Inspection on 16/03/09 for Millington Springs

This inspection was carried out on 16th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Millington Springs 25/03/08

Millington Springs 17/10/07

Millington Springs 14/11/06

Millington Springs 10/02/06

Millington Springs 05/08/05

Millington Springs 10/01/05

Millington Springs 20/08/04

Millington Springs 18/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Millington Springs Portland Road Selston Nottinghamshire NG16 6AN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Lewis     Date: 1 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Millington Springs Portland Road Selston Nottinghamshire NG16 6AN 01773581114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Elder Homes Midlands Ltd care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Dementia - over the age of 55 years (DE) 10 Dementia - over the age of 65 years DE(E) 10 No more than 10 persons should be accommodated at Millington Springs in the DE or DE(E) category when there are aready 10 persons accommodated in the individual or combined categories of DE or DE(E) Millington Springs Care Home is registered to provide care with nursing to male and female service users whose primary care needs fall within the following categories:Physical Disability over the age of 50 years (PD) 5 Physical Disability over the age of 65 years PD(E) 5 No more than 5 persons falling within the categories PD or PD(E) should be accommodated in Millington Springs Care Home when there are already 5 persons accommodated in the individual or combined categories of PD or PD(E) Old age, not falling within any other category (OP) 42 10 0 5 Over 65 10 42 5 Care Homes for Older People Page 4 of 29 The maximum number of persons to be accommodated at Millington Springs Care Home is 42 Date of last inspection Brief description of the care home The manager said that the current weekly fees for the home are #301 residential care and #501 nursing care high dependency needs. Rates are dependant upon needs and are further discussed during the preadmission procedure. The fee does not cover the cost of hairdressing and chiropody. The most recent inspection report is available in the reception area. 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 and ten people with dementia care needs. 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 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. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality of care. Prior to the inspection the previous registered manager had submitted an Annual Quality Assurance Assessment (AQAA), which detailed what the service was doing well, what had improved since the last inspection in 2008 and any plans for improving the service in the next twelve months. Questionnaires were sent to the people living in the service, relatives as well as staff to understand what the service is like. However the acting manager said these were never received. Questionnaires will be sent again and used for the next inspection. The unannounced inspection was carried out by one inspector and took place over Care Homes for Older People Page 6 of 29 eight hours including lunch time. The main method of inspection was case tracking, which involved selecting three service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. Two staff and two sets of relatives were formally interviewed as well as two service users who were not part of the case tracking. A partial tour of the service was undertaken looking at communal areas as well as a selection of bedrooms to ensure that the service was safe and homely. Information regarding the running of the home as well as medication documents were looked at to form an opinion about the health and safety of people who use the service. A review of all the information received from this service since the last inspection was considered planning this visit and helped decide what areas to look at. The previous registered manager resigned in January 2009 and an acting manager from another home within the Elder Homes Group is currently at the home between one and two days a week to oversee the management of the service. A new manager has been appointed and will take up post in April 2009. At the time of this inspection the fees ranged from 338 pounds to 498 pounds depending on assessed needs. What the care home does well: What has improved since the last inspection? Staff ensure that people who use the service are listened to and their views respected. Peoples cultural dietary needs are met by the menu provided. Staff are aware of what constitutes restraint and a new policy has been developed by the service to ensure that no one is restrained inappropriately. Planning permission for the extension to the service has been obtained and work is due Care Homes for Older People Page 8 of 29 to start in April 2009 and the patio area to the rear of the service will be improved and no longer a trip hazard to service users. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people were not always assessed prior to moving to the service, staff ensure that sufficient information is available to meet service users needs. Evidence: The last person admitted to the service was case tracked to make sure that their needs had been assessed so as to ensure that staff could provide the care and support they needed. Although there was not an assessment completed by the service on file the acting manager had received a copy of the persons assessment completed by the social worker and staff at the hospital. This had been used to create the care plan to help staff provide suitable care for the person. The service user was spoken with and confirmed that staff had talked to them on the day they were admitted to discuss how they wanted their needs to be met. The Care Homes for Older People Page 11 of 29 Evidence: service users relative also said that staff had discussed the persons care on admission. Both agreed that staff had been very supportive and caring. The service user described staff as wonderful and kind. Intermediate care is not provided in this service. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs are addressed in a way that is consistent, safe and respectful. Evidence: Three care plans were looked at to ensure that there was enough detail about peoples need so staff were able to care for them well. The care plans all followed the same pre printed format with a section for staff to add more personalised information if necessary. The plan provided some detail to assist staff to provide the care the person needed but some lacked personalisation. Staff spoken with said that they understood how to care for service users and that as well as the care plans information was shared among staff at hand overs and daily records to ensure that people received the care they needed. There was some evidence that service users and relatives were involved in creating the plan, however this was not always recorded in the plan itself. Service users Care Homes for Older People Page 13 of 29 Evidence: spoken with confirmed that staff had spoken with them about their care needs when they first moved into the home. Staff spoken with also said that when people first move to the home they sit with them to discuss their care needs. Plans were reviewed regularly and showed where needs had changed this ensures that services will always receive the care they need. Care plans and records show that the arrangements currently in place ensure that service users health care needs are maintained and are safe. There is good evidence in service users files that health care professionals including the continence nurse, district nurse and GPs are called in to support service users with health care issues showing that the staff at the service are being proactive in maintaining the health and wellbeing of service users. From those service users spoken with it was clear that health care professionals are called in when they feel unwell or needs change. If I feel unwell the staff will call a doctor There is evidence in service users plans and from around the home that staff ensure that pressure relieving aids are being obtained for service users to maintain skin integrity and minimise the risk of pressure ulcers. A relative spoken with said that they were always kept informed about their relatives well being and if there were any concerns a GP was called. Staff spoken with said that there was good communication between the nursing staff and the care staff to ensure that information about care needs was passed ensuring service users always had the support they needed. The medication was checked to ensure that service users received the medication they were prescribed. The service has a very good in house auditing system and shows that the management of the service are not complacent around medication. Records were checked and found to be in order with no unexplained gaps. Service users spoken with all said that they received their medication on time and staff stayed with them whilst they took it. Service users were spoken with said that staff always treated them with respect and Care Homes for Older People Page 14 of 29 Evidence: spoke to them nicely. During the course of the day staff were heard to speak to service users in a pleasant manner. At the last inspection a requirement was made to ensure that service users wishes were respected. From discussion with service users and staff as well as observation it was clear that this is now taking place and this requirement is now met. It Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users social and recreational needs are recorded in their plans and there are a variety of activities throughout the day for people to be involved in. Evidence: A requirement was made at the last inspection to ensure that people are consulted about their lifestyle expectations so they can take part in meaningful activities. This was partially met and recommendations for good practice will be made as a result. Service users spoken with said that staff asked them if they wanted to take part in activities and they could choose to be involved or not, as they wished. However, as at the last inspection the television was still positioned in such a way so that not all the people in the lounge could view it. Staff did not seem to be aware as to whether people were actually interested in the programme on or if the channel needed changing. When asked most service users were not really interested in the television programme on. This shows that service users are still not being fully consulted about how they want to spend their day. Relatives spoken with said that they were able to visit their loved ones when they wanted and were always made to feel welcome by staff. This was observed though out Care Homes for Older People Page 16 of 29 Evidence: the day and staff were heard offering drinks to visitors. Information was available on the notice board regarding upcoming events and included links with local churches. There are photographs in the reception area of previous activities that have been organised in the home. Service users spoken with said they are able to make decisions about what time they get up and go to bed as well as bringing in personal possessions to their bedrooms. There was also information regarding the Mental Capacity Act on service users plans detailing whether a person had the capacity to make decisions or what type of support they might need. This ensure that service users are able to exercise choice and control over their lives. A requirement was made at the last inspection regarding people with cultural dietary needs being met appropriately. This requirement is now met. In discussion with the cook she was aware of the dietary needs of service users and where a specialist diet needed to be arranged such as for diabetics. The midday meal was observed of meat pie, mash potatoes and vegetables, with mince for those who had difficulty chewing and swallowing. Where people needed assistance with their meal staff were seen to give help in a discreet manner and other people were seen to have aids such as plate guards so as to encourage independence as long as possible. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints are responded and investigated according to the company procedure. Service users are protected from abuse by a staff group who understand their responsibilities. Evidence: The companys complaints procedure is on display in the reception area and residents spoken with said they were aware of who to complain to. A service user who had been admitted recently to the service said that the complaints procedure had been explained when they came into the home. Their relative also said that the complaints procedure had been explained to them. Other relatives spoken with all said that they knew who to complain to and felt that they would be listened to. Staff spoken with understood their role in the complaints procedure and would pass on issues to the manager as well as trying to resolve concerns themselves. Complaints received by the service have been investigated according to the services procedure and outcomes and actions recorded. This ensures that when a person makes a complaint they feel confident it will be listened to and action taken. Staff spoken with said that they received training in safe guarding adults and understood what was abuse and what they needed to do if they suspected it. Residents spoken with said they always felt safe and staff never spoke to them in such a way as to make them feel frightened. Care Homes for Older People Page 18 of 29 Evidence: At the last inspection a requirement was made to ensure that staff understood what was restraint. The pre inspection information and in discussion with staff it was clear that this has now been met and will ensure that service users are not restrained without a clear understanding as to why this is happening and consultation with interested parties. This requirement is now met. Residents personal monies are stored securely and records are well maintained showing what the money is used for and by whom. Two signatures are used at all times to maintain the records minimising the risk of financial abuse. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is generally fit for purpose and is well maintained internally. The poor maintenance of the external grounds may negatively affect the lives of service users. Evidence: A partial tour of the service was made and a sample of bedrooms were viewed to ensure the home is clean, well maintained and comfortable for service users. A requirement was outstanding from a previous inspection from December 2007 regarding the garden area at the rear of the service. The paving is uneven and potential trip hazard to people using the service. In discussion with service users they did not feel this impacted on their lives as they did not go outside. Staff spoken with were aware that there was a potential risk of falls to those service users who had mobility problems and so it could prevent people going outside without staff supervision. The acting manager said that the home owner had got planning permission and was in the process of getting quotes to carry out the work needed to remedy this problem. Although the requirement is not fully met there is evidence that the home owner is dealing with the issue and so the requirement will not be made at this inspection but will be reviewed again at the next inspection. Care Homes for Older People Page 20 of 29 Evidence: Service users spoken with said that they liked their bedrooms and that they were kept clean. Relatives confirmed that they felt the service was kept clean and well maintained. Staff spoken with said they felt there were enough cleaning staff on each shift. Cleaning staff were observed during the day carrying out their duties. There were no unpleasant smells in any areas of the service inspected, this shows that the staff are managing the cleaning well. Service users said that their laundry was done to a satisfactory standard and had no complaints or concerns. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust and protect service users from people who may abuse them. Staff are well trained but lack of an induction may lead to poor outcomes for service users. Evidence: Information received prior to the inspection and from discussion with service users and staff it was evident that there were enough staff on duty. One resident said Even at night if you call you dont wait that long before someone comes to you. The service has exceeded the 50 target for all staff to be trained to National Vocational Qualification Level 2 or higher. This ensures that there is a suitably qualified work force to meet the needs of service users. There is evidence in staff files that training is on going and staff receive a variety of courses including dementia care and infection control to enable them to provide the care and support that service users need. Staff confirmed that they are encouraged to attend training. The recruitment practices within the service are robust and evidence was seen in staff files that all staff complete an application form and have Criminal Record Bureau checks prior to them starting work. The previous registered manager left the company earlier in the year and so new staff Care Homes for Older People Page 22 of 29 Evidence: have not undergone an induction. The current acting manager is aware that this is a problem and is taking steps to ensure that all staff have a suitable induction to enable them to work effectively with all service users and understand the health and safety needs of the service. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the service is currently being managed in the best interests of the service users it is currently without a registered manager and there is potential that the welfare of service users may not be protected. Evidence: The service currently does not have a registered manager and is being temporarily managed by a unregistered manager from a service within the company. A new manager has been recruited and is due to start in April 2009. Staff, service users and relatives did not raise this as a concern. The information received prior to the inspection showed that all policies and procedures were regularly updated this ensures that the home is run following up to date guidance. The arrangements in respect of service users money were checked to ensure their interests are being protected. The records all tallied with the amounts held on the Care Homes for Older People Page 24 of 29 Evidence: premises. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 That staff receive induction training to ensure they are competent to carry out their duties within the service. Staff must understand the needs of the service as well as the health, safety and well being of service users. 18/04/2010 2 31 9 The person who manages the service must be registered as fit to do so by the Commission. This ensures the service is only managed by a person who has the skills and is assessed as being suitable to be in charge of a care service. 18/07/2009 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Service users should be assessed where possible prior to moving to the service to ensure that there is enough information for staff to meet service users needs Ensure evidence is provided that staff have involved service users and/or their representative in the creation and review of care plans. Service users should be seated so that they can see the television or provision made for a quiet lounge where residents may go if they do not want to watch television. Ensure that service users have full and safe access to all parts of the service. 2 7 3 12 4 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!