CARE HOMES FOR OLDER PEOPLE
Millington Springs Portland Road Selston Nottinghamshire NG16 6AN Lead Inspector
Jayne Hilton Unannounced Inspection 10th February 2006 04:45 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 Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Millington Springs Address Portland Road Selston Nottinghamshire NG16 6AN 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) 01773 581114 Elder Homes Midlands Ltd Tina Frances Kapp Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability over 65 years of age (5) of places Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One physically disabled named service user aged 49 with nursing needs can be admitted. Home for 42 Older Persons (OP) of which 5 can be physically Disabled (PD) 5th August 2005 Date of last inspection Brief Description of the Service: Millington Springs is a purpose built home with 32 bedrooms, sited on Portland Rd, Selston, Nottinghamshire. The home provides personal care with nursing for older people and the home can also cater for physically disabled people. The home has 3 lounges, 5 bathrooms, all with shower facilities, 1 walk in shower facility and 14 WCs. One bedroom has en-suite facilities and one bedroom has a shower cubicle. A pleasant garden area is provided at the rear and adequate car parking facilities to the front of the building. The home was purchased by Elder Homes Midlands Ltd and has undergone some refurbishment. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 2 1/4 hours and was carried out by Regulation Inspector Jayne Hilton. The focus of this visit was to assess if the previous requirements set had been complied with and to assess any key standards remaining. A partial tour of the building took place with the communal areas and a selection of bedrooms being inspected. Residents and staff were spoken with on the day and care and staff records were looked at. As the inspection commenced at tea - time on a Friday the manager was preparing to go off duty as the inspector arrived. The manager did stay for approximately half an hour to assist the inspector, which was appreciated however the manager was unable to remain for the full inspection pending another appointment. What the service does well:
Residents spoken with were all positive about the care they received and the way staff provided that care. Individual plans and risk assessments address the needs of most service users. The home provides a comfortable and homely environment for residents. The residents are able to participate in activities of their choice and receive a wholesome and varied diet of their choosing. Relatives were observed coming and going throughout the inspection and service users confirmed they could receive visitors in private. The manager understands her responsibilities to improve standards within the home and is able to provide clear leadership to ensure this happens. Service users needs are fully assessed in line with National minimum standards. Service users feel their needs are met fully by the home. Service users are confident about making complaints. Safeguarding adults procedures are in place and evidence was seen within the care plans for service users to be assisted with the civic process. The deployment of staff is also adequate. Medicine management is satisfactory. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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 Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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 the following standard(s): 3,4 Service users needs are fully assessed in line with National minimum standards. Service users feel their needs are met fully by the home. EVIDENCE: Three plans of care were looked at for the purpose of this inspection. The ‘Standex’ system previously used is now in the process of change and two of the care plans were observed to now meet with standard 3. Plans evidenced that full assessments were taking place and that the plan identifies how needs are to be met. Where residents have specific care needs, plans were limited by the Standex structure and some information in one care plan had not yet been transferred. [See standard 7.] However residents spoken with were all positive about the care they received and the way staff provided that care. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7,8,9 Individual plans and risk assessments address the needs of most service users. The completion of the transfer to the new system is needed to ensure all service users needs are fully met. Medicine management appeared satisfactory. EVIDENCE: Two of the care plans examined were found to be appropriate and up to date and had been transferred to the new format. One other had not been transferred to the new system and was found, to have not been updated, for six months. This was concerning as the manager and staff had discussed some issues in relation to this particular service user’s care needs. Daily records and accident records were completed however it is imperative that the service users care plans are reviewed and updated within 14 days to ensure the service users needs and any changing needs are fully met. The residents spoken with reported that staff were very kind and helpful and responded to call alarms promptly. Plans of care detailed that weights were routinely recorded and monitored and residents saw chiropodists and other health care
Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 10 professionals as required. Where residents need bed rails or risk assessments for keys and limitations on furniture in their bedrooms this is now in place. Medicine management was only briefly assessed. The requirement set at the last visit in relation to room storage temperatures is now met. A medicine round was observed and all practice observed was satisfactory. The treatment room was clean and tidy. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12-15 The residents are able to participate in activities of their choice and receive a wholesome and varied diet of their choosing. Relatives were observed coming and going throughout the inspection and service users confirmed they could receive visitors in private. Although service users wishes are included in care plans, evidence of staff practice shows that improvement in verbal communication with service users needs to be improved. EVIDENCE: There was a list of activities in place in the reception area and service users confirmed that the arrangements for activities were still in place and that the activities co-ordinator keeps them occupied with a variety of activities and entertainment. Due to the number of lounges residents were able to choose where they sat and what they watched on television. One member of staff was observed to move a service user in a wheelchair without any interaction or communication of where she was taking her. Another service user informed the inspector that the staff member would be taking the service user to bed; however, the service users had not been given any opportunity to exercise any choice over the matter. The meal was not sampled but residents spoke with were positive about the meals and felt that the quality was good. There is four-week rotating menu
Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 12 and a menu board displayed in the dining room offered a good range of alternative options. Records were seen for where service users had chosen alternative options, which is an improved service at Millington Springs as this issue has been longstanding. Service users confirmed they were now given a choice. The dining room was pleasant and residents were observed to be given three options of desert during the inspection and a care assistant heard describing the contents of cheesecake to a service user who asked what it was. Where assistance was needed, two staff were, however observed standing to assist with service users with eating, which is not good practice and the manager was seen to challenge the practice at once. Service users reported satisfaction with the meals that they were adequate in portion and served hot enough. One service user who prefers brown bread conformed this was provided. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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 the following standard(s): 16-18 Service users are confident about making complaints. Safeguarding adults procedures are in place and evidence was seen within the care plans for service users to be assisted with the civic process. EVIDENCE: Copies of the complaints procedure were seen around the home and residents spoken with knew who to complain to and felt confident that it would be dealt with. The manager reported that there had been a recent issue in relation to safeguarding adults and that local procedures had been instigated and resolved appropriately. Care plans contain information about service users wishes and abilities to participate in the civic process. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 19-26 Service users live in a comfortable, clean and well-maintained environment with facilities provided to meet their needs. Bedrooms are also comfortable and personalised. EVIDENCE: A requirement had been set at the last inspection regarding the patio area. Work on this area has taken place to level the paving slabs and therefore the possible trip hazard has been somewhat minimised. It is recommended that the patio area be continually monitored in respect of this. The inside the home is well maintained and a sample of resident’s bedrooms were looked at and found to be in good order with bed linen in a good state of repair including towels and sufficient stocks of linen. Residents spoken with said that they were happy with the arrangements regarding locks on their door, one resident spoken with said that although there was a lock on the door, he chose not to lock it. Other residents confirmed that they had locks and chose to lock their door. Bedrooms were personalised and the décor satisfactory.
Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 15 The manager reported that plumbing work had been finalised and the inspector and service user noted that the pressure in one room, which, had previously been identified as poor, was now improved. The temperature of the water was only tepid in the hot tap however. Water outlet records were examined and records for the communal areas were up to date, however the bedroom outlets were not found for the most recent months. Residents spoken with said that their laundry was done regularly, on the day of the inspection the home was clean and generally free from any mal odour. One bedroom did however have mal odour present and the carpet stained. Staff explained that despite frequent cleaning the mal odour could not be eliminated. It is therefore required that new flooring suitable to meet the service users needs is provided. Evidence was seen that the washing machines were up to standard with the water regulations. A new hoist is on order and grab rail’s are sited around the home. Bathrooms are equipped appropriately and were found to be clean and hygienic. Staff was observed to wear protective clothing whilst undertaking tasks. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The deployment of staff is adequate. The procedures for the recruitment of staff appear now to be robust. Training provision for staff could not be fully assessed due to the records not being available for inspection. EVIDENCE: Four care staff were on duty with a RGN leading the shift. Staff working rotas were seen, the inspector was able to ascertain that the ancillary hours for the home were sufficient. The rota does still need to provide specific information as to the hours individual staff work for example Late = 2pm – 9pm. The manager should ensure that rotas show this. Staff files were looked at and showed that where staff had been employed from countries other than Britain references had been sought ands appropriate police checks for the country of origin and CRB and PoVa checks had been made. Records were seen for manual handling training for staff, however other records had been taken home by the manager to update. The annual training plan for all staff employed at the home needs to be submitted to CSCI as evidence that an appropriate level of training is being provided. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,37,38 There is no quality monitoring systems in place to ensure the home is run in the best interests of service users. The records inspected were mostly satisfactory but not all records were available for inspection. It was not possible to fully make a judgement that service users health safety and welfare is fully promoted and protected, as not all information was available. EVIDENCE: There are no quality monitoring and auditing systems in place apart from Provider representative Regulation 26 visits. Quality Monitoring systems must be introduced to meet the regulatory requirements. Standard 35 could not be assessed, as the records and information were not available for inspection. Regulation 37 notifications are sent to CSCI as routine.
Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 18 Overall it appeared that good level of health and safety procedures and practice was in place but the standard could not be fully assessed. Servicing and maintenance certificates were up to date. The records for Portable appliance testing were not inspected and evidence of these must be submitted to CSCI. Fire safety tests were satisfactory, including records of staff fire drills. There is a fire plan in place but there was no evidence that a fire risk assessment was in place and evidence of this must be provided. There was also no evidence that safe systems to prevent legionella were in place and again this information is required. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 19 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X 2 2 Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 14,15,17 Requirement Ensure the identified service users care plan is up to date and the individuals care needs reviewed at least monthly or as the person’s needs change. Ensure the floor covering in the identified bedroom is replaced and the malodour eradicated. Ensure the records for staff training are available at all times. Ensure the annual training plan for all staff is submitted to CSCI in order for the training levels to be assessed. Ensure quality monitoring and auditing systems are implemented Ensure records are available for inspection at all times and in the absence of the manager for the following: Service users finances/valuables held on their behalf. Portable appliance tests Fire risk assessment Timescale for action 24/02/06 2 3 OP19OP26 OP30 16 17,18 10/05/06 10/03/06 4 5 OP33 OP37 24 12,13,17 10/04/06 24/03/06 Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 21 Of Systems in place to prevent legionella Water outlet temperatures for sinks in bedrooms [Oct 05-Feb 06] Provide evidence of these records [apart from Service users financial records] to CSCI by the target date. 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 OP19 OP27 Good Practice Recommendations Ensure service users are consulted regarding their wishes for going to bed and that staff communicate/interact as appropriate. Whilst staff are assisting service users with eating, the staff member should be seated. Continue to keep the patio area under review to ensure risk to service users is minimised. Provide a ‘key’ to the shift times on the rota. Millington Springs DS0000057365.V282914.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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