Inspection on 04/05/05 for Millfield Nursing And Residential Home

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Nursing And... 30/05/08

Millfield Nursing And... 13/09/07

Millfield Nursing And... 09/10/06

Millfield Nursing And... 10/11/05

Millfield Nursing And... 07/01/05

Millfield Nursing And... 17/08/04

Millfield Nursing And... 12/02/04

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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 6SP Lead Inspector Bridgette Hill Unannounced 4 May 2005 08:35 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 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@highfield-care.com Highfield Care Management Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Donna Smith Care Home with nursing 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7 January 2005 Brief Description of the Service: Millfield is a purpose built care home set within a modern housing estate, on the outskirts of Bolsover. The home is registered to admit up to 40 elderly people with nursing and/or personal care needs.Millfield provides a pleasant environment for the service users and the accommodation is provided on two floors. There is passenger lift and staircase access to the first floor facilities.There are lounge/dining areas on both floors of the home. All bedrooms are single occupancy, with en-suite facilities.The staff call/alert system operates in all areas of the home. There is an outdoor courtyard area in the centre of the home, accessible to the service users. The home has a hairdressing salon.Support services are in place with a choice of General Practitioners, and chiropody, dental, optician and other services arranged as appropriate. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place over 7 hours. During the inspection 4 staff members and 9 residents and 1 visitor were spoken with. Various records including care planning records were examined the findings are recorded in the body of this report. The Manager was not on duty at the time of the visit and some records were not available for inspection. Deputy Manager Melanie Harding was on duty on the day of the visit. A follow up call was made to the Manager to discuss the findings. What the service does well: What has improved since the last inspection? What they could do better: Development of the upstairs lounge/function room is required to make it a more used and desirable area for residents to comfortably use. Residents records were not held securely and this system must be reviewed. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Information was made freely to residents and visitors who chose to access it but the statement of purpose did not give accurate information to residents or their representatives regarding management of the home. Staff were knowledgeable of residents needs and therefore able to ensure that needs were being met. EVIDENCE: The statement of purpose required updating to reflect changes in the company that have taken place. The service user guide was available in the reception area along with the inspection report. Residents and visitors knew the location of this but had not chosen to look at it. Most resident spoken to said that the home had been chosen for them by family members. Care management information and free nursing care assessments were available in care files of those residents funded by local authorities. Staff said the Manager undertook pre admission visits to Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 9 prospective residents. One resident said she had met a staff member before being admitted to the home. All staff spoken to had a good knowledge of the residents assessed needs as described in the care plans. Intermediate care as described by standard 6 was not offered at this home. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Care plans were not specifically detailed or updated enough to ensure staff had the knowledge to meet the residents assessed needs. Information was passed on verbally but this did not give adequate protection to residents. EVIDENCE: A sample of four residents care plans were assessed. Care files contained a range of risk assessments and follow up inspections of residents bedrooms indicated that where risks were identified and appropriate for example where tissue viability risk was identified these were followed up by relevant equipment in place. Some care plans were not descriptive as to how care was to be delivered using general terms such as ‘as required’. One care plan had not been updated to record changes in condition/diet. Some care plans had been signed by the resident some hadn’t. Some residents said they had not been offered the opportunity to be involved in this process. One resident said they were happy to leave the care plan to staff to complete. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 11 One resident said that showers/baths were generally offered once per week and they would like this to be more frequently. Where medications had been prescribed and were handwritten these were not signed by the required two members of staff to verify the instructions as correct. One out of date item was still being used for one resident. Some gaps were evident on administration records. The records for residents indicated that appointments were made with GP’s, dentists, chiropodists and opticians to meet residents’ healthcare needs. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 There was structure and consistency in the provision of activities being offered to residents but these were not supported by documentation to ensure they were meeting residents assessed needs. EVIDENCE: An activities programme was displayed in the entrance for the week ahead. Residents spoke positively of the work undertaken by the activities coordinator. Fundraising activities outside and inside the home were held to raise monies for a residents fund, from totals raised this appeared to be very successful. This money was partly being used to take residents out to Skegness for the day. Some records relating to activities held were examined these stopped in February 2005 even though activities have continued. Care plans did not always make reference to assessed social needs. The type of activities varied some being individual with the resident and others being group activities. The types of activities included; bingo, growing plants Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 13 and vegetables, craft activities and outings. External entertainers did visit the home periodically. A church service is held in the home monthly and a book was in the reception area for anyone to write in for prayers to be dedicated to those in need. This book was used by residents, visitors and staff. A choice of meal was routinely offered at teatime but not lunchtime. Alternatives were made available according to staff and residents spoken to appear to be aware of this. All residents spoken were able to make positive decisions regarding choice of food and it is recommended that a proactive plan is put in place to offer a choice of lunchtime meal to residents prior to it being served. Residents were positive about the quality of foods served. Kitchen records were in good order. Some work identified on previous inspection reports re the flooring in the kitchen had not been actioned. The visitor spoken to said staff were helpful and there was space to residents in private. Records indicated that relatives were contacted by staff where this was required. The Service User Guide had not been amended to include access to records information as per the recommendation on the previous visit. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17,18 Staff had received sufficient training and had appropriate knowledge of procedures relating to the protection of vulnerable adults to ensure appropriate actions would be taken if abuse were suspected. Residents statutory right to vote was satisfactorily facilitated by staff. EVIDENCE: Staff spoken to had received training in the protection of vulnerable adults and were conversant with the procedure to follow. The procedure in place made reference to locally agreed procedures. Residents were registered on the electoral roll and had received postal ballots for the forthcoming election. Some residents spoken to had chosen to vote others had not. Staff said they had assisted some residents to complete the ballot paper. Where postal votes had not used by the resident these had sometimes been given to relatives. This did not provide adequate protection for misuse of the residents vote. It was not possible to assess the standard relating to complaints at this visit, as some records were not available. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,25,26 Systems for ensuring in house maintenance were established and effective. The restructuring of the company had affected on going redecoration work and some parts of the home were not decorated to a required standard. The communal space available was not being used to it maximum potential and one room was not suitably furnished and laid out for residents to use. EVIDENCE: Residents bedrooms were well personalised and many residents were observed to spend time in their room. Residents spoke positively of being able to spend time alone watching television. One resident said they would like their bedroom to be decorated as this had not been done in 4 years. Bedrooms and communal areas of the home were observed to be clean. New tables and chairs had been purchased for one lounge upstairs. The smoking lounge upstairs smelt of smoke with the only extraction route for Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 16 smoke being through open windows, this was not adequate. Downstairs corridors had been redecorated as per the last inspection report, upstairs had not been done and this is an outstanding requirement. Staff said that the changes in the company had led to a suspension of ongoing redecoration due to restructuring of staff within the company. Upstairs there was a lounge/function type room. This was laid out in a boardroom style and was not being used by any residents. Staff reported that residents did not use this room very much. The chairs in the room were pushed in one corner with the seats facing the wall. This appears to be a valuable but very underused space that had few easy chairs in it, no television and presenting as uninviting. Residents said they used the enclosed garden area in good weather and a new gazebo was in place there. Window restrictors were in place and water temperatures were checked on a regular basis and records were available. The laundry area was large, suitably equipped and staffed. Residents said their clothes were returned promptly and in good condition. A hook type lock had been fitted on the sluice following a recommendation on the last report. A chain type of lock was fitted on some rooms, staff reported that were no longer used. As these give the potential for confused residents to lock themselves in and cause distress (they could be operated from the outside by staff) these should be removed. Staff said that no additional variable height beds had been purchased as was required at the last inspection visit, this remains outstanding. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 The numbers and level of skill of staff on duty was adequate to meet the needs of the residents. The staff team is a developed one and the company has ensured that staff have received training in order to ensure staff are skilled in being able to meet residents needs. EVIDENCE: Staffing rota’s indicated adequate numbers of staff on duty. The ratio of staff who held NVQ qualifications in care was impressive and exceeded the minimum standard. Staff reported the company had a good commitment to training. Training records were examined and staff were spoken to regarding training. Staff said the company was committed to providing training. Records indicated staff had attended a range of training and statutory updates were completed. Staff were spoken to individually and as a group. All care staff at the home had worked there for in excess of 5 years and said they worked well together as a team. Residents gave many positive comments about the staff. Staff supervision records were not available at this visit and the listed requirement relating to this will be inspected at the next visit. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,37,38 Robust procedures were in place to ensure that health and safety checks were undertaken. The storage of records did not protect residents from potential breaches of their confidentiality. EVIDENCE: The public liability certificate was displayed and in date. Residents were given information on the limits of the insurance provided by this for their personal effects. Records for establishing financial liability were not assessed at this visit. Residents records were held on open shelving in an office that was observed to be left unlocked when not in use. Staff spoken to confirmed that the office door was not locked when unused. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 19 Health and safety needs were addressed through staff training. Fire records and maintenance of equipment records such as gas, lift and electrical wiring were all up to date. A handyman worked at the home 3 days per week and records indicated that regular health and safety checks were completed. A number of beds were observed to be sited next to radiators. Risk assessment were not in place to identify and address the potential risk of this. Whilst radiators were of a low surface temperature type some risk is evident. Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 x x x 3 x x 2 2 Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 21 YES 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. 2. 3. 4. Standard OP1 OP6 OP6 OP6 Regulation Schedule 1 4(1) (c) 15(1) 15(1) 15(1)(c) Requirement The statement of purpose must be updated to reflect changes in the companies organisation Care plans must be updated to record changes in assessed needs Care plans must be individualised and descriptive of how assessed needs are to met If it is assessed as inappropriate that the service user or their representative are consulted or this option is declined this must be recorded. Residents must be consulted regarding their personal hygiene preferences Topical and external preparations must be used within manufacturers approved timescales If a Medication Administration Record (MAR) chart is handwritten by a member of staff this must be signed and dated by them. This must then be checked, signed and dated by a second member of staff. All Medication Administration Records (MAR) must have codes recorded where medicines are Timescale for action 30th July 2005 30th July 2005 30th July 2005 30th July 2005 5. 6. OP6 OP9 12(2)(3) 13(2) Schedule 3 13(2) Schedule 3 30th July 2005 30th July 2005 30th July 2005 7. OP9 8. OP9 13(2) Schedule 3 30th July 2005 Page 22 Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 9. 10. OP12 OP19 15(1) 16(2)(m) 23(5) due to be given recording if it was given or a reason that it was not given Care plans must include details on social care needs are being met according to assessed needs The findings of the latest Environmental Health report must be acted upon 30th August 2005 Date given previously 31.3.05 new date 30th July 2005 Date given previously 31.3.05 new date 30th July 2005 Date given previously 31.3.05 new date 30th July 2005 30th August 2005 30th August 2005 11. OP19 23(2)(d) 12. OP19 23(2)(b) An action plan must be produced identifying early timescales for the redecoration of corridors and staircase/stairwell areas (downstairs only completed at visit on 4th May 2005) The flooring in the kitchen must be repaired 13. OP19 23(2)(b) 14. OP20 23(2)(g) 15. 16. OP24 OP24 13(2)(c) 16(2)(c) The Provider must ensure there are systems and resources in place to ensure the home is maintained to required standards Communal space in the home must be appropraitely furnished so that is suitable for the social, cultural and recreational needs of the residents Unsuitable locks must be removed from residents bedrooms An action plan to provide adjustable beds must be forwarded to CSCI (by the timescale set against this requirement) 30th August 2005 17. OP36 18(2) Date given previously 31.10.04 new date 31st August 2005 All staff must receive appropriate Date to training and supervisionTraining commence 30.9.04 had been addressed, but the supervision system was not formalised Not able to assess at this visit Version 1.20 Page 23 Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc 18. 19. OP37 OP38 17(1)(b) 13(4)(a) Residents care records must be held securely to ensure confidentiailty is maintained Risk assessments must be in place for each resident where beds are sited next to radiators 30th July 2005 30th July 2005 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. 2. 3. 4. Refer to Standard OP14 OP15 OP20 OP25 Good Practice Recommendations Information about rights of access to records should be included in the Service User Guide Residents should be given a proactive choice of meal at lunchtime The Provider should implement an effective smoke extarction system for the smoking lounge The quality of the lighting should be improved in corridor areas (deterioration of the current light fittings) Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millfield Nursing and Residential Home C52 C02 S2065 Millfield V221780 040505 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!