CARE HOMES FOR OLDER PEOPLE
Milliner House 23 - 29 Marsh Road Luton Beds LU3 2QS Lead Inspector
Irene Miller Unannounced Inspection 20th November 2008 09:50 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 Milliner House DS0000066373.V373234.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. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Milliner House Address 23 - 29 Marsh Road Luton Beds LU3 2QS 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) 01582 490080 01582 491080 millinerhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Colleen Mullen Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th January 2008 Brief Description of the Service: Milliner House is situated on the Marsh Road in Luton within easy reach of the town centre amenities by car or public transport. The home is within walking distance of community resources, which include churches, shops, pubs and restaurants. An enclosed garden area is at the rear of the building alongside parking. The home provides personal care for up to 30 people over the age of 65 years who have dementia and 10 people over the age of 65 who have mental health needs. Accommodation is provided across two floors, there are 40 single rooms providing en suite facilities. The home consists of 4 unit areas, each area consisting of bedrooms, and lounge/dining facilities. The home has a rear garden which is accessible to people living in the home and car parking is also available. Access to the first floor is via a shaft lift or stairs. Various communal areas are located throughout the home. The manager at the home provided the following information on charges. The fees for this home vary from £459.00 per week, to £809.00 plus per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing and chiropody services. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes.
The focus of all inspections undertaken by the Commission for Social Care Inspection (CSCI) are based upon seeking the outcomes for Service Users and their views of the service provided. This visit was unannounced and focused on the ‘key standards’ under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of people using the service were sample checked this involved looking through written information available on their care, such as care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). The home cares for people with dementia and mental disorder and where possible discussions took place with the people, and indirect observations were made of care practices, in effort to establish the general well being of people using the service. During the visit records in relation to staff recruitment and training, how the home responds to concerns and complaints, the management of medication and the homes general policies and procedures were viewed. What the service does well:
Internal health and safety audits are carried out quarterly and annual quality assurance and surveys capture the views of people using the service and their representatives on how the home can improve its services. The outcomes of the surveys are posted within the front entrance of the home and detail the actions taken to address issues identified for improvement. The service is proactive in responding to complaints and safeguarding issues and ensures that the regulation, commissioning and safeguarding authorities are informed on the actions taken to protect the rights of people using the service.
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 6 The service continues to keep the Commission for Social Care Inspection informed of notifiable (regulation 37) events such as accidents and incidents, hospital admissions, and major changes in the health conditions of people using the service. The home employs an activity person who coordinates the activities for people using the service to engage in. Within the care plans there were records of seeking the input of people using the service and their representatives in identifying the individual preferences in relation to hobbies, interests and pastimes. Work had begun on improving the environment by creating one of the rooms into a pub with a brewery theme and a bistro style coffee shop. One room is used as a cinema, another room is themed as a children’s nursery and there is a sensory room available with soft lights and soft furnishings that promotes relaxation. A complimentary therapist visits the home weekly and therapies include facials and manicures. Each of the units has a small kitchen facility to enable snacks and beverages to be made which helps in promoting flexibility in providing individualised care for people using the service. In discussion with people they confirmed that they are given choices as to how they conduct their lives and pleased with the choices offered included meals, activities available. There is a relaxed atmosphere at the home relatives visiting during the inspection were seen to be greeted by staff in a courteous manner and confirmed that visiting times are flexible. What has improved since the last inspection?
The environment where people living with dementia are accommodated had signage in place and sensory boards, for people to touch and look at, the doors leading to bedroom are designed to look like ‘front doors’ with letterboxes and door knockers, with the aim of the corridors having a street theme. Dementia Care training has taken place and further training is planned on person centred dementia care through staff embarking on a distance learning course ‘Yesterday, Today, Tomorrow run by the Alzheimer’s Society. Milliner House is currently registered to provide care for a number of people with a mental disorder and some training had taken place on the Mental
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 7 Capacity Act, the registered manager confirmed that she was seeking training for staff on personality disorders. 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. The summary of this inspection report can be made available in other formats on request. Milliner House DS0000066373.V373234.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 Milliner House DS0000066373.V373234.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): Standard 3 (Standard 6 is not applicable to this service) Quality in this outcome area is good. People considering using the service are provided with sufficient information to decide whether the home is right for them, and their needs are assessed prior to admission into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose was on display in the home and provided information on the staffing, accommodation and services available at the home. Pre assessment documentation was available within the care records of people who were care were tracked at this visit. There was sufficient information available to inform the staff on the needs of the person.
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 10 Staff spoken with during the visit demonstrated that they were aware of the needs of the people using the service. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 & 10 Quality in this outcome area is adequate. Shortfalls in identifying and recording the changing needs of people using the service can place them at risk of their healthcare needs not being fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person had returned back to Milliner House following a stay in hospital, with Grade 3 pressure area sores, the home had taken appropriate action in alerting CSCI and Luton Borough Council Safeguarding Team through following the safeguarding procedures. At this visit we chose to look at the care plan for this person to see how their healthcare needs were being met by the home. We looked at their care plan for pressure area care and there was records of the pressure sores being treated by the district nurse service, of pressure area equipment being in use and of staff repositioning the person in bed at two hourly intervals.
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 12 Within the ‘daily evaluation notes’ in the care plan there was reference of ‘the catheter bag being emptied’, we spoke with the staff on duty who confirmed that the person had returned back from hospital with a urinary catheter fitted. We looked at the continence management care plan to check on how staff were to provide catheter care and found that, this important change had not been identified within the care plan, in addition the care plan had been reviewed since the person had returned to the home and did not reflect that the person was now catheterised. We looked at the care plan for a person diagnosed with diabetes, the care plan stated that the person was a diet controlled diabetic, however on checking the medication prescribed for this person it was established that they were also prescribed medication to control their diabetes and this was not reflected within their care plan. There was documentation within the care plan on the person’s nutritional needs and records of prescribed food supplements and the monitoring of weight gains and losses. The ‘eating and drinking’ care plan stated that the person needed ‘encouragement to feed themselves’ and to sit with other service users at meal times. However in discussion with the staff it was established that since their return from hospital the person was being cared for in bed, therefore the care plan required updating to reflect the change in the support required at meal times. We looked at the care of a person who was identified at being at high risk of falls. A falls risk assessment had been completed with the aim of identifying the hazards that could increase the risk of falls, and the measures in place to reduce the risks to a minimum. Areas such as having good lighting and keeping obstacles (such as furniture) to a minimum and correctly fitting footwear had been identified. The person had problems with their eyesight and within their care plan there were records of having access to optical services and review of their medication by their general practitioner. One person was observed lying on their bed and looked in discomfort saying that they had ‘terrible pains in their back’, this was brought to the immediate attention of the registered manager who acted swiftly in making arrangements for the person to receive medical attention. We looked at how this person’s pain was managed, within their care plan there was information that they were diagnosed with having Osteoarthritis. We looked at how pain is controlled for this person and found that the medication prescribed to provide pain relief had been discontinued, it was difficult to establish when this medication had been discontinued. There were several entries within the care plan of the person having complained of back pain and of being seen by the First Point of Call Nurse (FPOC) service on several occasions. This was brought to the attention of the registered manager who contacted the surgery to make arrangements for the person to have a full review of their medications carried out by their general practitioner. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 13 Generally within the care plans there were records of people having contact with their general practitioner and other healthcare professionals such as the optician, chiropodist an optician. As previously stated the home uses a community service called First Point of Contact (FPOC) which is effectively a triage service and acts as a rapid response service to attend to minor ailments etc. and does not replace the right for people to be seen by their general practitioner. General observations of staff interactions with people using the service were positive, the atmosphere within the home was pleasant and people treated as individuals with respect and dignity. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 & 15 Quality in this outcome area is good. The service strives to provide a range of activities to meet the individual needs of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activity person who coordinates the activities for people using the service to engage in. Within the care plans there were records of seeking the input of people using the service and their representatives in identifying the individual preferences in relation to hobbies, interests and pastimes. The environment where people living with dementia are accommodated had signage in place and sensory boards, for people to touch and look at. The doors leading to bedroom are designed to look like ‘front doors’ with letterboxes and doorknockers, with the aim of the corridors having a street theme. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 15 Work had begun on improving the environment further by creating one of the rooms into a pub with a brewery them and a bistro style coffee shop. One room is used as a cinema, another room is themed as a children’s nursery and there is a sensory room available with soft lights and soft furnishings that promotes relaxation. A complimentary therapist visits the home weekly and therapies include facials and manicures. In discussion with the registered manager she confirmed that staff training on therapeutic therapies was planned to take place during December 2008, this training would build upon the skills of the staff team to highlight the benefits of people living with dementia engaging in social interaction and meaningful activities. The daily menu was displayed on a large chalkboard within the corridor areas on each floor, it was noted that one of the handwritten boards was hard to read due to the style of handwriting. This was pointed out to the registered manager who arranged for it to be rewritten in a print style that was clear to read. People were observed receiving their lunchtime meal that consisted of Roast Chicken, roast potatoes and vegetables; an alternative meal was available which was Cheese and Onion Quiche. Each of the units has a small kitchen facility to enable snacks and beverages to be made; this promotes flexibility in providing individualised care for people. In discussion with people they confirmed that they are given choices as to how they conduct their lives and pleased with the choices offered included meals, activities available. There is a relaxed atmosphere at the home relatives visiting during the inspection were seen to be greeted by staff in a courteous manner and confirmed that visiting times are flexible. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18 Quality in this outcome area is good. People using the service and their representatives can be assured that any concerns or complaints they have will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The and The and complaints procedure was on display within the front entrance of the home within the homes statement of purpose and service user guides. procedure gave clear instructions on how and who to raise complaints with the timescale of the service responding to complaints. Review of the homes records identified that one complaint had been received since the random inspection from a relative about the care of a resident. CSCI are satisfied that the provider responded appropriately to the complaint. CSCI had been made aware of a number of safeguarding alerts that had been raised by the provider to Luton Borough Council safeguarding team and records had been retained by the home. We were satisfied with the actions taken to safeguard the people in their care. Through review of staff training files there was records of staff having been provided with Safeguarding Adults training.
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26 Quality in this outcome area is good. People using the service are provided with a home that is clean, well maintained and pleasant. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is divided into four separate areas, these are known as houses. Each house has a dining and sitting room and a small kitchen area located within the corridor. All bedrooms are single with en suite facilities. Communal facilities include a small cinema; activity room, sensory room and a hospitality room are also available for people to use. There is an enclosed rear garden for use by the people living at the home. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 18 The furnishings, fittings and décor are of a good standard and all were noted to clean, tidy and free of odours. Items of protective clothing were available for staff and were seen to be in use. The kitchen and laundry areas were clean and systems in place for clinical and medical waste to be disposed of appropriately. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 & 30 Quality in this outcome area is good. People using the service are cared for by staff that are appropriately trained to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff recruitment files were sample checked; there was evidence of the home having carried out pre employment checks through having obtained written references and records of interview probing previous employment, skills and experience. Checks with the criminal record bureau (CRB) and the Protection of Vulnerable Adults Register (POVA) are carried out centrally. In some instances staff commence employment at the home after having obtained clearance through the POVA register, and the new staff member works under supervision pending clearance of their CRB. It was difficult to establish how this arrangement is monitored and it was explained at the time of inspection that in this event the home must be able to demonstrate that the new staff member has worked under strict supervisory arrangements with a named supervisor until the CRB is cleared. This is important in helping to ensure that the recruitment process protects people. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 20 Review of the staff training records, indicated that staff have received mandatory training to include moving and handling, manual handling, food hygiene and fire safety awareness. Discussion with the registered manager confirmed that on going training takes place on Dementia Care that is provided through a dementia consultant and further training was planned to take place on person centred dementia care which involves staff undertaking a distance learning course over an eight week period. Milliner House is currently registered to provide care for a number of people with a mental disorder and recent training had taken place on the Mental Capacity Act, the registered manager confirmed that she was seeking further training on personality disorders. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35 & 38 Quality in this outcome area is good. The home is run in the best interests of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In discussion with the registered manager she was able to demonstrate a good understanding of her responsibilities and the needs of people living at the home. Internal health and safety audits are carried out quarterly and annual quality assurance and surveys capture the views of people using the service and their representatives on how the home can improve its services.
Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 22 Within the front entrance of the home there was information on display giving the outcome of the most recent quality assurance survey, and details of the action being taken to address issues identified for improvement. Small amounts of money are held on behalf of people living at the home to help assist them in paying for additional services such as chiropody treatment and hairdressing. A sample check of the records confirmed that transactions and receipts confirmed robust accounting systems are in place to ensure that people’s finances are well managed. The home is proactive in responding to complaints and safeguarding issues and ensures that the regulation, commissioning and safeguarding authorities are informed on the actions taken to protect the rights of people using the service. Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The current healthcare needs of service users must be identified within their individual care plan. This will ensure that staff are fully informed of the current needs of the people in their care. Changes to prescribed medications for people using the service must be clearly recorded within their care plan and associated medication records. This is to ensure that people receive their prescribed medications. Staff taking up employment pending CRB clearance must only work under strict supervisory arrangements, to include a named supervisor linked with the new staff member. This is important to ensure that the recruitment process protects people. Timescale for action 28/02/09 2 OP9 13(2) & 18(1) (a) 28/02/09 3 OP29 19 Schedule 2 28/02/09 Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milliner House DS0000066373.V373234.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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