CARE HOMES FOR OLDER PEOPLE
MILLFIELDS Mill Lane Nevison Pontefract WF8 4JF Lead Inspector
Mavis Pickard Unannounced 21 April 2005 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. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Millfields Address Mill Lane Nevison Pontefract WF8 2LS 01977 690606 09177 690606 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) Mr John Fieldhouse & Mrs Jill Fieldhouse Mrs Jennifer Tucker CRH PC 38 Category(ies) of OP - Old Age - 38 registration, with number MD(E) - Mental Disorder - over 65 - 38 of places PD(E) - Physical disabilities - over 65 - 7 MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 21/10/04 Brief Description of the Service: Millfields is a care home providing personal care and accommodation for 38 older people. The home and its sister home, Stella House, is owned by Mr John Fieldhouse and Mrs Jill Fieldhouse. The home is situated in a residential suburb approximately one mile from the town centre of Pontefract, is close to local amenities and has been in operation and under the same management for 8 years. Accommodation is arranged on two floors and has a passenger lift. All bedrooms are single and six rooms have en-suite facilities. There are appropriate communal facilities provided by the home, including pleasant gardens which are accessible to service users. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was found to be running well. People spoken to, who live at the home, said that they enjoy living at Millfields and would recommend the home to others. On the day of this unannounced inspection, the home presented as being clean and bright. Residents, many of whom were having their hair done, seemed to be relaxed and happy in their home. The Inspector met informally with 8 residents and more formally with 2 newly admitted residents and their families/friends who said the home meets their expectations. The manager and staff were going about their tasks in a relaxed way and were noted to have a pleasant relationship with residents. The atmosphere in the home is commendable. What the service does well:
The home has a registered manager and group of staff who have worked at Millfields for a long time and are keen to continue raising standards of care in the home. There are regular home meetings where residents and their families/friends can have input into the way the home functions and into what activities and leisure pursuits/pastimes are provided for people living there. Private areas of the home, such as bedrooms, are decorated and furnished nicely and people spoken to said that their needs are met. Shared spaces, such as lounges and dining rooms, are clean, bright and attractive. The home is centrally heated and residents said that they can turn the heat up or down to suit. The home provides three meals every day plus regular snacks and drinks when required. Residents say that if they don’t want what the home is offering the cook will offer an alternative. People who live at the home, and their family/friends have told the Inspector that the home and its staff offer a ‘top rate’ service to older people and that they feel lucky to have found such a lovely care home. The atmosphere in the home is open and inclusive, people can come and go as they please and as far as their ability allows. Families are made to feel welcome, as are visitors. The Inspector was made to feel welcome and the homeowner said he welcomes unannounced visits.
MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 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 MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 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) 3,4 & 5 The Inspector found evidence that appropriate assessment processes are in place. EVIDENCE: The home’s policies are that all prospective residents will have comprehensive assessment of their perceived need prior to admission. The case records of 2 most recently admitted residents were inspected. It was found that a resident admitted a week ago had been assessed prior to admission by the home’s manager and that she considered that the home would be able to meet his current care needs. From evidence presented in the assessment and care plan, and from speaking with the resident and their relative, the Inspector is confident that the home is able to meet the assessed needs of this resident. The second newly admitted resident came to the home in an emergency situation. Although the home avoid emergency admissions where possible, a decision was taken that, in view of this prospective resident’s need, they would admit.
MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 9 a Although the manager was not able to conduct a pre-admission assessment, the home considered that they could meet the needs of this service user because a comprehensive assessment and care plan had been provided by the resident’s social worker. The Inspector was able to speak with this resident, their relatives and a friend who all consider that her needs are being met. People spoken to confirmed that staff at the home had provided verbal and written information about the services the home provides and stated that they are satisfied that their relative’s assessed needs are being met. Both families stated that they visited the home prior to their relative being admitted and were able to make a decision whether the home would be suitable for their needs. The home’s Statement of Purpose states that they do not provide facilities for intermediate care. The registered manager confirmed on the day of inspection that that remains the case. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 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,&10 Health care needs are assessed and met within an environment that ensures privacy and where respect is maintained. EVIDENCE: Having inspected the case files of 2 newly admitted residents, the Inspector found that there was evidence that the residents’ health and social care needs are set out in an individual care plan. Both service users had a comprehensive care plan which sets out individual perceived needs in relation to that resident, eg. mobility, continence, eating and drinking, weight, social and activity etc. These plans give evidence of the perceived need, what action is to be taken to meet that need and goals which are aspired to, showing over time how these may be achieved. Care plans give evidence of health care needs including medication and the actions taken by the home to meet these needs. From speaking with people living in the home generally, and from direct observation of interaction taking place between residents and staff and between residents and visitors including a visiting hairdresser, during this
MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 11 unannounced inspection, the Inspector could see that residents are treated with respect and that their privacy is maintained. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 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 The atmosphere in the home is welcoming, the food provided is varied and choice is available. EVIDENCE: During the inspection it was noted that the families and friends of residents were visiting the home and were being greeted warmly by the manager, staff and the provider. Residents spoken with during the inspection said that they could receive their visitors at any reasonable time. Many residents have lived locally prior to being admitted; families/friends and staff at the home said that Millfields is truly part of the local community. Menus were inspected during the visit and found to be providing wholesome and varied meals. Residents and families/friends spoken with said that, in their opinion, the food provided by the home is of good quality. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 and 18 Residents’ legal rights are protected although the home admitted, on one occasion, to allow a staff member to work in the home before their POVA check was received. The responsible person will now work to the CRB/POVA legislation and to the Department of Health guidance. EVIDENCE: Residents spoken election soon and wished. Families relative could vote with during this visit knew that there is to be a general said that they could take part in the civil process if they spoken with said that they would also ensure that their should they wish to. With reference to protection, the Inspector found that one recently employed staff member was working in the home and that, although she had a recent satisfactory Criminal Records Bureau [CRB] and Protection of Vulnerable Adults [POVA] check, this was from her previous employment. Millfields had sought a CRB/POVA but, on the day of inspection, it had not been received. [The manager confirmed that it had been received the day following the inspection.] The Inspector made the home’s responsibilities clear regarding this issue and accepted the home’s reassurances that in the future no staff will be allowed to work in the home before a current CRB/POVA check is received or that, whilst waiting for the full check to be received, a ‘POVA first’ check is undertaken. The manager confirmed that it has been the case, since CRB/POVA checks were introduced, that all staff working in the home are supervised and work alongside existing staff until their satisfactory CRB/POVA check has been
MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 14 received, which would still be required should a recruit start work after only ‘POVA first’ clearance. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 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) 19,20,24,25. The provider and manager ensure that the environment for people living in the home is safe and well maintained. EVIDENCE: The environment is safe and well maintained. Maintenance records endorse this. Residents have access to attractive and comfortable indoor and outdoor communal space. Residents’ bedrooms are well furnished, clean and suited to the needs of people accommodated. Staff working in the home said that they receive health and safety training and are encouraged to check the general state of the home during their working day and report any concerns to the manager. The manager said that she undertakes regular health and safety checks. The bedrooms of two recently admitted residents were visited although they were very newly admitted they and their families said that they had been encouraged to bring personal belongings in to the home and personalise their rooms.
MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 home employs sufficient qualified and experienced staff to meet the assessed needs of people accommodated. [Please refer to standard 18]. Progress is being made towards the expected 50 of care staff achieving National Vocational Qualification [NVQ] at level 2 or above by 2005. EVIDENCE: The Inspector spent several hours in the home during this unannounced inspection and was able to observe the way in which staff interacted with residents and how they ensured that their daily needs were met. Residents and families said that staff did all they could to ensure that needs were met. The Inspector was advised that a resident who is requiring very specialist medical treatment is being appropriately supported by all staff, and in particular one staff member with whom the resident has a special relationship. The home is enabling this staff member to accompany the resident on hospital visits and to support them through chemotherapy with the additional support of the hospital consultant, their own GP and Macmillan Nursing staff. The home has a robust training and development programme and a staff training facility which provides training for Millfields and its sister home Stella House. The manager stated that Millfields is striving to ensure that a minimum of 50 of care staff have at least NVQ level 2 and have a new group of staff ready to register. However, the home’s external trainers are presently unable to register new applicants because of changes within NVQ training.
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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) 31&32 The manager exhibits a leadership style which was noted by the Inspector to be inclusive and supportive to residents and staff. EVIDENCE: Millfields registered manager is a competent, experienced and qualified person who, in addition to being a qualified nurse, has now completed her NVQ 4 in Care and Management/Registered Managers’ award. From direct observation, the Inspector is able to state that the home’s atmosphere is relaxed and comfortable. Residents and their families/friends spoken with during the visit praised the home and the staff for creating such an environment. The manager exhibits a leadership style which was noted by the Inspector to be inclusive and supportive to residents and to staff. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x 3 3 x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 1 3 4 x x x x x x MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 19 No 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 18 Regulation 19 Requirement The registered person must ensure that a satisfactory Protection of Vulnerable Adults check has been received prior to working in the home. Timescale for action with immediate effect [21/4/05] RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard [21/4/28 Good Practice Recommendations The registered person should ensure that a minimum of 50 of care staff employed by the home has satisfactorily completed NVQ at level 2 or above within 2005. MILLFIELDS J51J01_S6200_Millfields_V220562_210405.doc Version 1.30 Page 20 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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