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Inspection on 04/10/07 for Millfield Lodge

Also see our care home review for Millfield Lodge for more information

This inspection was carried out on 4th October 2007.

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

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

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

What the care home does well

The majority of responses to the survey we sent out were positive, both from residents and from their relatives. One resident wrote, "The staff have helped me enormously and I now feel part of the home". Another resident wrote, "I am very happy here". A relative wrote, "On visiting we always get a warm welcome by all the staff and advice where mother is". The day we visited the home was well staffed. The shift was organised in a way that enables staff to know what their areas of responsibilities are. The morale of staff appeared good. A number of staff stated that the home had improved in the last year since the registered owner had taken over the management. This was echoed by a number of relatives. Staff training was good and most staff had a National Vocational Qualification (NVQ) level 2. Some staff had already started NVQ 3 and NVQ 4. One member of staff is doing the Registered Manager Award and other staff had completed courses relevant to their job. The home was clean, bright, spacious and airy. We did not identify any maintenance issues. The home has a full time maintenance person who was in the process of painting a number of doorframes. Some of the residents were sitting in the garden enjoying the good weather. The home has an activities coordinator who was engaging a group of residents in `reminiscing` about how things used to be when they were growing up. Residents freely contributed and clearly enjoyed the discussion. We saw care staff reading to residents and spending time with them. Daily social activities are available and these are illustrated on a board in the dining room. We observed lunch and saw that food was served hot and was home made. A four week menu was on display and snacks and drinks are offered throughout the day and evening. We were invited to have lunch and thoroughly enjoyed it. Care plans are implemented following the completion of a pre-admission assessment and those we saw gave a lot of detail in how to meet the residents` needs. These needs are reviewed monthly. Daily notes are kept and the monthly summaries highlight when a need has changed or is unmet. One relative wrote, "The care plans that have been put in place I feel are excellent and very reassuring".

What has improved since the last inspection?

The four requirements made at the last inspection had been met. The home continues to benefit from the strong and inclusive management style of the registered owner. There was evidence that residents, staff and relatives are encouraged to be involved in the decision-making processes. One such example is that relatives are invited to sit on the interview panel in the recruitment of senior staff. There are regular residents meetings. Residents chair the meetings. Meetings for relatives are also held bi-monthly. Records we inspected were good and no gaps were identified. We observed medication being administered safely. In our survey one relative wrote, "I feel happier about the levels of care and the home adjusts to suit my mothers changing needs".

What the care home could do better:

The home must demonstrate that residents are being treated as they wish to be treated and their dignity is maintained at all times. Care plans must be drawn up with the residents` involvement where ever possible and include their preferred routines of daily living. Some of this information could be uplifted from the original pre admission assessment. This will enable staff to respectresidents` preferred choices and preferences, particularly where the resident may not be able to verbally tell staff. A social history for each resident may be particularly helpful, even when staff know residents really well. There has been a high turnover of staff in the last year and a profile would assist new staff in engaging with residents and understanding their needs and behaviour.

CARE HOMES FOR OLDER PEOPLE Millfield Lodge Potton Road Gamlingay Bedfordshire SG19 3LW Lead Inspector Nicky Hone & Shirley Christopher Unannounced Inspection 4th October 2007 11:30 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.V352450.R02.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.V352450.R02.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.V352450.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2007 Brief Description of the Service: Millfield Lodge is situated on the edge of the village of Gamlingay. 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 CambridgeshireBedfordshire 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 fees for Millfield Lodge are £364 per week, or £449 to £600 per week for dementia care and higher dependency needs. CSCI reports are available from the manager. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Nicky Hone and Shirley Christopher carried out an unannounced inspection on the 4 October 2007 between 11:30 to 16:45. The last inspection to the home was on the 15 February 2007 and the inspection report that followed commented positively about the home. We felt that standards of care had improved and the challenge for the home would be to maintain its high standards and continue to move forward. On reviewing the evidence at this inspection the home continues to provide a high standard of care, in a clean and safe environment. The registered provider, who is currently also registered as the manager, continues to invest in her staff to ensure that they are suitably qualified and have the skills and competence to meet the needs of the residents. One of the inspectors did a lengthy piece of observation (two hours), in which she recorded what life was like for the residents. She found through her observations that interaction between staff and residents was mostly positive and appropriate, and staff were attentive and respectful. One requirement has been made relating to how staff address residents and how they spoke to them. We looked round the home, spoke with staff, residents, and visitors and looked at a number of records. The registered provider/manager completed a very detailed self-assessment form, which was returned prior to the inspection and 27 surveys for relatives, carers and advocates had been completed and returned to us. A number of comments have been included in the report. What the service does well: The majority of responses to the survey we sent out were positive, both from residents and from their relatives. One resident wrote, “The staff have helped me enormously and I now feel part of the home”. Another resident wrote, “I am very happy here”. A relative wrote, “On visiting we always get a warm welcome by all the staff and advice where mother is”. The day we visited the home was well staffed. The shift was organised in a way that enables staff to know what their areas of responsibilities are. The morale of staff appeared good. A number of staff stated that the home had improved in the last year since the registered owner had taken over the management. This was echoed by a number of relatives. Staff training was good and most staff had a National Vocational Qualification (NVQ) level 2. Some staff had already started NVQ 3 and NVQ 4. One member of staff is doing the Registered Manager Award and other staff had completed courses relevant to their job. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 6 The home was clean, bright, spacious and airy. We did not identify any maintenance issues. The home has a full time maintenance person who was in the process of painting a number of doorframes. Some of the residents were sitting in the garden enjoying the good weather. The home has an activities coordinator who was engaging a group of residents in ‘reminiscing’ about how things used to be when they were growing up. Residents freely contributed and clearly enjoyed the discussion. We saw care staff reading to residents and spending time with them. Daily social activities are available and these are illustrated on a board in the dining room. We observed lunch and saw that food was served hot and was home made. A four week menu was on display and snacks and drinks are offered throughout the day and evening. We were invited to have lunch and thoroughly enjoyed it. Care plans are implemented following the completion of a pre-admission assessment and those we saw gave a lot of detail in how to meet the residents’ needs. These needs are reviewed monthly. Daily notes are kept and the monthly summaries highlight when a need has changed or is unmet. One relative wrote, “The care plans that have been put in place I feel are excellent and very reassuring”. What has improved since the last inspection? What they could do better: The home must demonstrate that residents are being treated as they wish to be treated and their dignity is maintained at all times. Care plans must be drawn up with the residents’ involvement where ever possible and include their preferred routines of daily living. Some of this information could be uplifted from the original pre admission assessment. This will enable staff to respect Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 7 residents’ preferred choices and preferences, particularly where the resident may not be able to verbally tell staff. A social history for each resident may be particularly helpful, even when staff know residents really well. There has been a high turnover of staff in the last year and a profile would assist new staff in engaging with residents and understanding their needs and behaviour. 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.V352450.R02.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.V352450.R02.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): 3,6 People who use this service experience good quality outcomes in this area. Prospective residents can be confident that their needs have been assessed before admission to the home, will be reviewed regularly and will be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: We inspected two residents’ files. They both contained pre admission assessments, which were undertaken before the resident moved into the home. The manager writes to the resident confirming that they are able to meet their needs and information about the home is readily available. A number of residents stated that they and their relatives were able to look Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 10 round the home and stay for a meal before they decided if they wished to move in. After a resident moves to the home initial assessments, risk assessments and a care plan are put in place and kept under review. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before returning to their own homes. This service is not offered at Millfield Lodge, therefore standard 6 is not applicable. Millfield Lodge DS0000015176.V352450.R02.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): 7,8,9,10,11 People using this service experience good quality outcomes in this area. Generally, residents’ needs are documented so that staff can meet those needs in an individualistic and appropriate way, and medication is administered safely. The way staff address residents does not always show respect. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: We ‘case tracked’ two residents, which involved talking to those two people, looking at their records and talking to staff about those residents’ needs. The care plans included the residents’ strengths, abilities and what support they needed. Risk assessments were in place. Daily notes are kept and needs are reviewed monthly or more often if required. Care plans were informative and well written. They demonstrate that choice is offered and plans are specific to the individual. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 12 In their responses to our survey, and in discussion, a number of relatives and residents stated that they were not aware of the care plans, or the monthly reviews. Other relatives were aware. The manager said that 98 of relatives have signed the care plans and have been involved in monthly and annual reviews. Residents who are able to have signed their own care plans. Familiarity of routine is important for all residents but particularly when a resident has just moved in. In one of the plans we looked at, information in the care plan did not tell us about the person’s normal routine, for example the time the person likes to get up and go to bed, and how/where they like to spend their day. The information from the initial pre admission assessment should be transferred to the care plan to assist care staff in meeting residents’ needs. The GP does not routinely visit the home but the manager and senior care staff will accompany residents to the local GP surgery. Health care needs are meet by range of health care professionals as evidenced through the records we looked at. In their response to our survey, one resident said, “Prompt attention for all medical problems has been without exception”. We observed staff talking to residents. It was noted that residents were occasionally referred to as “love” or “darling.” We recognise that these are terms of endearment, but we found nothing in the care plans to indicate that people are happy with this. How residents wish to be addressed should be recorded and respected. On one occasion a member of the care staff asked collectively and loudly “who would like to go to the toilet.” This is not acceptable: this should be asked discreetly and on an individual basis. We have made a requirement around dignity and choice. We were pleased to see that a number of residents had formed close relationships and the staff were respectful of this. Relationships are nurtured where both parties are consenting and staff have ensured that relationships are not exploitative, due to the vulnerability of some residents. Care plans addressing ‘ sexuality’ have been drawn up in consultation with other relevant parties. Medication is administered by senior staff. They receive both internal and external training and are familiar with the home’s medication policy. Their knowledge is tested through multiple-choice questions, which were on staff files. Staff are observed whilst giving out medication and are only able to administer medication unsupervised when they are deemed competent. We looked at medication in respect of the two residents we were case tracking: one person was not taking any medication. Records of the second person’s medication showed that it had been handled and administered well. Medication audits are done by the manager bi- monthly and daily checks are carried out. The manager stated that Lloyds pharmacy do external audits. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 13 One resident is able to self-administer and has a secure place in their bedroom to keep their medication. Some staff have completed training in palliative care, but a number of staff stated that they would like to do this training. Residents’ last wishes are recorded on file. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 14 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 People who use this service experience good quality outcomes in this area. The home employs appropriate numbers of staff, including an activities coordinator to ensure residents social needs can be met within the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: An activities co-coordinator is employed at the home and she has done training in providing activities. She, and some of the care staff, were observed engaging with a group of residents discussing ‘the good old days.’ A number of the residents became quite animated and clearly enjoyed the discussion. Residents were free to join in or leave the discussion as they wished. We saw care workers taking residents outside for a walk and sitting reading to residents. The activities coordinator was familiar with the residents’ backgrounds and hobbies. She keeps records of the activities people have participated in either individually or as part of a group. A social history for all residents would be useful, especially for newer care staff who are not familiar Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 15 with residents’ backgrounds: a number of residents would find it difficult to remember things without being prompted. A list of daily planned activities were displayed in the dining room. An example of one day included: scrabble, flower arranging and conversation. The activities co-ordinator is also the hairdresser. In their response to our survey, one relative stated that it was difficult for residents to get their hair cut. The manager told us that this is not the case: it is very easy for the residents to get their hair cut. This is a service that the residents have to pay for and it is possible that funds have not been made available by relatives for this person to have their hair cut. We spoke to a number of visitors on the day of inspection and they said they are made welcome at the home. One relative, in their response to our survey, stated that visiting in the evening was not encouraged because staff were busy helping residents get ready for bed. The manager stated in the Annual Quality Assurance Assessment (AQAA) that there is an open visiting policy. Entries in the visitors’ book show that relatives do visit the home in the evenings. Relatives said they are given information with regards to their relative and had attended annual reviews. They were pleased that they are invited to attend meetings to discuss the service provided and to have the opportunity to praise the home or make suggestions for improvements. They said that the manager/owner takes their suggestions seriously and acts on them whenever possible. We observed staff offering choices to residents and a number of residents stated that they could choose activities of daily living. The daily notes and the care plans reflected this. Residents’ religious beliefs are respected and these are recorded. A vicar regularly visits the home. A number of relatives’ surveys were returned to the CSCI. The majority of the responses were very positive, with people praising the staff, the manager and the environment. However, there were also some comments that were not so positive: one relative stated that communication in the home could be improved upon; another said that you had to ask for things more than once before it was attended to. A number of relatives stated that items of clothing and personal items had gone missing. The manager said the staff work hard to ensure any ‘missing’ items of clothing are found, and a ‘lost and found’ book is in use to record anything that is reported missing. The home employs a full time cook and meals are of a high quality. There is a four- week menu and snacks and drinks are offered throughout the day. The food was home made, with a number of different vegetables, followed by a hot pudding, or a choice of fruit. Pureed/soft meals are provided as needed, and we saw that pureed foods are served individually so that the food retains its Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 16 individual flavours and still looks attractive on the plate. The menu for the day was on display in the main dining room. We spoke to one resident who said that mealtimes could be chaotic and care staff spend their time supervising people with mobility difficulties. He felt that the physical lay out of the dining room could be changed to make things better. The manager stated that they had tried this but it compromised residents’ health and safety. We discussed with the manager that, as the home has increased in numbers, whether it might be appropriate to have more than one ‘sitting’ or to fully utilise the other dining areas. The manager said that generally mealtimes are well organised and relaxed, not at all ‘chaotic’. Residents have a choice of where they sit and when they eat, and attempts at having two sittings, or using other dining areas, have failed in the past as the residents have chosen to eat in the dining room at the same time. Millfield Lodge DS0000015176.V352450.R02.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 People who use this service experience good quality outcomes in this area Residents and relatives know that their complaints/concerns will be responded to appropriately, and that staff are trained to protect them from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home has a complaints register and we saw that the home records and responds to complaints within the given timescale. Most of the relatives who completed our survey felt that their complaints were listened to and acted upon. No complaints have been sent to the CSCI since the last inspection. Care staff are given appropriate training in the protection of vulnerable adults (POVA), (or ‘safeguarding’ as it is now referred to). This training is arranged through Cambridgeshire County Council (CCC), and staff have access to CCC’s POVA policy which is in the reception office. There have been no referrals made to the POVA team since the last inspection. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 18 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 People using this service experience good quality outcomes in this area. The standard of the environment is good and provides a spacious, light and airy home, which is decorated and maintained to a high standard. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Millfield Lodge is purpose built, on one level, and has been refurbished and extended over the last year. On the day of inspection the home was clean and well maintained. The home employs a maintenance person. A full time housekeeper is responsible for the overall upkeep and cleanliness of the home and he has recently completed an NVQ in housekeeping. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 19 All bedrooms are single, and all except four have at least an ensuite toilet. Twenty new bedrooms have large ensuite shower rooms. Residents have a choice of two lounges, each with a dining area. There is a large dining room and several seating areas around the building. The home is spacious and residents with low needs are able to move around the home freely. Residents with higher needs have restricted access to parts of the home for their own safety. Some of the internal doors have coded locks. There is generous outside space with a very large garden and a path leading to the rear of the garden where there is a newly erected summerhouse. The garden is attractive and the home intends to have it further landscaped once the better weather arrives. Access to outside space is good and there is a ramp leading out of the front entrance. There is also a large central, enclosed paved courtyard with seating. A number of residents’ bedrooms open onto this area. Bedroom doors have people names and photographs on and residents can personalise their own rooms by bringing in small items of furniture, pictures, ornaments and so on. There is a locked facility within their room. We saw a number of bedrooms, all of which were clean and spacious. Most relatives who commented on the environment stated that the cleanliness has improved and maintenance is generally good. In our survey, one resident wrote, “My room is cleaned every day”. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 20 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 People who use this service experience good quality outcomes in this area. Staff are employed in sufficient numbers to meet the residents needs and there are robust procedures in place for the recruitment, training and support of all staff. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: On the day of inspection the home was adequately staffed. There were four care staff and one acting team leader. The manager, a cook, two domestics, one housekeeper, the activities co-ordinator, a maintenance person, and an administrator were also on duty. The home also employs a gardener. The manager confirmed that there were no current staff vacancies as she has just recruited to all the posts: she was waiting for CRB checks to come through. Staffing rotas and the AQAA showed that the home has had a high turn over of staff in the past year, but these were mainly either part time posts or senior posts. The manager conducts exit interviews when staff leave. Despite this the home continues to cover all the care hours, through a system of overtime, rather than using agency staff. Morale when talking to staff appeared good Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 21 and staff were positive about their main areas of responsibility and the management of the home. We inspected two staffing records and they contained all the relevant information, which is sought before staff are employed at the home. Interview questions were on file and the manager stated that relatives are asked to sit on the interview panel for senior staff positions. Records showed that staff training was mainly up to date or booked through the local council. Care staff have completed all the relevant statutory training and more specific training: dementia care, stoma care, and understanding Parkinson’s disease. The manager was asked to provide training on Picks disease, for which she has already printed out some literature for care staff. All staff complete an induction programme which includes a workbook covering the common induction standards. Millfield Lodge staff have done extremely well in that most care staff have completed an NVQ 2 in care. Three care staff are currently doing NVQ 3, four staff are doing NVQ 4 and one is doing the registered manager award. Medication is administrated by a core group of staff who are observed administering medication until they are deemed competent and have demonstrated adequate knowledge of the medication policy. Lloyd’s pharmacist and Cambridgeshire County Council provide medication training. There are two waking night staff on duty. One resident stated that a number of residents wander throughout the night and did not feel two members of staff could provide adequate supervision. On one of the files we looked at we noted that the resident was prone to wandering at night. The manager told us that she and the deputy manager have carried out random checks at night during the past year, and have discussed this with staff. Currently there are only two residents who like to walk around at night, but residents are free to do so if they wish and staff will make them drinks and snacks if they are unable to sleep. The manager said she and the staff are confident that the current level of staffing at night is satisfactory. During the day, care staff do half-hourly observations to ensure that residents are alright and do not need anything. We spoke to a number of staff who gave positive feedback of their experiences of working at the home. They confirmed that they had completed all the training appropriate to their jobs and had regular supervision every two months. Evidence of this was provided through the records we inspected. Staff appraisals are being introduced. Staff explained how the shift is organised. There are handover sheets and a handover takes place with each shift. All tasks are allocated, so staff are clear about what their areas of responsibility are for the day and staff can be held to account more easily if task are not completed. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 22 Care staff confirmed that there are regular staff meetings and they are encouraged to bring agenda items. Relative surveys asked what the home does well. Several relatives commented on the staff stating most staff were caring and compassionate. Millfield Lodge DS0000015176.V352450.R02.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): 31,32,33,35,36,37,38 People who use this service experience good quality outcomes in this area. Great improvements have been made at the home in recent months and the residents benefit from a home which is managed in their best interest. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: The registered owner has been managing the home on a day to day basis and feedback received on the day of inspection was good. The owner intends to continue providing a strong management presence, and to recruit to the manager’s post in the future. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 24 The home holds a small amount of money for most residents. We inspected one resident’s financial records and they were accurate. A balance sheet is held by the home and a copy is made for relatives. Receipts are kept. We inspected some of the records which the home must keep. Fridge/freezer temperatures and hot food temperatures were accurately recorded. Emergency lighting and fire alarm records showed that tests of the fire precaution systems are done at the required intervals. Records relating to accidents and incidents were seen and we are notified of these. One relative stated in the survey that some chairs are too low for some residents who need assistance with mobility and this could result in poor manual handling techniques. We noticed that some residents found it difficult to get up from the sofas. There has been a high turn over of staff in the last year and relatives commented, via the survey that this was a concern particularly when there always seem to be different people in charge. The manager said she is confident the past difficulties with staff recruitment and retention have been overcome and future staff turnover will be decreased. The manager stated in the annual quality assurance assessment, completed and returned before the inspection, how choice is promoted and how she ensures that the service is run in the best interests of the residents. Monthly resident meetings are held and bi-monthly meetings are held for relatives. Residents have participated in staff training and sat in on staff meetings and some relatives have participated in staff recruitment. Questionnaires are circulated by the home to all residents, their relatives and stakeholders and suggestions for improvement are noted and acted upon. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 25 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 26 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 OP10 Regulation 12(4)(a) Requirement Residents’ privacy and dignity must be respected at all times. Staff must use the term of address preferred by the resident. Privacy and dignity in all matters, especially with regard to personal care, must be maintained at all times. Timescale for action 30/10/07 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 OP38 Good Practice Recommendations The home should ensure that furniture is appropriate to meet the residents’ needs. An audit of the chairs and sofas is recommended to ensure residents can get up safely. Millfield Lodge DS0000015176.V352450.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Cambridgeshire Area 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.V352450.R02.S.doc Version 5.2 Page 28 - 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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