Inspection on 13/09/07 for Millfield Nursing And Residential Home

This inspection was carried out on 13th September 2007.

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

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

Other inspections for this house

Millfield Nursing And... 30/05/08

Millfield Nursing And... 09/10/06

Millfield Nursing And... 10/11/05

Millfield Nursing And... 04/05/05

Millfield Nursing And... 07/01/05

Millfield Nursing And... 17/08/04

Millfield Nursing And... 12/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Millfield Nursing And Residential Home Cedar Park Drive Bolsover Chesterfield Derbyshire S44 6XP Lead Inspector Sue Richards Unannounced Inspection 13th September 2007 09:30 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 Nursing And Residential Home DS0000002065.V341579.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 Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millfield Nursing And Residential Home Address Cedar Park Drive Bolsover Chesterfield Derbyshire S44 6XP 01246 825959 01246 825923 millfield@schealthcare.co.uk 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) Southern Cross Care Management Limited Donna Smith Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2006 Brief Description of the Service: Millfield is a purpose built care home set within a residential area in the market town of Bolsover, which lies approximately seven miles east of Chesterfield town centre. The home provides nursing and personal care for up to forty older persons. Accommodation is provided over two floors, with all bedrooms having single room occupancy each with an en suite facility. There is disabled access throughout with a variety of environmental aids, adaptations and equipment to assist those who may have physical and/or sight disabilities, including a shaft lift and a nurse call system throughout. There is a choice of lounge and dining areas located on each floor, including a small smoking lounge and there is level access to an enclosed outdoor courtyard area with seating provided. A separate hair dressing room is also provided. People are provided with care and support from a team of nursing, care and hotel services staff, including an activities co-ordinator who organised a variety of activities for people both in and outside the home. The registered manager has worked at the home for a number of years, being well established and provided with support via external management arrangements. A copy of the most recent inspection report is available in the home’s ‘Welcome Pack’, a supply of which are openly available in the main reception area. The range of weekly fees charged by the home are as follows: Privately funded – £452.00 for personal care only and for nursing care £671.00 nursing care – minus the free nursing care payment determined by the PCT. Local authority funded - £333.85 for personal care only (mid band) to £498.30 for nursing care (high band). Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account the information we hold about this service. This includes our previous key inspection report of 09 October 2006 and information provided in our annual quality assurance questionnaire completed by the home. We received ten survey returns out of ten forwarded to the home. At this inspection there were thirty-six people accommodated at the home, including twelve who receive nursing care. We used case tracking as part of our methodology. This involves the random sampling of three people, whose care and service provision was more closely examined. We spoke with people about the care and services they receive and looked at their written care plans and associated health/care records and also inspected their private and communal accommodation. We also spoke with staff and management about the arrangements for their recruitment, induction, training, deployment and supervision. Examined related records and observed some of staffs’ interactions and approaches with others. We spoke with the registered manager about her role and responsibilities and about the management and monitoring arrangements for the home. What the service does well: People live in a clean, safe and overall well maintained home, which is comfortable, well furnished and equipped and which for the most part suits their needs. They are generally well supported and informed during their admission and overall their health care needs are well met by a staff team who is mostly sensitive to their needs. There is a proactive approach to the organisation, planning and proposed development of suitable activities for people, who also receive a nutritious diet. People have access to information about how to complain and the majority are confident in doing so. They are also well protected from abuse. Peoples’ needs are usually met from a staff team, who is effectively recruited and trained. The home is well managed, and overall run in the best interests of the people who live there, whose health, safety and welfare is promoted and protected. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Provide information about the fees charged by the home as standard within the service guide/brochure, so as to provide clear and transparent information about fees on any initial enquiry by people, which accords legislation requirements. Include information as to the availability of the service guide in large print (or any other formats) alongside existing information provided regarding audiocassette availability. Provide that each person has a written plan of care for daily living (a daily living plan), signed and agreed with them, which details their known preferences and choices in respect of their daily living arrangements. Ensure that medicines administration records are always fully completed and that there are no gaps of recording in respect of any medicines administered. Ensure that food menus are available for people in a suitable formats, (or formats), which they can access. Ensure prompt attention to the repair of extractor fans located in internal areas, as may be required to ensure proper ventilation. Use a recognised or evidenced based approach to determine care staffing levels at the home, which includes calculated overhead hours for staff absence, training and holidays and also resident dependencies and social activities, so as to best promote people’s personal choices with regard to their preferred daily living routines. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 7 Keep a formal record of induction for each staff member in accordance with recognised care workforce standards. 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 Nursing And Residential Home DS0000002065.V341579.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 Nursing And Residential Home DS0000002065.V341579.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): NMS 1, 2 & 3 (The home does not provide for intermediate care therefore NMS 6 is not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well supported and reasonably informed during their admission to the home, although the standardised provision of fees information in the home’s guide may better inform people on initial enquiry. EVIDENCE: At our last key inspection of this service we judged that people receive appropriate assessments before moving into the home so that suitable care plans can be developed to meet their needs. In our annual quality assurance questionnaire completed by the home they said that they say they always provide relevant and key info about the home, Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 10 which is up to date and that a full needs assessments is always undertaken for each person and recorded, including a pre-admission assessment summary and care plans via that persons funding authority as applicable. They say that a copy of the most recent inspection report is always openly available. They feel they could do better by ensuring that reviews are carried out for each person who is privately funded within seventy-two hours of their admission as per local authority funded people. They say they have improved their admission process by ensuring greater continuity in their pre-admission and admission process, including the development of relationships and communications with outside agencies with regard to people’s placements. Over the next twelve months they aim to continue with their improvements, to look at providing day care and to ensure that best practise is promoted with regard to the admission process by way of staff training. At this inspection we spoke with people about the arrangements for their admission, including as to whether their needs were assessed and agreed with them and also the information they were provided with about the home. We also looked at the home’s written service guide/brochure. We also sent out ten surveys to people living at the home by way of random selection and asked them if they had received a contract and also whether they received enough information about the home before moving in there to help them decide if it was the right place for them. In the main people said that their relatives organised their admission on their behalf, including their fees arrangements. One person retained more direct control in their admission and fees arrangements and said they were provided with written information about the home and the others said they thought their relatives were given this. Of ten surveys returned, the majority said they were provided with a contract and with enough information about the home, although one person said that they were not provided with the latter. Two people said that they already knew the home well due to visiting relatives there previously and therefore considered themselves to be suitably informed. The home’s service guide/brochure details its availability in audio format, although possible provision of any other formats such as large print or other languages is not referred to. However, the manager advised that copies could easily be made available in large print. Also the guide/brochure did not provide clear details as to the home’s range of fees. Management advise that details of people’s fees are inserted once they are individually agreed with them. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 11 People spoken with said that there had been some discussions with them about their needs, although two people felt that staff are not as familiar as they could be about their individual preferences and needs in respect of meals (see Daily Life and Social Activities section of this report). However, one of those was very new to the home and felt that all staff is still ‘getting to know them.’ People’s recorded needs assessment information was also examined. This information includes many aspects of people’s known daily living preferences/likes and dislikes, although are recorded in various areas of their needs assessment and care planning documentation, rather than in a separate daily living plan, signed and agreed with them. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people’s health care needs are well met by a staff team who are mostly sensitive to their needs. EVIDENCE: At our last key inspection of this service we judged that the home’s development of people’s written care plans indicated that their health, personal and social care needs were satisfactory monitored and promoted. However, peoples’ individual preferences regarding some aspects of privacy were not always clear. We recommended that people’s care plans should clearly record the main routines of daily living for each resident and also their wishes and that all medication administration records should clearly detail the amount of medication received at the point of delivery. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 13 In our annual quality assurance questionnaire completed by the home, they say that they ensure that each person has comprehensive written care plans based on their risk assessed needs and which and reflect recognised clinical guidance and practise. That a people’s healthcare needs are properly accounted for and that their care plans are regularly reviewed. They say they always seek to promote people’s privacy and dignity. They say they have improved by ensuring that each person as a care plan for falls, privacy and dignity and risk of fire. They feel they could improve by direct inclusion of the resident in their monthly reviews and they intend to improve further by continuing to promote relevant staff training and better involving people in drawing up their care plans. At this inspection we spoke with people about the care and support they receive and about staff availability and approaches towards them. People who were able to express an opinion said they felt the care and support they received to be generally good and usually in accordance with their wishes and that the majority of staff usually listened and acted on what they said, although not all. They also said that staff promoted their dignity and privacy. (See also Daily Lives and Social Activities section of this report). We asked people in our written surveys about the care and support they receive and staff approaches with them. Of the ten returns, seven said they always receive the care and support they need and three said they usually or mostly do. Five said staff always listen. And act on what they say and five said they usually do. Comments received, include, “My mother receives extremely good care of a high standard.” “Staff are very polite, friendly and approachabl.” “Everyone is very kind and attentive at all times.” “Staff act in a professional manner and are attentive to people’s needs.” Six also said they always receive the medical support they need and four said they usually do, although one commented that they felt some of the nursing staff are keener and more responsive to changes in people’s conditions than others. For one of the people case tracked, there had been a significant change in their condition, which had occurred since the last multi-disciplinary care review attended by that person’s care manager and the local PCT. This was discussed with the manager who confirmed that notification of this change had not occurred with those representatives but agreed to ensure this. We examined the care plans for those people case tracked. These were well recorded, reflective of recognised guidance concerned with the care of older Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 14 persons and formulated in accordance with people’s risk assessed needs. Comments made under Section One – Choice of Home in this report in respect of individual daily living plans also apply here. Visits and inputs from outside health care professionals are also well accounted for as are people’s privacy needs. We also spoke with a visiting district nurse who made very positive comments about the home with regard to liaison and support. The arrangements for the management and administration of people’s medicines were examined, including the recording of medicines received. focusing on those people case tracked. These are satisfactory, atlhough there were two recent isolated omissions of recording, one of which related to a controlled drug. However, despite this error/omission there was a clear audit trail, including records of the actual amount of medicines received and all other records examined were well maintained. Additionally monthly management audits of medication are undertaken, which include examination of adminstration records. One of the people case tracked managed their own medicines. This is in accordance with recognise practise guidance concerned with the self administration of medicines. Millfield Nursing And Residential Home DS0000002065.V341579.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): NMS 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a proactive approach to the organisation, planning and development of suitable activities for people, who also receive a nutritious diet. The home’s stated aims to promote further opportunities for people to make choices in these areas. Should have a positive impact on their daily lives. EVIDENCE: At our last key inspection of this service we judged that people are provided with range of varied social and recreational activities and that they receive a suitably balanced diet, which accounts for individuals’ preferences and assessed needs. In our annual quality assurance questionnaire completed by the home, they say they well promote people’s preferred daily living preferences and ensure a Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 16 range of activities co-ordinated by two key staff. They also say they support people well in maintaining good contacts with family and friends, to access advocacy and choose where and when to eat their meals. They feel they could do better by increasing the hours provided for activities organisation and in seeking to provide better choice and access for people to the local community by way of trips out/community transport. Over the next twelve months they aim to further develop activities as stated above and to better accommodate people’s choices and to review meal provision/nutrition. At this inspection we spoke with people about their daily living arrangements, including social and recreational activities, meals and mealtimes and opportunities for them to exercise choice in relation to these. We also spoke with staff about those arrangements. We asked people surveyed if activities are arranged in the home that they can take part in. People spoken with said that staff tried to meet their preferred daily living routines, although sometimes this may be affected by staff shortages, such as sickness and absence. However, all said that staff usually discussed any changes to their preferred routines where necessary. People also felt that there are regular opportunities to engage in social and recreational activities in the home and sometimes outside the home, including religious observance. At the time of this inspection there were no people accommodated from diverse cultural or religious backgrounds, all being British white with Christian based religious beliefs. One room is converted into an old style pub/bar, with seating and tables. Some residents enjoy playing dominoes there. Details of regular activities organised in the home are provided within the home’s brochure and also displayed. These include games and quizzes, crafts, painting, baking and a variety of calendar events, trips out. Information about access to local transport is displayed along with a ‘Memories Board’ put together by a group of those accommodated and a display of people’s artwork. Peoples’ rooms are well personalised, with many items of their own furnishings and possessions and information about advocacy services is displayed in the main reception area. Six people surveyed said activities are usually arranged that they can take part in. Two said they always are and two said only sometimes but felt this was due to their condition/ability rather than activities not being available. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 17 Four people surveyed said they always enjoyed the meals at the home indicating their view that the standard of food was high, being wholesome and nutritious and with good variety. One relative commented that menus are openly displayed on the notice board, although a number of comments are also received with regard to the excessively small print, which for many is unreadable and the location of recently revised menus, which are also too high for those people who may be in wheelchairs. Staff is however, aware of this and detail the daily menu in large printed writing on a menu board in the dining areas to assist people. Additionally some felt that individual choice could be improved. Lunches served on the day of the inspection were done so in an unhurried manner. Tables were attractively set and people ate where they chose. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of people know how to complain and are confident in doing so and as far as is reasonably possible people are well protected from abuse. EVIDENCE: At our last key inspection of this service we judged that the home’s complaints procedure is clear and accessible and that people’s safety is enhanced by staff awareness with regard to adult abuse and protection measures. We recommended that the manager attend training concerning the local interagency procedures for the protection of vulnerable adults, which is achieved. In our annual quality assurance questionnaire completed by the home, they say they always provide people with suitable information about how to complain. That concerns and complaints received by them are fully recorded and acted on in timely manner and that they always aim to promote openness and approachability. They also say that all staff is suitably trained and instructed with regard to recognising and responding to abuse and that the factors described above have resulted in a reduction of formal complaints. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 19 At this inspection we spoke with people about raising concerns and complaints and their confidence to do so. We also people by way of our written survey whether they know who to speak to if they are not happy and if they know how to make a complaint. Overall people spoken with said they knew who to speak to and how to complain, although felt that matters are usually dealt with without the need to make a formal complaint. Of those people surveyed, eight said they always know who to speak to if they are not happy and know how to complain. One said they usually knew who to speak to and one said they were unsure. However, three people (including one person spoken with said they did not know how to complain. Additional/supporting comments received are all positive and included, “The matron and all the team are very approachable and act on whatever feedback they receive from people.” “I’ve always felt free and able to make my views and feelings known.” A copy of the complaints procedure is displayed in the main reception area and written information is also provided about how to complain in the home’s brochure. The home has received two complaints over the last twelve months, including one referred and investigated via local joint agency safeguarding adults’ procedures. Neither of these are upheld/substantiated. Staff spoken with is conversant with the procedures to following in the event of witnessing or suspicion of the abuse of any resident and confirmed they received training and instruction in respect of these. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 20 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): NMS 19, 24 & 26. Quality outcome in this area is good. This judgment has been made using available evidence, including a visit to the home. People accommodated, live in a clean, safe and overall well maintained home, which is comfortable, well furnished and equipped and which for the most part suits their needs. EVIDENCE: At our previous inspection of this service we judged that the home is generally satisfactorily maintained and residents have a safe and comfortable environment. We made a requirement that the maintenance of bathroom areas must be reviewed and the correct ratio of functional bathroom facilities to the number of residents maintained. We also said that bars of soap should not be left out for communal use, as they are a potential source of infection. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 21 In our annual quality assurance questionnaire completed by the home, they say the home always clean, well maintained and decorated to a high standard. They say they could improve on the personalisation of people’s bedrooms and ‘keeping on top of environment issues.’ They say they have started to improve the front garden area and provided new curtains and matching bedspreads in all bedrooms. They intend to develop and improve the internal courtyard area for people to access over the next 12 months. At this inspection we looked at the private and communal areas accessed by people case tracked and also the laundry. All internal areas seen were clean and odour free, well maintained, furnished, decorated and equipped, although the inner courtyard is in need of attention to make it more accessible and pleasant to use for people. However, the manager advised of work due for imminent start to redevelop this area by an outside contractor. Detailed plans are provided, which are extensive and designed around the needs of people who may live at the home. The requirement and recommendation made at our last inspection as detailed above are complied with. Extractor fans sited in some internal toilets do not function despite written requests for their repair and maintenance via the company procedures. People spoken with say they are satisfied with their environment, which they feel is comfortable and clean and suits their needs. Eight of ten people who completed our written surveys said the home is always clean and fresh. Comments received include: ‘There is a high standard of cleanliness at Millfield.’ ‘People’s rooms are always cleaned each day and the home is light and airy and regularly redecorated.’ ‘I am very pleased with the standard of cleanliness.’ Two of those surveyed said the home is usually clean and fresh, although one person commented on urine odours and a lack of cleanliness in their en suite and also the poor state of the internal courtyard, which they feel is not pleasant for people to use. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 22 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): NMS 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgment has been made using available evidence, including a visit to the home. People’s needs is usually met from a staff team, who is effectively recruited and trained, although the methodology used to determine manpower planning and staff deployment may not always best promote people’s personal choices with regard to their preferred daily living routines. EVIDENCE: At our last key inspection of this service we judged that satisfactory staffing levels are maintained at the Home and staff development was suitably organised so that residents’ care and interests were being appropriately met. In our annual quality assurance questionnaire completed by the home, they said that they ensure that staff is effectively recruited, trained and deployed and that 85 of care staff have achieved at least NVQ level 2. They say that they have improved staff training and supervision arrangements but could improve by providing a more comprehensive staff induction programme. They plan to continue to develop staff training and aim to increase the number of bank staff employed to provide more efficient access to staff cover in the event of sickness and absence. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 23 At this inspection we spoke with staff about the arrangements for their recruitment, induction, training and deployment and inspected associated records, including the personal records for four of the most recent staff starters. We spoke with people accommodated about the staffing availability and asked people by way of written survey if staff is available when they need them. Seven of those said they usually are and three said they always are. At the time of this inspection there were thirty-six people accommodated, including twelve people who receive nursing care. Duty rotas indicate there are ongoing difficulties covering for sickness and holidays. Staff spoken with felt this to be an issue, although said that they reorganise their routines when this occurs and are confident that people’s needs are safely met, although this may sometimes result in changes to people’s preferred routines, where possible, in consultation with them. Discussions with people accommodated were reflective of the above, but all felt that staff worked hard, that they felt safe and reasonably well cared for. Discussions held with the registered manager about the arrangements for staff deployment and planning were that staffing is based on a set formulary of staff to resident ratio as determined by the company. A recognised staffing tool calculating for residents’ dependency levels and staff overheads (absence, holidays and training), is not formally used by the home for the purposes of determining staffing levels. Staff files examined and discussion held with staff indicated that staff is properly recruited in accordance with recognised procedures and that they are suitably trained, although formal records of induction are not in place in accordance with recognised standards. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 24 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): NMS 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home is well managed, and overall run in the best interests of the people who live there, whose health, safety and welfare is promoted and protected. EVIDENCE: At our last key inspection of this service we judged that the home is run in a systematic and effective manner and that people’s safety and interests are satisfactorily promoted. Although formal consultation with people as to their satisfaction with the care and service provision could be improved. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 25 We recommended that the arrangements for formal consultation with people and also with their relative/representatives and staff should be developed. In our annual quality assurance questionnaire completed by the home, they say that the manager is experienced and competent to run the home and that people’s health, safety and welfare is well promoted. They feel they could improve in their consultation with people. They also say that over the last twelve months have introduced monthly management action plans and they have identified that over the next twelve months they wish to maintain people’s health and safety and ensure good staff training (although do not refer to how they could improve consultation with people). At this inspection we spoke with the manager about her own training and development over the last twelve months and about the arrangements for quality assurance and monitoring, including consultation with people as to their satisfaction with the care and services the home provides. We also examined the arrangements for the management and handling of people’s monies via those people case tracked and spoke with people about the arrangements for ensuring safe working practises in the home. General observations were made during our inspection of the environment as to general safety and also some staff practises. Records were also examined in respect of staff training, equipment maintenance and the recording and reporting of accidents and untoward incidents in the home. Annual satisfaction surveys with people accommodated are in place, which sometimes include people’s relatives/representatives. The results of these are collated and are displayed openly on the residents’ notice board at the home. The manager advised that resident and relatives meetings were arranged, but with little or no attendance. Therefore the residents’ notice board is regularly used to provide key information for people, including a regular newsletter. A consultation questionnaire was also circulated via local authority care managers, although returns are said to be minimal. There is also a formal quality assurance and monitoring system in place in respect of the service, which includes monthly auditing systems and the involvement of external management. Records of these are kept together with clear records of monitoring and action plans. Staff spoken with is conversant with their roles and responsibilities and those of others. They advised that they have the equipment they need to assist them in their work and that access to training is good, including that relating to safe working practises. Records examined were reflective of this. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 26 Staff is conversant with their responsibilities and procedures to follow in the event of an accident or untoward occurrence in the home. Accident records sampled via case tracking are properly recorded and minor in nature. Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 27 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5ba, bb, 5bc, 5bd Requirement Information must be provided as standard in the service guide in accordance with that specified under regulation 5 (amended 01/09/06) of the Care Homes Regulations 2001 so as to provide clear and transparent information about fees on any initial enquiry by people. Gaps of recording relating to the administration medicines to any person must not be left unaccounted for. Administration records must always be fully completed to ensure best and safest practise in accordance with recognised guidance concerned with the administration of medicines. Extractor fans located in internal wcs, must be maintained in working order. A formal record of induction must be kept for each care staff member in accordance with recognised care workforce standards. Timescale for action 30/11/07 2. OP9 13(2) 13/10/07 3. 4. OP19 23(2)(b) & (p) 17, Sch 4 13/11/07 13/12/07 OP30 Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations Information as to the availability of the service guide in large print (or any other formats) should be included alongside the existing information provided regarding audiocassette availability. Each person should have a written plan of care for daily living (a daily living plan), signed and agreed with them, which details their known preferences and choices in respect of their daily living arrangements. Menus should be provided for people in a suitable format (or formats), which they can access. A recognised or evidenced based approach should be used to determine care staffing levels at the home, which includes calculated overhead hours for staff absence, training and holidays and also resident dependencies and social activities. 2. OP3 3. 4. OP15 OP27 Millfield Nursing And Residential Home DS0000002065.V341579.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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