Inspection on 17/05/07 for Millings The

This inspection was carried out on 17th May 2007.

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

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

Other inspections for this house

Millings The 07/03/06

Millings The 13/06/05

Millings The 03/02/05

Millings The 29/07/04

Millings The 22/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Millings The 5 North End Bedale North Yorkshire DL8 1AF Lead Inspector Anne Prankitt Key Unannounced Inspection 17 May 2007 09:15 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 Millings The DS0000007856.V335064.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. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millings The Address 5 North End Bedale North Yorkshire DL8 1AF 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) 01677 423635 01677 427220 www.residential-homes.net Clifton St Annes Personal Care Services Ltd. Mrs Sandra Yvonne Anderson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: The Millings is a care home registered to provide accommodation and personal care for 40 people over the age of 65 years. The Millings is situated in the market town of Bedale. The home was formally the rectory, which has been converted for its current use. There is ample parking space available for visitors. The building is set in beautiful grounds. Accommodation is provided on three floors. There is a passenger lift, which provides access to all floors. The registered manager confirmed on 17 May 2007 that the current weekly fees range from £430 to £460 each week. Additional charges are made for hairdressing, chiropody, manicures, toiletries and newspapers. Before people are admitted to the home they are provided with an enquiry pack, which explains what the service provides, a brochure, and information about how to complain. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the registered manager, Sandra Anderson, returned a completed questionnaire to the Commission for Social Care Inspection. It provided some good information about the home, including who lives and works there. The inspector also kept a record about what had been happening at the home since the last inspection. Before the site visit, surveys were sent to a random selection of people who live at the home and also to professionals who visit, so that their views about the service could be sought. Three hours of planning took place before the site visit, which took one inspector seven and a half hours to complete. Time was spent at the site visit talking to some of the people who live there, the staff, and the registered manager. Some records were looked at, including a selection of care plans, health and safety records and staff files. Feedback was provided to the registered manager at the end of the site visit. What the service does well: People who are thinking of living at the home have their needs assessed before they are offered a place. This helps to check that the home will be able to meet them. People are offered care and support by a staff team who have been given training to help them provide care in a safe and proper way. People are given choices in their daily lives, and flexibility so that they can continue to enjoy their own routine wherever possible. People know that they can complain, and that they will be listened to. Staff know their responsibilities in passing on any concerns which affect the safety and vulnerability of people, so preventing them from any risks. The premises are set in beautiful surroundings upon which many areas of the home look out onto. All parts of the home are well maintained to promote the comfort of the people living there. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience good quality outcomes in this area. People’s needs are assessed before they are admitted, so that it can be assured that they can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who are thinking of living at The Millings have their needs assessed by a senior member of staff before they are admitted, to check that the home can meet them. People are also encouraged to spend a day at the home to give them a better idea about what it provides. One person recalled that they had looked round before making any decisions about moving there and had found this to be very helpful. People who returned their surveys agreed that they were given sufficient information about the home before they moved in. The information in the assessment is useful to staff because it helps them make sure that they give the right care and support as soon as the person is admitted. It also allows them to begin to develop a more in depth care plan for people which is added to after they are admitted. Because, of this, it is Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 9 important that the written assessment is always completed in full, so that the relevant information discussed with the person is available to all care staff. This had not happened in one assessment seen, although staff said that the assessment had been completed fully. The registered manager confirmed that the home does not provide intermediate care. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. People get good care from staff who understand their needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Each person who lives at the home has a care plan, which explains people’s strengths, and also where they may need support. They contain good information about people’s health and social needs, and of any risks associated with their care. They are regularly reviewed, so that the information, although currently a little disorganised, remains up to date and relevant. Periodic reviews also take place with family members and a survey sent out to check that people remain satisfied with the care that they get. Staff need to make sure that decisions made regarding care provision, which do not agree with the findings of the risk assessment, are always justified and documented. The registered manager is planning to reorganise the plans, which will help to make the information easier for staff to follow. The staff at the home make sure that people have continued access to health professionals in the community, and they have built good links with them. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 11 One visiting professional spoke very highly of the service. Another commented ‘I think they provide an excellent home. The residents are treated with respect and their needs are met. The care is excellent’. People praised the staff, and the care that they provide. They all agreed that they were treated with dignity and respect. Their made comments that the home was ‘Excellent’ and provides ‘good care’. Others said that ‘I couldn’t wish for any more’ from the home and that ‘The staff are very good’ and ‘I’m very pleased I came’. Some people choose to manage their own medication, which they are able to do after staff have completed a risk assessment to check that it is safe for them to do so. Staff are reviewing the current records to check that all those who keep only eye drops or ‘when required’ medication also have a risk assessment completed. For the remainder of people, suitably trained staff handle their medication. The medication procedures were satisfactory. One person self prescribes vitamin tablets, which are purchased by their family. Assurance has been given by staff that this arrangement has been agreed between the general practitioner, the person concerned and their family. Staff administer this medication, and have included it on the Medication Administration Records. Advice was given about the following: • • • Although staff know that they have been administered, they must make sure that eye drops and ‘when required’ medication is appropriately signed for. Staff should make sure that they do not share medication belonging to one person with another who is prescribed the same medication. A formal agreement with the General Practitioner needs to be made so that staff are clear about which medication can be given to people without prescription. Assurance has been given that these matters have already been, or are being addressed. On the day of the site visit, a fridge was delivered to the home which will be used specifically for the storage of medication which needs to be kept cool. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience excellent quality outcomes in this area. People can be assured that they will be able to maintain important links with their friends and family, and that their social and spiritual needs will be considered. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: An activities co-ordinator provides a range of activities for people, which are chosen by them during their meetings. The planned activities are published in advance, so people can choose which they would like to attend. People spoken with particularly enjoyed the ‘chairobic’ exercises. Consideration is given to those with poor sight, to make sure that they have an opportunity to join in socially with others. A member of staff explained how they were able to spend time socially with people, especially during the morning. This helps them to get to know people better. People were satisfied that they are not restricted by any routine at the home. This means that they are able to continue to live their life as they choose wherever possible. Some explained how staff assist them to visit the local church or chapel, and they were pleased that this enabled them to maintain Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 13 links with the local church community. Those who are unable to attend can join in the services which take place at the home. People agreed that their friends and family are welcomed at the home at any time. Because of the close proximity of the home to the town centre, staff are able to take them out to the shops, for coffee, and to local functions. The chef said that they do not have a budget that they are restricted to, and staff have facilities available to them so that food can be offered to people on a twenty four hour basis. The main meal was very well presented. People serve their own vegetables, which are presented in tureens on each table. There is no advertised choice to the main meal, but people would be offered an alternative upon request. The mealtime was unrushed, and was very much a social occasion. People stayed behind after the meal to sit and chat with their company. They were offered fresh fruit after their meal. The registered manager said that they now have ‘themed evenings’, where food from other countries is served, and each Wednesday, people are offered a special three course menu. Effort is made to make sure that the choice available to people on special diets is not restricted. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. People can be assured that their complaints will be taken seriously, and that they are protected by staff who will pass on any concerns to the management. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There is a complaints procedure which is included in the service users’ guide, and which is on display in the home. All those spoken with felt confident that they could take their complaints to the registered manager, and that she would deal with them to their satisfaction. All those surveyed agreed that they knew how to complain. Staff knew that any complaint made to them should be reported to the registered manager. Three complaints have been made to the home since the last inspection. There was a clear record of the action taken in each case by the registered manager, and a record was made that each complaint had been resolved to the satisfaction of the complainant. Staff at the home are due to have updated training in abuse awareness to further raise their understanding of what constitutes abuse. Those spoken to were clear that they would refer any concerns brought to their attention to the registered manager, who in turn would report the matter to the appropriate body for investigation. Staff knew that they could not keep secrets where abuse was alleged or suspected. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience excellent quality outcomes in this area. People live in a warm, comfortable, safe and well maintained home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is set back from the main road in the centre of Bedale. It is surrounded by beautiful well kept gardens that the people who live at the home greatly appreciate. The building is tastefully decorated, and provides a variety of communal space for people to enjoy. It was extremely homely, and care had been taken to position chairs at suitable points around the building so that people can stop for a rest when mobilising around the home. Bedrooms contain personal belongings, and are individualised. All of the areas seen were cleaned to a high standard, and are a credit to the cleaning staff. The registered manager and the proprietors carry out a full audit of the building on an annual basis, and the registered manager meets with the maintenance man weekly to make sure that any maintenance issues are dealt with. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 16 The fire officer visited the home recently. There were no recommendations made following his visit. The registered manager has completed a fire safety risk assessment. She explained that the fire procedure is discussed with all the people who live at the home at every one of their meetings. This helps to make sure that they remain safe should a fire occur. The maintenance man shares his time between this and another home operated by the company. He makes sure that the in house checks, such as hot water temperatures and the fire alarm weekly checks, are kept up to date. The registered manager and proprietors make sure that outside contractors carry out scheduled services of other equipment so that the premises remain safe. The laundry facilities are suitable for the service that the home provides. The laundress was satisfied that she was provided with sufficient information from staff so that she could minimise any risk from cross infection. She was provided with protective clothing, and information about what to do if she accidentally spilt any hazardous chemicals. One person living at the home said ‘Look at my laundry. I am so lucky to have it delivered back to me like this’. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. The proprietors invest in training for their staff so that they have appropriate training to help them in providing a service to people in a safe and responsible way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There are dedicated care, cleaning, maintenance and catering staff at the home. During the night, there is always a senior member of staff on call to provide advice and support for night staff whenever needed. Whilst very satisfied with the care, some people who returned their survey did comment that they had to wait occasionally for attention if staff were busy with others. For instance, one commented ‘There are a few occasions where care may be delayed but not knowingly. There are times when the staff may be busy with another resident or elsewhere when there might be a delay.’ But on the day of the site visit all but one person, who said that staff are very rushed during the afternoon shift, were entirely positive about staff availability. Their comments included ‘There are always plenty of staff’, ‘Staff come whenever I ring my bell’. The registered manager said that the rota and staff numbers can be flexible to meet people’s needs and changing dependency, and that there had been no issues raised within the recent survey circulated to people who live at the home. However, the registered manager should keep this under review. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 18 There is a rolling programme of training, including a National Vocational Qualification programme, which staff attend enthusiastically. Mandatory training is provided to all staff at the home, so that they can work in a safe way. Further training and supervision is offered so that staffs’ understanding of the people that they care for is continually developed. The registered manager is currently thinking about ways in which she can organise different training for staff, such as hand massage therapy, which she feels would benefit the people who live there. From discussion with the registered manager, and examination of a recruitment file, it was identified that steps are taken to make sure that the necessary checks are made before staff are allowed to provide care at the home. This helps to protect the people who live there from unsuitable workers. The registered manager must make sure that she keeps a record of discussions with the Criminal Records Bureau (CRB) department when she has sought advice about when a repeat CRB check is needed. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience excellent quality outcomes in this area. The home is well run by a proactive registered manager who seeks the views of the people who live there, and takes positive action to make continual improvements to the service that they get. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager has worked in this position for seven years. She is suitably qualified to fulfil the position. She is well liked by the people who live at the home, and staff commented on how much they value the support that she and the proprietors give. The home is run taking into account the needs and wishes of the people who live there. Their views are sought formally in a questionnaire, which is also sent to relatives and visiting professionals to the home. The registered Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 20 manager explained that the results of the survey are taken seriously, and action taken where further improvements could be made. She said that she is well supported by the proprietors, and that the ethos of the home is that the people who live there remain central to any decisions that are made in the way that it runs. Regular meetings are held with staff and the people who live there, to check that this remains the case. She meets with the director on a regular basis, who is always available for advice and support. Advocacy services are also invited to attend meetings, so that they can give support to people wherever this may be needed. Staff comments included ‘This is a well run home’. The home does not look after any money belonging to the people who live there, but it does provide individual lockable storage space so that valuables can be kept secure. From the information given prior to the site visit, and from a sample of certificates looked at, it was evident that equipment at the home is regularly serviced. This helps to keep the premises safe. The proprietors are currently looking into whether the systems in place to reduce the risk from legionella need to be updated. They will be taking action if the company they have approached advise them that this is necessary. Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 21 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millings The DS0000007856.V335064.R01.S.doc Version 5.2 Page 24 - 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!