Inspection on 22/07/08 for Millfield Lodge

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

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 Lodge 04/10/07

Millfield Lodge 15/02/07

Millfield Lodge 02/10/06

Millfield Lodge 29/11/05

Millfield Lodge 20/08/05

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 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Millfield Lodge Potton Road Gamlingay Bedfordshire SG19 3LW Lead Inspector Elaine Boismier Unannounced Inspection 22nd July 2008 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millfield Lodge Address Potton Road Gamlingay Bedfordshire SG19 3LW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01767 650734 01767 651434 Ms Anita Ram Ms Anita Ram Care Home 31 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (31) of places Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2007 Brief Description of the Service: Millfield Lodge is situated on the edge of the village of Gamlingay in the South Cambridgeshire District. It is located at the end of a short private drive and is within about a mile of the shops, doctors 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. Millfield Lodge is a single storey building. In 2006 the home was extended and the original home altered and refurbished. The home now has thirty-one single bedrooms. The twenty newer rooms each have a large ensuite shower room; seven rooms have an ensuite toilet, and four rooms have a washbasin. There are two lounges. One of the lounges has a large conservatory attached, which has doors to an enclosed patio area. Both lounges have dining areas and there is a large dining room. There are two bathrooms and a shower room, as well as a kitchen, laundry room, offices and staff room. The home has plenty of parking spaces at the front, and large gardens to the rear and side of the building. The current fees range from £368 to £550 with additional costs to include those for chiropody and hairdressing. Further information about the fees can be obtained from the home. CSCI reports are available from the manager or from our website at www. csci.org Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This star rating could improve should action be taken by the home to maintain those areas assessed as good and to take action in response to the findings of this report. We, The Commission for Social Care Inspection, carried out this unannounced key inspection, by two Inspectors, between 9:50 and 15:50 thereby taking 6 hours to complete. We looked at information received about the home since the last inspection of October 2007 and up to this inspection of July 2008. We sent out surveys to staff, residents and relatives and some of these we received. We also received a completed Annual Quality Assurance Assessment (AQAA) that had been completed by the Manager and sent to us before the inspection. During the inspection we looked around the premises, spoke with some of the residents, staff and the Manager, examined documentation and observed the day-to-day activities going on in the home. For the purpose of this inspection report people who live at Millfield Lodge are referred to as “people”, “person” or “resident/s”. What the service does well: Comments in the residents’ surveys included, “I was very well taken care of, thank you” and “I am happy with my care.” One of the people said that they were “Very well looked after “ and felt that they were (pleasingly) “mollycoddled”. One of the letters received by the home said, ”During the time with you I was always pleased to see how cared for Mum looked; she was always obviously dressed with affection.” Care plans were detailed and person centred, providing the staff clear guidance in how to meet the assessed needs of the residents. People are given the opportunities to live a good quality of life. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 6 People are listened to if they are unhappy about something. People live in a safe, comfortable and clean home. People receive safe and proper care from well trained and generally well recruited staff. We read the following comments in the surveys that staff “…are certainly very caring” and that staff have attended training that … is reflected in the high standard of care provided.” People benefit from a home that is generally well managed. A relative wrote in their survey “In the 15 months my father has been here we have seen a steady improvement in everything the home is doing. Practices, procedures etc are constantly being updated.” What has improved since the last inspection? What they could do better: Action must be taken should any person be found to have unintentional weight loss. We expect the home to manage this issue rather than we make a requirement on this occasion. We have made a requirement for people to have access to a falls prevention co-ordinator to consider ways to reduce the number of falls occurring and therefore reducing the risk of serious injury. Special instructions for the administration of medicines must be followed to protect residents from harm and an immediate requirement was made about this. We have made a requirement that all safeguarding events are reported in line with local reporting procedures, to reduce the risk of abuse occurring at the home. (Safeguarding was previously known as protection of vulnerable adults against abuse or POVA). There must be a reduction of the risk of infection by ensuring that the methods of providing personal care are safer. We expect the home to manage this issue rather than we make a requirement on this occasion. All required information about staff must be obtained before they start working at the home. We expect the home to manage this issue rather than we make a requirement on this occasion. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 7 We must be notified of any untoward incident and any other events occurring in the home, as defined under regulation 37 of the Care Homes Regulations 2001. We have made a requirement about this. All of those people attending a fire drill must have their names recorded. We expect the home to manage this issue rather than we make a requirement on this occasion. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is good. People have a good standard of information about the home and there are good systems in place to make sure the home is a suitable place for them to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the 6 residents’ surveys said that the person had received enough information about the home before they moved in. One person wrote, “The information I received was very detailed and turns out to be true.” A copy of the last inspection report was in the Manager’s office. According to the AQAA “A comprehensive pre-admission needs assessment of the prospective resident is completed by senior staff either during their visit to the Home (if they choose this) or staff visit their home, hospital or other establishments and make available photos of the Home environment. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 10 Examination of 4 people’s care records indicated that these people had assessments of their needs by social care and health care professionals and the Manager had confirmed in writing, to the person that the home could met the person’s assessed needs. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. People receive an adequate standard of healthcare that could be better for them to be safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA explained to us “Every resident has a detailed care plan in place, written clearly, easily understood and person-centred. Each care plan covers all the areas of need documented in NMS standard 3 and based on the Activities of Daily Living model of care. Residents and/or their representatives are involved in developing their care plans based on their life histories, risk assessments and assessments of needs to promote their independence and choice in their day-to-day living” and “We request that residents or their representatives involved sign their care plans to indicate their agreement . Care plans are reviewed monthly or more frequently if necessary, they are updated to reflect changing needs and adjustments agreed to the plans of action.” Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 12 We examined four people’s care records and found that these were detailed and person centred, providing the staff with clear guidance in how to meet the assessed needs of the residents. During our observation, of staff working, we saw that they provided care as directed in the care plan, such as reducing agitated behaviour by diversion activities and staff were able to tell us the individual needs of residents. Some of the care plans had signatures of the people’s relatives to confirm that care was provided in a consensual way. The care records also demonstrated that where a person declined the care offered, this was clearly recorded and discussed with the person’s relative. Care plans were actively reviewed each month. Risk assessments for falls, nutrition, risk of pressure sore development and moving handling were updated each month with the exception of two risk assessments for nutrition. During our examination of the record of weights we found that the (above) two of the four people had stable weights. For the remaining two people there was a record of unintentional weight loss: • The record for one of these people had a weight loss between 18th June 2008 and 20th July 2008 of 11.9kilogrammes: the risk assessment for nutrition had not been updated to reflect this significant decrease in weight. The care plan stated that should the person have unintentional weight loss, the GP or dietician should be contacted; there was no record of action being taken to contact any of these healthcare professionals. We discussed this recorded significant amount of weight loss with the Manager and, although we considered this might have been an error of recording no action was taken (e.g. re-weighing the person) and no sense was made of such a significant weight loss. For the second person there was a recorded weight loss of 3.1 kilogrammes between 20th June 2008 and 20th July 2008. There was no record of what action taken, if any, in response to this unintentional weight loss, althought the care plan stated that the GP or dietician should be contacted. We saw that this person had been assessed, by a community psychiatric nurse, to have an increased level of needs requiring nursing care. We expect the home to manage this issue rather than we make a requirement on this occasion. • An examination of the record of accidents was carried out and we noted that there was a high number of falls sustained by a number of the people. According to the Manager she analyses these incidents and stated that the incidence of falls occur more during the afternoons and evenings. We found no record that the home had contacted the the falls prevention coordinator for their specialist advice. The Manager stated that she had spoken with the district nursing services and GP practices and the advice given by these healthcare services was that there was no further action to be taken. We Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 13 have taken the view, however, that specialist advice must be sought to assess if the number of falls could be reduced, and such specialist advice to be provided by a falls prevention co-ordinator. A requirement has been made about this. The care records, that we saw, indicated people have access to a wide range of healthcare professionals to include opticians, dentists, GP practices, chiropody services and district nursing services. At the time of our inspection a person was attending an out patients appointment, with the support from staff and a district nurse was visiting some of the residents to carry out healthcare treatments. All of the 6 residents’ surveys said that the person received the medical support, personal care and general support that they needed. Comments in the surveys included, “I was very well taken care of, thank you” and “I am happy with my care.” All of the 5 surveys from relatives said that the home always provided the support and care to meet the needs of their relative. Comments included, “The staff understand my mother’s needs well” and “My mother is well cared for and safe”. We also read from another relative’s survey, “I am always surprised at the time staff spend with everybody…” One of the people said that they were “Very well looked after “ and felt that they were (pleasingly) “mollycoddled”. One of the letters received by the home said, “During the time with you I was always pleased to see how cared for Mum looked; she was always obviously dressed with affection.” Staff we spoke with said that, when providing personal care to people who had been incontinent, staff would use either incontinence wipes or flannels to clean the person. Staff were unable, however, to distinguish which flannel was to be used for the person’s face area and which flannel was to be used for their (main) body. Such practices pose a risk of infection and we expect the home to manage such an issue, rather than we make a requirement on this occasion. A specialist pharmacist inspector examined the practices and procedures for the safe handling, recording and administration of medicines. People are protected by good and clear policy and procedural documentation on the safe use of medicines and staff are aware of this. The facilities provided to store medication are satisfactory and the temperatures well controlled and recorded to maintain the quality of medicines used. Separate storage is provided for controlled drugs but we found that one medicine which should have been stored and recorded as a controlled drug was not, although staff spoken with were aware that it should have been. We expect the home to manage this rather than make a requirement on this occasion. Records of the receipt, administration and disposal of medicines are of good standard and provide a clear audit trail of medicines in use. We found one example of a stock discrepancy which could have been the result of an arithmetical error in the records. The records of administration of medicines for two people were Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 14 inaccurate, one who did not receive his night-time medication on 21/7/08 and another whose medication was given on the morning of the inspection. We again expect the home to manage this without the need for a requirement. For one person, whose medication is clearly labelled to be taken 30 minutes before food and according to the specific instruction on the leaflet with the medication that states it should be at least 30 minute before other medication, the record shows it being given at the same time as other medication and this was confirmed by care staff. This poses a risk to this person and an immediate requirement was made to remedy this. There is one person who self-administers his medication and his care plan contained a good assessment of his needs and a risk assessment. The assessment stated that this would need to be reviewed every two months but did not appear to have been re-assessed since August 2007. We expect this to be managed by the home. Staff training of the safe use of medicines is of a good standard and staff are assessed for their competence to administer medicines safely. But in the staff training file we found two reports of where medication had not been given to a resident but the records had been completed to show they had. CSCI have not been notified of these incidents, the reports were not dated and there was no record of any remedial action taken. A requirement was made, following our last inspection, for people’s dignity to be respected at all times. The AQAA told us “Staff are aware of the DH Dignity in Care Report of Public Survey 2006.” People we spoke with said that staff always knock before they enter the person’s bedroom and we saw this was the case. Staff described how they would carry out people’s personal care and these descriptions provided evidence that people’s dignity and privacy is respected. We saw staff interact with people in the appropriate, kind and caring manner and called the person by their name. This requirement has been met. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. People are provided with opportunities to live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of the residents’ surveys (5) said that the home provided activities that the person could take part in. People wrote, “I enjoy participating in activities organised by the home” and “ I like do to reading with books I get from the library that visit the home. Also I go for walks with care staff…we go shopping with (the) Activities Cordinator (sic)”. The AQAA told us “We have an Activities Coordinator who is employed for five days per week up to 15 hours in total. She is aware of each residents lifestyle aspirations and incorporates their choices in planning the activities. She is trained and experienced in the provision of activities for older people and people with dementia”. Examination of the staff duty roster, for week beginning 21st July 2008, indicated that the activities co-ordinator was due to work from 14:00 hours to 16:00 hours, Monday to Friday. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 16 People we spoke with, including staff, told us that there had been a bar-b-q held at the home, on the 19th July 2008. Activities that people took part in were recorded in their care records, and these included exercise games with the use of a softball, sing-along sessions and manicures. All of the 5 surveys from relatives said that they visited the home on a regular basis. One of these surveys said,” I feel very welcome when I visit.” We saw some people’s guests arriving at the home. According to the Manager the relatives take an active part in influencing what takes place at the home and minutes of the last residents’ and relatives’ meeting, held on the 27th April 2008, confirmed this to be the case. All of the relatives’ surveys said that the home always supported the people to live the life that they chose and the AQAA said “On a daily basis staff consult with residents (or visiting relatives/representatives) to seek their views on how they wish to spend their day…”. People we spoke with said that they could stay in bed if they chose to (although they wanted to get out of bed when staff came into their rooms). We saw people sitting with other residents or by themselves, as they so wished. One of the people said that they were allowed to sit by themselves when they chose to do so. All of the 6 residents’ surveys said that the person liked their meals. Comments included, “The food and the service are excellent” and “The catering staff do a first class service”. Another of the surveys indicated that if the person did not like what was on the menu “I get something else to eat.” People we spoke with said that they liked the food and we saw that alternative menu choices, that had been offered, were recorded. People were eating chicken and mushroom pie, vegetables and apple pie with custard. We saw staff assisting some of the people with their food and this was done on an individual basis with care staff sitting down by the person they were helping. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. People are listened to but they are at some risk of abuse due to the current standard of reporting of safeguarding events. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the 6 residents’ surveys said that staff listened and acted on what the resident said to them. All of these surveys, and the 5 surveys from relatives, said that the person knew what to do if they wanted to make a complaint and information about the home’s complaints procedure was available in people’s own rooms. During the tour of the premises we saw this information was available although this could be expanded to indicate where the home’s complaint procedure that is referred to in the information provided throughout the home, could be obtained. All of the surveys from staff said that the person knew what action to take if a concern was made to them from a resident or visitor to the home. One of the surveys, from a relative, said, “Whenever we have had any concerns they are dealt with quickly and professionally.” The AQAA told us that all of the 6 complaints that have been made were responded to within the required 28 days timescale and 5 of these complaints were not proven. We examined the record of complaints and we found there were no recurring elements of these Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 18 complaints. The responses to the complaints were detailed and carried out within the 28 required period of time. We have received no complaints. Staff told us what they would do in the event of a witnessed event, or suspicion of abuse against any of the residents and if they were uncertain who to contact would know where to get this information, in the Manager’s office. We found that there was such information as told to us by the members of staff. Staff training records indicated that staff have attended training in safeguarding awareness for 2008 and this had been provided by the Manager. Two most recently recruited staff induction-training records were seen and these contained an induction awareness of safeguarding issues (See Standard 30 of this report). Examination of people’s care records and information provided to us before the inspection indicates that the home has not followed correct safeguarding reporting procedures, for at least three incidents: • An internal investigation had been carried out by the home following an allegation of a physical assault by a member of care staff to a resident. The home had not contacted the safeguarding team for advice before carrying out this investigation. A person had unexplained bruising to their body; the home had not reported this finding to the safeguarding team. A person had thrown crockery at staff and onto the floor, in front of other residents; the home had not reported this to the safeguarding team. • • We have made a requirement about this. During the inspection we witnessed an incident of physical abuse against one resident by another resident. We saw staff defuse the situation in a calm and measured manner thereby reducing the recurrence of such an untoward incident. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. People live in a safe, comfortable and clean home although some of them are at some risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us that certain areas of the home have improved within the last 12 months. These include “…major works in landscaping of the gardens with very solid, comfortable and pleasant garden furniture. The gardens are now very pleasing (sic) for residents, relatives and staff to enjoy and well used. Roof blinds have been fitted to create comfortable room temperatures in both summer and winter seasons. The lighting in the large dining room have been replaced with three chandeliers.” Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 20 The home was found to be well decorated and generally well-maintained with gardens and courtyard areas that were safe and accessible for people to visit. According to the Manager arrangements are in place to provide sensory stimulation for people with mental health needs in the garden and inside the home. All the surveys from residents said that the home was always fresh and clean and we found that this was the case. Staff training records indicated that 18 of the 23 current staff have attended training in infection control. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. People can be confident that they receive care from well trained and generally well recruited staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People wrote their views about staff in their surveys that we have received. All of these surveys considered that the staff were available when the person needed them. People wrote that there was “…excellent help at all times” and “Have no problems with the staff, they are always very helpful”. All of the 5 staff surveys said that there was always enough staff on duty and that there are bank staff “to cover in case of emergancy (sic) or sickness of staff. Staff we spoke with said that there was enough staff on duty and we saw people being cared for in an unhurried manner and receiving individual attention. Staff told us that they liked working at the home and according to the AQAA, and the Manager, there has been a relatively small turnover staff with 5 whole time and one part time staff leaving within the last 12 months. All of the 5 surveys from relatives said that staff always/usually had the right skills and experience to look after their relative properly. Comments about staff in these surveys said that staff “…are certainly very caring” and that staff Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 22 have attended training that “…is reflected in the high standard of care provided.” The home has at least 11 members of staff with a National Vocational Qualification (NVQ) level 2, in care with some of the staff having NVQ level 3 in care. We saw from the training records a small number of staff are attending training at level 4 and, according to the Manager and records that we saw, there are some staff who have a healthcare qualification, such as nursing or physiotherapy, before they started working as care staff at Millfield Lodge. The home has above 50 of staff with an NVQ level 2, equivalent or above, in care. An examination of two files of staff most recently recruited was carried out: all the required information was available with the exception of an unexplained gap in employment history between November 2007 and March 2008. We expect the home to manage this issue rather than we make a requirement on this occasion. We received 5 surveys from staff and these told us that the members of staff attended an induction training that covered all aspects to prepare them for the work that they were employed to do. These staff surveys told us that staff have attended ongoing training to make sure that the care they provide is safe and up to date to be able to meet the needs of the residents. During our examination of the staff records of people most recently recruited we saw that their induction training programme was with the use of the Skills for Care national minimum standards. These training records indicated that the person and their mentor had signed off parts of the induction training, once these had been completed. Staff told us, and their training records confirmed, that they had attended ongoing training such as care of people with dementia and Parkinson’s disease and external trainers had provided this training. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is good. People benefit from a home that is generally well managed although reporting procedures could be better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: With regards to the management of the home a relative wrote in their survey “In the 15 months my father has been here we have seen a steady improvement in everything the home is doing. Practices, procedures etc are constantly being updated.” The Registered Manager is also the registered owner and is supported by an Assistant Manager, one senior team leader and three team leaders, as part of the management system of the home. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 24 Information provided to us before this inspection and findings during this inspection, indicates that people and their relatives are satisfied with the management of the home. We found from the information before the inspection and during this inspection that we have not received required information of any untoward event occurring with the home. These events include the following: • Medication errors (See Standard 9 of this report) • Safeguarding issues (See Standard 18 of this report) • Injuries sustained by residents, such as falls, requiring medical attention (See Standard 8 of this report). We have made a requirement about this. The AQAA explained to us what quality assurance systems the home has,” The Home has an effective consultation-based quality assurance process, involving stakeholder questionnaires, an external quality monitoring audit conducted by an experienced consultant, frequent residents and relatives meetings and a plan that points to the future development of the service. The results of the stakeholder surveys are made available for everyone in the Home and the information obtained influences practice and planning for improvements.” We saw that surveys had been carried out for 2008 although, as yet, the results of these surveys have yet to be collated and analysed. The AQAA was detailed and clear and told us what the home did well in, how it had improved within the last 12 months and areas that could be improved upon. Minutes of the residents’/relatives’ meeting for April 2008 were seen and the information provided indicated that people offer their views and suggestions about the home and these included suggestions about the activities and food. The activities programme, that was on display, said that the programme was devised according to what people had asked for. Three people’s personal monies, that the home takes care of for safe-keeping, were checked. The amounts of monies reconciled with the balances. Receipts for hairdrssing and chiropdy, for example, were available. All of the staff surveys told us, and staff we spoke with confirmed, that staff have 1:1 supervision at least every two months and records of these were seen. The supervision records indicated that training needs are discussed and the home’s policies and procedures, such as safeguarding and the Statement of Purpose, are also considered during these supervision sessions. A recommendation was made for an audit to be carried out on the sofas and Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 25 chairs, to ensure that people could get up. According to the AQAA “Three new chairs chosen by relatives and residents were replaced following an audit of chairs to establish comfort and safety of residents.” We saw no person having difficulty getting out of a chair and therefore we consider this recommendation has been considered. The AQAA informed us that 100 of catering staff and 100 of care staff have attended training in safe food handling. The AQAA also told us that service checks are in date for hoists, portable appliance tests (PATs) and fire detection and fire fighting equipment. We saw that some, but not all, of the PATs were in date and records confirmed that service checks had been carried out on hoists. Speaking with staff and examination of health and safety records indicated that staff have attended training in first aid, fire safety and moving and handling. We saw safe moving and handling practices including the use of a moving and handling belt. Other records we saw included safety checks on the hot and cold water supply, the temperatures of food fridge and freezers and emergency lighting and fire alarms and these were satisfactory. The last fire drill had been carried out within the last 6 months although there were no names of who attended this fire training session. We expect the home to manage this rather than we make a requirement on this occasion. Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 x 3 3 x 3 Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 13(1)(b) Requirement People must have access to a falls prevention co-ordinator to reduce any risk of serious injury. Ensure special instructions for the administration of medicines are followed and that the records made reflect this. This will protect residents from harm. Safeguarding procedures must be followed to protect vulnerable people from the risk of abuse and any harm to their welfare. Any untoward event must be reported to CSCI, to ensure that the registered person complies with their responsibilities of their registration, which ultimately protects people in their care. Timescale for action 01/09/08 2. OP9 12(1) 13(2) 24/07/08 3. OP18 13(6) 30/07/08 4. OP31 37 30/07/08 Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millfield Lodge DS0000015176.V368539.R01.S.doc Version 5.2 Page 30 - 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!