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Inspection on 05/08/05 for Millington Springs

Also see our care home review for Millington Springs for more information

This inspection was carried out on 5th August 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable and homely environment for residents. Although there are many new staff, those spoken with appeared caring and committed to their work. The manager understands her responsibilities to improve standards within the home and is able to provide clear leadership to ensure this happens. Activities are arranged that residents can choose to participate in and meals are provided in a pleasant environment.

What has improved since the last inspection?

The manager has now been registered with the Commission. The manager is working towards improving the plans of care but still has some way to go. Practice in maintaining the medication administration record sheets has improved as has the process for obtaining medication in time for residents. Many residents and visitors spoken with were very positive about the care they received. One resident said that `Millington Springs used to have a bad reputation in the area but having come here now I think it is a very good home`.

What the care home could do better:

The manager must ensure that residents are fully consulted in areas that impact on their lives, such as menus and how they wish to receive their care. Where residents are unable to make their views known either relatives or a representative should be involved. Plans of care need to be improved to ensure that they cover all aspects detailed in the standards. Although there is clearly refurbishment taking place, the outside area in the garden remains a potential hazard and must be looked at to minimise this risk. Where foreign nationals are being employed a Criminal Records Bureau check must be done for this country not just their country of origin. Staff rotas must provide more detail in showing clearly what hours staff are doing.

CARE HOMES FOR OLDER PEOPLE Millington Springs 160 Portland Road Selston Nottinghamshire NG16 6AN Lead Inspector Susan Lewis Unannounced 5 August 2005 at 9:30 am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Millington Springs Address 160 Portland Road Selston Nottinghamshire NG16 6AN 01773 581114 01773 812894 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Elder Homes Midlands Ltd Tina Kapp Care Home with Nursing 42 Category(ies) of 42 - Old Age registration, with number 5 - Physical Disability of places Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10/01/05 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 WC’s. 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 C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5½ hours and was carried out by one inspector as part of the annual inspection process. A partial tour of the building took place with the communal areas and a selection of bedrooms being inspected. Residents, visitors and staff were spoken with on the day and care and staff records were looked at. What the service does well: 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 C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The needs of current service users are met within this setting but limitations of the care plan system means that they are not always recorded placing residents at potential risk. EVIDENCE: Three plans of care were looked at for the purpose of this inspection. The home uses the ‘Standex’ system, which although acceptable does have some limitations and does not ensure that all the areas required to be covered in standard 3 are covered. 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 are limited by the Standex structure and some information is limited. However residents spoken with were all positive about the care they received and the way staff provided that care. Visitors spoken with were also happy with the way their relatives were cared for. Staff spoken with understood the care needs of residents and were able to discuss how care was to be provided. It was noted at the last inspection that the content of the plans depended on who had filled them out this remains the same. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Individual plans address needs but risk assessments are not always completed for areas where residents may be at risk. Residents are treated with respect and dignity. EVIDENCE: On the day of the inspection there were a number of residents who were at the home for respite care. The plan of care was inspected for one of these residents and both the resident and relative were spoken with. They had had a previous experience in another care home, which was negative but were very positive about this stay. The resident reported that staff were very kind and helpful and always made sure that when equipment was used it was done so correctly ensuring that the resident felt safe. All residents spoken with confirmed that doctors were called if they felt ill, that staff always respected their privacy and spoke to them with respect. Staff spoken with said that they had been instructed during their induction in how to maintain privacy and dignity of residents. Staff were able discuss in detail how they would maintain a resident’s dignity whilst providing personal care. One plan viewed gave small details of care such as the type of soap preferred and type of clothing; this was seen as good practice. Plans of care detailed that weights were Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 9 routinely recorded and monitored and residents saw chiropodists and other health care professionals as required. Only one plan looked at showed that residents were involved in the drawing up of care plans and their review. The Standex system provides a good structure for plans however the shortcomings are that it does not enable staff to do thorough risk assessments outside those identified by the system. This is seen where residents need bed rails or risk assessments for keys and limitations on furniture in their bedrooms. This was identified as a requirement at the last inspection and has yet to be addressed. Medication was observed being given to residents and Medication records were only signed once the resident had taken the medication. All sheets looked at were correct and signed. There had been a requirement set at the last inspection regarding the practice of signing before giving out medication. This requirement is met. A requirement was also set to ensure that medication be acquired promptly, the manager has now changed the way prescriptions are obtained for new residents who arrive after the medication delivery day. This requirement is met. The storage of medication was appropriate and records seen were well maintained. The manager must ensure that the temperature of the room where medication is stored remains within permitted limits. There is recent legislation regarding the disposal of medication, the manager is aware of her responsibilities in this matter and is seeking advise from The Environment Agency and her local Pharmacist to ensure arrangements are made that meet the regulations. This was discussed at some length during the inspection. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 The residents are able to participate in activities of their choice most residents are assured of nutritious meals but are not involved in creating menus. EVIDENCE: There was a list of activities in place in the reception area and staff were seen to refer to it to find out what was happening on that day. A keep fit instructor visited the home and residents were asked if they wanted to be involved. Staff were seen to encourage residents to take part but where residents said no staff respected that wish. Residents spoken with who had taken part said that they enjoyed the activity. During the course of the day residents were seen involved in a variety of activities including receiving visitors and watching television. Due to the number of lounges residents were able to choose where they sat and what they watched on television. Some residents sat in the reception area, staff were observed talking to these residents as they went about their tasks. 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 but residents spoken with said they were not involved in menu planning. The dining room was pleasant and residents were given discreet assistance, aids were used to enable residents to remain independent where appropriate. A requirement was made at the last inspection to record what residents eat where it differs from the main meals. This has not been met. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 11 The cook was spoken with and she had a good understanding of residents’ dietary needs and reported that staff inform her of residents’ dietary needs on admission to the home. Two residents who did not want large midday meals were offered soup, however this was ‘cupasoup’. The registered manager must ensure this provides sufficient nutrition to the residents. The temperature of meals was recorded, as was the temperature of the fridges and freezers therefore minimising the risk of infection. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and visitors are aware of how to make their views known. Staff understand how to protect residents. EVIDENCE: Copies of the complaints procedure were seen around the home and residents and visitors spoken with knew who to complain to and felt confident that it would be dealt with. Staff spoken with had a good understanding of what constituted abuse and knew what to if they witnessed it, all residents spoken to said they felt safe and staff treated them well. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25 and 26 Improvements to the décor have been made but there are still matters outstanding that may place residents at risk. EVIDENCE: A requirement had been set at the last inspection regarding the patio area. Work on this area has not taken place and it remains uneven and a possible trip hazard. Residents were seen to walk freely around this area and one resident spoken with said that the uneven surface had not affected his walking in that area. This requirement remains unmet due to the potential risk residents are placed at. The inside the home is well maintained and a sample of residents bedrooms were looked at and found to be in good order with bed linen in a good state of repair however it was noted in some bedrooms towels were very threadbare. The registered person must ensure that residents are provided with suitable towels. 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 Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 14 door. A full inspection of the water temperatures could not take place during this inspection as the plumbers were in replacing the heating system and the water was either turned off to some bed rooms or there was no hot water available. The manager must ensure during such significant refurbishment that suitable arrangements are made to ensure that disruption to residents is kept to the minimum. Residents spoken with said that their laundry was done regularly, on the day of the inspection the home was clean and free from odour. The plumbing that was being in the process of being done was also to ensure that the washing machines were up to standard with the water regulations. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The deployment of staff is adequate however staff rota do not clearly indicate ancillary staff’s working hours. The procedures for the recruitment of staff are mostly robust but need to ensure that all checks are carried out to eliminate any risk to residents. EVIDENCE: Staff working rotas were seen, a requirement was made at the last inspection to provide a breakdown of hours worked by ancillary staff. The rota seen still did not provide specific information as to the hours individual staff worked. The manager must 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 had been made. However the registered person must also ensure that police checks for this country are also carried out. A requirement was made at the last inspection for Criminal Records Bureau checks to be made for the volunteer and the Responsible Individual who carries out the Regulation 26 visits. The check for the volunteer was seen and the check for the Responsible Individual was seen at the Commission’s office. This requirement is now met. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32 The home is being managed well and is being provided with clear leadership ensuring residents receive consistent care. EVIDENCE: The manager is now registered with the Commission. Residents, visitors and staff spoken with were positive about the manager and the way she managed the home, saying she was supportive and approachable. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x x 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 x 14 2 15 2 COMPLAINTS AND PROTECTION 2 x x x x 2 2 3 STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x x Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 18 yes 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 7 Regulation 12,13,14 Requirement The registered provider must ensure that risk assessmentsare carried out for residents in the identified areas, particularly smoking, bed rails, where used, and keys for bedroom doors. The registered person must ensure that the temperature of the treatment room is monitored and remains with suitable limits. The registered person must ensure that residents are enabled to make decisions with respect to the care they receive and health and welfare. Previous requirement 10/03/05. The registered person must ensure that residents receive food that is wholesome and nutritious. The registered person must ensure that the paving slabs are levelled and free from trip hazards. Risk assess where service users may need assistance with the camber of the ramp when using the outside of the building. Previous requirement 10/03/05. The registered person must ensure that having regard for the Timescale for action 31/10/05 2. 9 Medicines Act 1968 12 31/10/05 3. 14 31/10/05 4. 15 16 1/10/05 5. 19 12,13,16 1/10/05 6. 24 16 31/10/05 Page 19 Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 7. 24 16,23 8. 25 13 9. 27 18 10. 29 19 size of the care home and the numbers and needs of the residents that he provide adequate towls fo residents use. The registered person must ensure that the poor water pressure in the taps of he room identified at inspection is investigated. As this could not be fully tested at the inspection due to the plumbers doing maintenance work this will fully assessed at the next inspection. However this has been a previous requirement and enforcement action will be taken if this is not met when tested next. The registered person must ensure that where residents are supplied with wash hand basins that the water supplied out of the taps is at the correct temperature. The registered person must ensure that the rota shows a breakdown of ancillary staff hours. The registered person must ensure that all staff employed at the home have an up to date Criminal Records Bureau check carried out in this country. 1/10/05 1/10/05 1/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations The registered person should ensure the Standex care plan system cover needs identified in standard 3. Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 © 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 Millington Springs C03 C53 S57365 Millington Springs V243113 050805 Stage 4.doc Version 1.40 Page 21 - 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. 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