ between early May 2005 and the date of the inspection (20th August 2005). Another plan needed ‘a pattern of elimination to be established’: entries on the daily record were not satisfactory to enable this to happen. There was no photograph on the file. A second care plan was checked for records of meals eaten. Daily diary notes did not refer to actual food eaten, but there were many entries referring to Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 10 ‘lunch not eaten’, ‘poor appetite’, ‘no breakfast today’ and so on. The record of this person’s weight showed s/he had been losing weight since August 2004. The ‘record of professional visits’ in the care plan (from 08.01.04 to 14.07.05) showed no evidence that the weight loss had not been discussed with any professional (for example, GP, nurse, or dietician). The home uses a weekly dosette box system for medication. When the inspectors arrived at the home, the full dosette boxes for the following week were in a cardboard box under the desk in the unlocked room adjacent to the kitchen. Records of the administration of medication (MAR sheets) were checked. There were a number of issues: several gaps where there was no signature so there was no record of whether the medication had been administered; a code ‘F’ had been used in several places but there was no definition of what this meant; changes to the MAR sheets were not signed; and it had been recorded that a medication was missing from the dosette box for two days, but there was no follow-up action recorded. Controlled drugs are stored correctly. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Records and discussion indicated that little activity is offered to the residents. Families are welcomed at the home anytime and a balanced, nutritious diet was recorded on the menus seen. EVIDENCE: The ‘activity record’ in one resident’s care plan showed four activities had been undertaken between 7th and 31st May 2005: these activities were ‘sing-a-long’, ‘softball’, ‘sing-a-long’, and ‘walked round the garden and had tea’. There were no further entries on this record since 31st May 2005. The activities diary was seen. The first entry was on 18th July 2005 and there were nine entries (in thirty three days) where a short activity had been recorded. Discussion with staff indicated that some other activities are undertaken but not recorded, but that usually there are not enough staff on duty for any activities to be started. Families are made welcome at the home anytime, and are invited to stay for a meal if they wish to. Menus and the record of food provided were seen. The menu offers a good, varied diet. The cook on duty explained that sometimes the menu is altered, to reflect events in the home: for example, on the day of the inspection a family was joining the residents for lunch, so the Sunday roast meal was being Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 12 cooked instead of the planned menu. The record of food provided did not record when an individual had eaten an alternative to the menu and this was not recorded in the care plan of one resident who was reported to have different meals almost daily. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure: it was reported that no complaints have been received. Staff have not had training in the protection of vulnerable adults. EVIDENCE: The home’s complaints procedure is displayed in the entrance hall. The deputy manager confirmed that no complaints had been received. Reports written by the provider when she carries out the visits to the home as required by regulation 26 (Care Homes regulations 2001) always indicate that relatives are very satisfied with the care offered. The home has the Cambridgeshire policy on Protection of Vulnerable Adults (POVA) available in the duty office, and the deputy manager was familiar with the procedure to be followed if abuse is reported. A member of staff spoken to demonstrated a good understanding of POVA and abuse even though she had not received any training in POVA. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 and 26 Residents have access to safe and comfortable indoor communal areas and the majority of the home was clean and odour-free. Access to the garden is limited by the building work and a bathroom is used for storage. EVIDENCE: The home was light and airy, comfortably furnished and reasonably well decorated. The majority of the home seen was clean, however two of the bedrooms seen had a strong smell of urine. A large extension to the home is being built. To achieve this the original office has been demolished and the whole of the back garden is being used by the builders. Access to the site is via one side of the home, so the car park, driveway and front lawn are still accessible, as is the small enclosed patio outside the conservatory. The office has partly been relocated to a portable building next to the car park: this has no internal access from the home. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 15 The main bathroom had several items including commodes, a chair, a wheelchair and a hoist stored in it. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 There are not adequate staff on duty to ensure that the needs of the service users are met. Staff do not receive sufficient appropriate training for the job they are employed to do. EVIDENCE: At the time of the inspection there were four staff on duty at the home: the deputy manager who also carries out hands-on care; one care assistant; one member of staff who was carrying out the domestic chores, but who was on the rota to do care assistant duties once the domestic chores were completed; and the cook who explained that her main role is care assistant, but she cooks when the cook is having a day off. The rotas showed that during the week there are two care staff on duty, plus the manager, for the majority of the time. Several staff work a long day (thirteen hours). All the staff members spoken to said they very much enjoy working at the home. The records of activities undertaken, and daily records of tasks carried out with residents, are evidence that there are not enough staff on duty to meet the needs of the residents, and this was confirmed by staff. Following the previous inspection and discussion with the proprietor, an additional care assistant was added to the team for parts of the day, but this had not been continued. One staff member said s/he had had training in fire safety and basic food hygiene, and is pleased to be undertaking a National Vocational Qualification (NVQ) in care level 2. S/he had not had training in moving and handling, use Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 17 of a hoist, first aid, infection control, POVA, or care of people with dementia. Training records were not seen. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38 The management practices carried out by the home are not adequate to ensure the safety and well-being of the residents. EVIDENCE: The acting manager was not on duty at the time of the inspection: the home does not currently have a registered manager. The deputy manager is a qualified social worker and is undertaking NVQ level 4 in care. She was professional and helpful towards the inspectors and showed enthusiasm for offering a good service, and knowledge of the requirements of residential care. Records of fire alarm checks showed that no test of the fire alarm (required to be undertaken weekly) had been carried out between 14th July 2005 and 18th August 2005 when ‘the fire alarms went off’. It was recorded that monthly tests of the emergency lighting had been carried out each month except June 2005. Records of the training that staff have received in fire safety were not clear enough to confirm that every staff member receives training in fire safety Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 19 awareness twice in every twelve months. Records of fire drills were not seen. One fire exit has been relocated due to the building work: signs indicating the direction of the new fire exit were confusing. Not all records required to be kept in the home were checked at this inspection. The staff duty rota and record of visitors to the home were satisfactory. The record of food provided, care plans and records of tests of the fire equipment and fire drills (referred to in the relevant standards above) were not satisfactory. Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 2 x x x x 2 STAFFING Standard No Score 27 1 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x x x 2 1 Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 7 8 Regulation 15 12 Requirement Evidence must be available to demonstrate that care plans are followed by staff The health and welfare of all residents must be maintained at all times. An immediate requirement notice regarding this in respect of one resident was left at the home Medications must be stored securely at all times. An immediate requirement notice was left at the home regarding this. Records of the administration of medication must be completed accurately Arrangements must be made to provide adequate and suitable activities for the residents Staff must be trained in the protection of vulnerable adults Bathrooms must be usable and not used for storage All parts of the home must be kept free from offensive odours. This was a requirement following the inspection on 21 March 2005: the timescale was not met Timescale for action 30 September 2005 22 August 2005; and ongoing in respect of all residents 20 August 2005 3. 9 13(2) 4. 5. 6. 7. 8. 9 12 18 21 26 13(2) 16(m) and (n) 13(6) 23(2)(j) 16(2)(k) 20 August 2005 30 September 2005 31 October 2005 30 September 2005 30 September 2005 Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 22 9. 27 18(1)(a) 10. 28 and 30 18(1)(c) 11. 12. 37 37 17 and sch 4 17 and sch 4 13. 38 23(4)(e) The registered person must ensure that adequate numbers of staff are working at the home to meet the need of the service users at all times. This was a requirement following the inspections on 21 March 2005 and 10 August 2004. The timescales have not been met. Staff must receive training appropriate to the work they are to perform. A training plan is to be sent to the CSCI within the timescale. All records must be maintained in the care home as required by regulation The record of food provided must be kept in sufficient detail to demonstrate that the diet is satisfactory and to record any special diets for individual service users. This was a requirement following the inspection on 21 March 2005: the timescale was not met Fire drills must be carried out and recorded Tests of the fire alarm system must be carried out weekly as required and recorded. An immediate requirement notice was left home regarding this Signs, which indicate fire exits and the route to the exit, must be clear All staff must receive training in fire safety On receipt of this report and ongoing 30 September 2005 31 October 2005 On receipt of this report and ongoing 14. 38 23(4)(c) On receipt of this report and ongoing 20 August 2005 15. 38 23(4)(b) 16. 38 23(4)(d) On receipt of this report and ongoing 31 October 2005 Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 23 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 Good Practice Recommendations Millfield Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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 Lodge I53 Millfield Lodge s15176 v219263 200805 stage 4.doc Version 1.40 Page 25 - 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. 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