Inspection on 29/11/05 for Millfield Lodge

This inspection was carried out on 29th November 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 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Millfield Lodge Potton Road Gamlingay Bedfordshire SG19 3LW Lead Inspector Nicky Hone Unannounced Inspection 10:10 29th November and 1 December 2005 st 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.V269315.R01.S.doc Version 5.0 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.V269315.R01.S.doc Version 5.0 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 Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th August 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 a large extension to the rear of the home was being built. The office has been demolished and moved to a portable building at the front of the home and the back gardens are no longer accessible. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection of Millfield Lodge for the inspection year 2005/6. The inspection was undertaken by two inspectors on the 29th November and the 1st December 2005. The first day of the inspection was unannounced and the second day of the inspection was announced. The inspectors spent 5 hours in the home and spoke to service users, staff and the acting manager. A tour of the home was undertaken and documentation was read. The acting manager completed a pre inspection questionnaire and some of the information contained in the questionnaire has been used to write this report. Prior to the inspection the Commission received 8 completed relatives’/visitors’ comments cards and the comments received are reflected in this report. What the service does well: What has improved since the last inspection? What they could do better: The acting manager was informed of three areas where immediate action had to be taken. Immediate requirement notices were left at the home stating that staff must not start work at the home until all of the checks are in place, prescribed creams must be stored correctly and fire doors must not be kept in the open position by a means not approved by the fire safety officer. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 6 Staffing levels must be reviewed to ensure that there are enough staff on duty in the home and care plans must provide staff with further information about how to care for the service users. 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 DS0000015176.V269315.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: None of these standards were assessed. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 the following standard(s): 7,8 and 9 The care plans do not adequately provide staff with the information that they need to satisfactorily meet service users needs. Medication practices have improved since the last inspection but service users are put at risk by the inappropriate storage of prescribed creams. EVIDENCE: Three care plans were inspected. The care plans did not provide clear guidance to staff about how to meet the needs of the service users. An example of this is that a care plan stated ‘ for care staff to monitor X’s dietary and fluid intake’. The care plan gave no further guidance in relation to this need. The care plans did not identify all of the needs of the service users. An example of this is that a risk assessment undertaken in respect of one service user identified that the service user was at risk of drinking toiletries and chemicals. The guidance to staff in the care plan in relation to maintaining a safe environment was ‘for care staff to ensure X is comfortable and her immediate environment is free from hazard’. The care plans did not contain the information that was included in the risk assessment. One service user is at Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 10 risk of developing pressure sores but a care plan in respect of the prevention of pressure sores had not been developed. During the previous inspection it was noted that the actions taken by staff in relation to a service user who had a significant weight loss over a short period of time had not been recorded. There was evidence during this inspection that staff were now recording the actions taken. Service users are weighed monthly but it was noted that on two occasions one service user who had lost weight had refused to be weighed on the day that she was due to be weighed and staff had not attempted to weigh her again until the next month. Where service users are losing weight they must be weighed on a regular basis. The medication records were checked and it was noted that there were no gaps in the records of medications administered and that if medication was not administered the records stated the reason why. Dossette boxes were all securely stored. These were requirements from the previous inspection. One service user had an entry made in their daily record stating that ‘Nitrazepene should be stopped for three nights’. There was no evidence that the GP had made this decision or been consulted for advice. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 and 15 Families are welcomed at the home at anytime. Service users are provided with a varied menu. The range of activities provided must be reviewed to ensure that the activities provided appeal to as many service users as possible. EVIDENCE: Since the previous inspection a part time activity co-ordinator has been employed. A record of activities undertaken by service users is kept. Staff must ensure that all service users are provided with the opportunity to participate in activities. The records for one week showed that although activities took place every day only five service users were involved. Activities undertaken during the week commencing 23 November 2005 included putting up Christmas decorations, conversation, puzzles, listening to stories and soft ball. The range of activities undertaken must be reviewed. All of the relatives/visitors who returned a completed questionnaire to the Commission for Social Care Inspection stated that they are made to feel welcome whey they visit the home, that they can visit at any time and that they can visit their relative/friend in private. At the time of this inspection an extension to the home was being built. The inspectors were informed that when it is completed the service users will be Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 12 moved to bedrooms in the extension. Service users must be given a choice about this. The majority of bedrooms in the home will still be in use when the extension is completed and service users must not be moved to another bedroom if this is not their decision. The meal seen during this inspection looked appetising and well presented and was beef stew and fresh vegetables. The home has a varied menu and the inspectors were informed that the majority of the food served consists of fresh ingredients. Alternatives to the menu are provided. There is a four weekly menu. A record of food eaten by service users is maintained. This was a requirement that featured in the previous inspection report. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a satisfactory complaints procedure but relatives and representatives of service users must be made aware of the procedure. EVIDENCE: The home has a satisfactory complaints procedure which is on display in the entrance hall. Six out of the eight relatives who forwarded a completed questionnaire to the Commission stated that they did not know how to make a complaint. The home has the Cambridgeshire policy on Protection of Vulnerable Adults (POVA) available in the office and the team leader stated that she was familiar with the policy and the procedure to be followed if abuse is reported. The inspectors were informed that since the previous inspection staff have received training in the Protection of Vulnerable Adults. This is a requirement from the previous inspection which has been met. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 the following standard(s): 19,21,and 24 Service users live in a well-maintained, comfortable and clean home but their safety is compromised by doors being wedged open with pieces of furniture contrary to fire regulations. EVIDENCE: At the time of this inspection the home was clean and free from any offensive odours. The previous requirement that all parts of the home must be kept free from offensive odours has been met. The home is well maintained and has a homely atmosphere. On touring the home it was noted that two bedroom doors were kept in the open position by a means not approved by the fire safety office. One bedroom door was kept in the open position with a footstool and another was kept in the open position with a chair. An immediate requirement notice was left at the home and on the second day of the inspection a ‘doorguard’ had been fitted to the bedroom door which had been kept open by the footstool. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 15 A bathroom was being used as a storage area – equipment stored included three wheelchairs, three zimmer frames, 1 set of sit on scales and a portable hoist. Given the fact the home is currently having extensive building work undertaken and that the bath and toilet were still accessible to the service users the previous requirement that bathrooms must be usable and not used for storage has not been carried forward on this report. However, once the building work has been completed bathrooms must not be used as storage areas. 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 been partly relocated to a portable building next to the car park: this has no internal access from the home. A wardrobe in one of the bedrooms seen during this inspection did not have enough space to hang all of the service user’s clothes. Many of the items were laying on the bottom of the wardrobe. Adequate enclosed space for hanging clothes must be provided. Bedrooms were well decorated and there was evidence that service users had been encouraged to bring their personal effects into the home. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. Staffing levels must be reviewed to ensure that there are enough staff on duty to meet the needs of the service users. Staff receive appropriate training for the job that they are employed to do. EVIDENCE: On the morning of the first day of the inspection there were three members of care staff (a team leader and two care assistants), two domestic staff and a cook on duty. The staff rotas were inspected and showed that the this is the usual amount of care staff on duty in the morning, that in the afternoon there are usually three care staff on duty and during the night there are three staff on waking night duty. The acting manager stated that until recently there were two members of waking night staff on duty but she had increased this to three because two members of staff were not adequate. The inspectors stated that it is unusual for the same amount of care staff to be on duty during the day and night. A review of staffing levels must be undertaken to ensure that there are sufficient staff on duty. The inspectors were of the view that there may be not be enough care staff – several of the service users were not calm and staff were rushed. Five of the eight relatives/visitors who returned a completed questionnaire to the Commission stated that there were not enough staff on duty. Four relatives/visitors commented on the high turnover of staff. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 17 The files of the staff on duty on the morning of 29 November were seen on the second day of the inspection. It was noted that three of the staff had been employed without a CRB disclosure being applied for, that there was no evidence that gaps in employment had been explored and that a written reference from a previous employer had not been requested. The acting manager stated since the 29 November she had checked the staff files and that the members of staff without the CRB disclosure had been informed that they could no longer work in the home until an application had been completed. None of the files seen contained a statement of terms and conditions of employment. Since the previous inspection the training undertaken by care staff has increased. Two members of staff have completed the NVQ level 2 in Care Award and are awaiting validation of their results. Courses recently undertaken by staff include Infection Control, Fire Safety, Manual Handling, POVA, First Aid and Risk assessments. The acting manager stated that training in Dealing with Challenging Behaviour is due to be undertaken by staff on 11 and 12 December. The home has a training plan detailing the courses to be undertaken by staff during 2006. The requirements that featured in the previous report in relation to staff training have been met. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 and 38 The management practices inspected were adequate and ensure that the health and safety of the service users are not compromised. EVIDENCE: The acting manager confirmed that a formal Quality Assurance System operates in the home and that the views of service users and their relatives/representatives are also sought informally on a regular basis. The team leader in charge during the first day of the inspection stated that service users are encouraged to handle their own finances but that the home will hold money on their behalf. The financial records of money held on behalf of three service users were inspected and were satisfactory. The fire safety log was inspected and it was noted that staff the fire alarms and emergency lighting is now being tested at the required intervals. Staff have Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 19 received fire training since the previous inspection and a fire drill has also been carried out. Fire exit signs and routes to the fire exits were clearly displayed. These were requirements from the previous inspection. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X X 2 X x STAFFING Standard No Score 27 2 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 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 Standard OP7 Regulation 15(1) Requirement Care plans must detail the actions required to be taken by staff to meet the needs of the service users and must identify all of the service users’ needs. Service users who are at risk of losing weight must be weighed on a regular basis. Prescribed creams must be stored securely. An immediate requirement notice was left at the home regarding this. Changes to prescribed medication must only made on the instruction of the prescriber. Arrangements must be made to provide adequate and suitable activities for residents. Carried forward as timescale of 30 September 2005 not met. Service users must not move rooms unless there is clear evidence that they have made an informed choice to do so. Relatives/visitors must be made aware of the complaints procedure. Timescale for action 31/01/06 2 3 OP8 OP9 12(3) 13(2) 29/11/05 29/11/05 4 OP12 16(m)(n) 31/01/06 5 OP14 12(2) 01/12/05 6 OP16 22(5) 31/12/05 Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 22 7 OP19 23(4)(c) (i) 8 OP24 23(2)(m) 9 OP27 18(1)(a) 10 OP29 19(1) sch 2 Fire doors must only be kept in the open position by a means approved by the fire safety office. An immediate requirement notice was left at the home regarding this. Adequate enclosed space for service users to store their clothing must be provided in each bedroom. Staffing levels must be reviewed and the outcome of the review forwarded to the Commission for Social Care Inspection. Full information as stated in Schedule 2 must be obtained before a person commences employment at the home. An immediate requirement notice was left at the home regarding this. 29/11/05 30/01/06 31/12/05 01/12/05 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 Refer to Standard OP29 Good Practice Recommendations All staff should receive a statement of terms and conditions of employment. Millfield Lodge DS0000015176.V269315.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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. 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