CARE HOMES FOR OLDER PEOPLE
Millreed Lodge 373 Rochdale Road Walsden Todmorden Lancashire OL14 6RH Lead Inspector
Liz Cuddington Unannounced Inspection 12th September 2006 12:00 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 Millreed Lodge DS0000057454.V302828.R02.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. Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Millreed Lodge Address 373 Rochdale Road Walsden Todmorden Lancashire OL14 6RH 01706 814918 01706 817919 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) Millreed Lodge Care Ltd Mrs Elizabeth Shufflebottom Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (2), Terminally ill (2), of places Terminally ill over 65 years of age (2) Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. To accommodate a maximum of two persons in category TI/TI(E) at any one time To accommodate a maximum of two persons aged under 65 years of age with a physical disability Two named persons over 60 years of age Date of last inspection 8th March 2006 Brief Description of the Service: Millreed Lodge is set in landscaped grounds alongside the Rochdale canal and Walsden Water, and is situated on the main Rochdale Road in Todmorden. Banks, a post office and shops are one mile away in the local town. The home provides care with nursing for a total of thirty-three people The accommodation was created many years ago by the conversion of a textile mill. More recently a new conservatory and reception area has been added to the ground floor accommodation. All of the bedrooms have en suite toilet facilities. There is a passenger lift that serves all floors. The fees at Millreed Lodge are between £405 and £432 per week, plus hairdressing, chiropody and other items such as newspapers. Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group, for example ‘Choice of Home’, and ‘Health and Personal Care’. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers these outcomes to the people who use the service. The judgement categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded in the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk Over an inspection year care homes usually have one or two inspections; these may be announced or unannounced. One inspector carried out this unannounced inspection, which lasted eight hours and forty-five minutes. The methods I used to gather information included conversations with residents, visitors and staff, case tracking, examining records and touring the home. I also sent out questionnaires for residents and their relatives to complete. This purpose of the inspection was to assess a selection of the National Minimum Standards for Care Homes for Older People. I looked at twenty-five of the thirty-eight standards. At the last inspection in March 2006 six good practice recommendations and no requirements were made. I have made five requirements and six good practice recommendations following this inspection. Although there are still some areas for improvement the home continues to progress and significant improvements have been made. The outcomes for residents in two of the seven outcome groups were judged to be “good”. The remaining five groups were judged as “adequate”. This means that the overall judgement for the home is “adequate”. I would like to thank the ladies and gentlemen who live at Millreed Lodge, and all the staff, for their welcome and hospitality during the inspection. What the service does well:
Pre-admission assessments are carried out and they show that prospective residents’ needs can be met by the home. The care plans are clearly set out, regularly reviewed and show how each person’s needs are being met. Comments by relatives said that they are informed and consulted about their Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 6 relative’s care. My own observations confirmed that residents’ rights to privacy and personal choice is respected by the staff. The ladies and gentlemen who live at Millreed Lodge are able to exercise their personal choice in all aspects of their daily lives. Visitors confirmed to me that they are welcomed into the home. I was at the home during the lunch and teatime meals. The portions were plentiful and everyone who commented said they enjoyed their meals. The home is clean and hygienic throughout and I saw suitable infection control measures in place. When I visited there were sufficient staff on duty to meet the needs of the residents, although some relatives commented in the questionnaires I sent out that they felt there were not always enough care staff on duty. Eight of the care staff have completed the National Vocational Qualification (NVQ) in care. A trainer comes in regularly to provide a range of staff training courses. Staff have had fire safety and first aid training. The kitchen is hygienically kept and food is stored safely. What has improved since the last inspection? What they could do better:
There needs to be evidence to show that the resident or their relatives have been involved in the development and review of their care plan. Risk assessments for all residents need to be completed, where needed. Controlled drugs records must be correctly written up and any medication changes must be accurately recorded on the residents’ record charts. The home’s adult protection policies and procedures would benefit from updating to fit the needs of the home. The small conservatory needs some attention to make it more welcoming if it is to be used either for activities or as another lounge. The bedroom doors need to have locks fitted.
Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 7 Not all of the staff training records were completely up to date. It would be good practice to follow normal recruitment procedures when promoting from within the existing staff team. More care staff need to complete an NVQ in care in order to meet the 50 minimum which is expected. The manager is to look at extending the scope of the quality assurance system Refresher training in the use of the sling might be valuable, to preserve the dignity of residents when they are being transferred using the hoist. The residents’ care plans need to be securely locked away when the room they are stored in is not occupied. 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. Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. Relevant pre-admission assessments are made and kept with the care plan files. EVIDENCE: Comprehensive pre-admission assessments, carried out by the home and Social Services, are kept in the residents’ care plans and are used as the basis for the plans. They show that prospective residents’ needs can be met. Millreed Lodge DS0000057454.V302828.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. The care plans are clearly set out and show how each person’s needs are being met. Regular reviews are carried out but residents or their relatives do not appear to be involved. Medications are securely stored. There were some administrative errors and information about changes is not always accurately recorded. Staff are aware of individual needs and residents’ privacy is maintained. EVIDENCE: The care plans I examined showed in detail how each person’s care is to be provided. Staff regularly review the care plans and the signatures on the plans confirm this. There was no evidence to show that the resident or their relatives had been involved in the development and review of their plan. The care plans detail how each individual’s health is to be promoted. Advice from healthcare professionals is sought when needed and the actions taken are
Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 11 clearly documented. The plans include pressure area, skin integrity and continence assessments. There was no psychological risk assessment for a resident who has a history of mental health problems. The medications are securely stored and when a member of staff administers medicines the Medicines Administration Record (MAR) charts are signed at the same time. The charts also show when someone has not taken a dose of their medicine, and the reason, although there were a few signatures missing. When I checked the amounts of medicines in stock against the amounts received and administered, I found the numbers were accurate. One person’s controlled drug record was not correctly written up, although two members of staff had correctly signed the record when a dose was administered. Another person’s medication had been changed, following verbal advice from the GP, but no record of these changes had been made on the MAR chart. My own observations confirmed that residents’ privacy and dignity is respected by the staff. Medical examinations are carried out in residents’ own rooms. Millreed Lodge DS0000057454.V302828.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. Individual needs and preferences are respected and supported. Visitors are welcomed to the home. The meals are good and varied and any assistance needed is offered discreetly. Residents’ privacy and dignity is respected. EVIDENCE: There are activities available in the home and those residents who are able to do so still manage to get out and about. I did receive some comments from residents and relatives that they would like there to be more activities. From my own observation, and comments made by residents, the ladies and gentlemen who live at Millreed Lodge are able to exercise their personal choice in all aspects of their daily lives. During the inspection I saw numerous visitors being welcomed into the home. There are two lounges and the bedrooms have comfortable chairs in them. There are arrangements for religious observance within the home, for those who cannot get out to attend church. I was at the home during the lunch and teatime meals. The portions were plentiful and everyone who commented said they enjoyed their meals. At lunch
Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 13 there was a choice of two main courses and two desserts and at teatime most people had at least two of the choices followed by dessert or cakes. Staff assisted residents who needed help with their meals in a considerate way and at a pace to suit the resident. Millreed Lodge DS0000057454.V302828.R02.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. Residents and relatives are aware of how to make a complaint. The home has suitable adult protection policies and procedures, which would benefit from updating. EVIDENCE: Records of complaints investigations are kept in the file of the resident the complaint refers to. The home uses the adult protection policies and procedures provided by Calderdale Social Services. This would benefit from updating and customising to fit the needs of the home. There is a ‘whistle blowing’ policies and procedures in place to support and safeguard staff if they needed to raise concerns of poor practice or abuse. Adult protection training is to be provided by Calderdale Social Services’ Adult Protection Officer. Most staff have already done some training in this area. Millreed Lodge DS0000057454.V302828.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 & 26 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. The home is generally well maintained and clean. Improvements to the décor and furnishings have been started, since the last inspection. The laundry meets hygiene and infection control standards. The bedroom doors do not have locks fitted. EVIDENCE: A programme of redecoration in the communal areas and bedrooms is underway. There is some new furniture downstairs and the carpets have been replaced. The small conservatory roof has been repaired. This room needs some attention to make it more welcoming if it is to be used for activities, or as another lounge. Three twin rooms have been converted to single rooms. The track hoist in one of the downstairs bathrooms has been repaired, although the room was not ready to use when I visited the home.
Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 16 Each bedroom has a lockable storage space but the bedroom doors do not have locks. In order to give people choice about privacy, these doors need to have locks fitted. The home is clean and hygienic throughout and I saw suitable infection control measures in place. The laundry is clean and there are two washing machines with integral sluice programmes. There were some slight odours in two of the bedrooms. The manager said this would be dealt with soon, when the rooms have new carpets fitted. Millreed Lodge DS0000057454.V302828.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. Staff are employed in sufficient numbers to meet the needs of the residents. Mandatory CRB and POVA checks have been carried out, but not all staff files show that all other recruitment procedures have been completed. There is suitable staff training available, but not all the files contained all of the necessary records. EVIDENCE: When I visited there were sufficient staff on duty to meet the needs of the residents. There is at least one nurse on duty between 8am and 8pm, along with five care assistants until 2pm and four until 8pm. There is one nurse and two care assistants for the night shift from 8pm until 8am. The staff rotas confirm that this is the normal shift pattern. There are twenty care assistants employed at Millreed Lodge. Eight of them have completed the National Vocational Qualification (NVQ) in care. Four members of staff are studying for the award and another is about to start. When I spoke to the cook she said she was due to start a City & Guilds catering qualification. While I was at the home a trainer came in the evening to do dementia care training with the staff. She told me she comes in regularly to provide a range
Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 18 of staff training courses. I looked at staff training records. Not all of them were completely up to date. The staff recruitment processes include Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks, as well as an application form and two references. I would expect to see evidence that, where appropriate, staff’s qualification certificates had been seen and copies taken before they were offered a position. There were no copies of certificates for one newly recruited member of staff. One member of staff was offered another job on the home’s domestic staff team by letter, without having to complete an application or provide references. It would be good practice to follow normal recruitment procedures, even when promoting from within the existing staff group. Millreed Lodge DS0000057454.V302828.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. The manager is sufficiently qualified and experienced to run the home. The home’s quality assurance systems need developing to make them more effective. The home’s policies and procedures need to be reviewed. Moving and handling training has been done but staff need some refresher training. Residents’ finances are correctly handled. Confidential records must all be securely stored. Refrigerator and deep freezer temperatures are being recorded daily. The kitchen is clean and hygienically maintained. Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 20 EVIDENCE: The home’s manager is a Registered General Nurse. She has achieved the NVQ level 4 Registered Managers’ Award and is an NVQ assessor. The manager also has sufficient experience to manage the home. There are quality assurance systems in place, which seem to be providing some good feedback. The manager is to look at extending the scope of the system to include, for example, visiting healthcare professionals, and perhaps introduce a quality questionnaire for staff to complete. Regular staff meetings are held. Most of the residents who are unable to manage their own money have relatives who do this for them. Small amounts of cash are kept in a safe for individuals, if they wish. Accurate records of any transactions are kept. The staff have taken moving and handling training. I observed one occasion when a hoist was being used and although the staff were very careful, the way the sling was arranged did not fully preserve the dignity of the resident. Some refresher training in the use of the sling might be valuable. The home’s policies and procedures have not been updated recently. A lot of the confidential information kept at the home is securely stored in a room, which is locked when unoccupied. On the day of the inspection the residents’ care plans were not securely locked away when the room they are stored in was not occupied. This needs to be remedied. Staff have had fire safety and first aid training. The accident book is kept up to date and the manager has analysed the accidents to determine if there was a pattern to them. The kitchen is hygienically kept and food, refrigerator and deep freezer temperatures are being recorded regularly. Millreed Lodge DS0000057454.V302828.R02.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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X 3 2 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 1 2 Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(2)&(3) Requirement Wherever possible care plans must show that the service user, or their representative, has agreed the plan. Risk assessments must be completed to reflect the service user’s care needs. Medication records must be accurate. All recruitment processes must comply with The Care Homes Regulations 2001. All confidential information must be stored securely. Timescale for action 31/03/07 2. 3. 4. 5. OP8 OP9 OP29 13(4) 13(2) 19 & Schedule 2 17(1)(a) 31/12/06 30/11/06 30/11/06 30/11/06 OP37 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. Refer to Standard OP18 OP24 OP28 Good Practice Recommendations All staff should take Protection of Vulnerable Adults training as soon as possible. Locks should be fitted to all bedroom doors. More staff need to achieve an NVQ in care in order to meet
DS0000057454.V302828.R02.S.doc Version 5.2 Page 23 Millreed Lodge 4. 5. 6. OP33 OP33 OP38 this standard. The quality assurance information would benefit from widening the scope of the surveys. The home’s policies and procedures need to be regularly reviewed, and updated where necessary. Moving and handling refresher training should take place. Millreed Lodge DS0000057454.V302828.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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