Inspection on 17/09/07 for Mills Meadow

This inspection was carried out on 17th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Mills Meadow 16/09/08

Mills Meadow 25/08/06

Mills Meadow 23/01/06

Mills Meadow 10/08/05

Mills Meadow 21/03/05

Mills Meadow 03/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Mills Meadow Fore Street Framlingham Suffolk IP13 9DF Lead Inspector Mary Jeffries Unannounced Inspection 17th September 2007 2:45 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 Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mills Meadow Address Fore Street Framlingham Suffolk IP13 9DF 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) 01728 724580 01728 724959 lucy.roughley@socserv.suffolkcc.gov.uk Suffolk County Council Mrs Lucy Roughley Nicola Jeanette Fountain Care Home 35 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (35) of places Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user aged over 65 years of age, whose name was given to the Commission on 05/07/06 who requires care by reason of dementia and is living on Rose Hamlet. 25th August 2006 Date of last inspection Brief Description of the Service: Mills Meadow Framlingham is a residential care home for older people, which is owned and managed by Suffolk County Council, Department of Social Care. The home has a total of 35 registered care beds. The home is registered to provide care for older people; up to 16 of these may require dementia care. Included in both categories are short-term care beds. The home is situated in the centre of Framlingham, a small market town in rural Suffolk. As such, the home is close to shops, and other community facilities and resources. It also benefits from having its own transport, used for outings, appointments, and activities. The home is all single storey, divided into a number of Hamlets - selfcontained units providing residential care. Poppy Hamlet accommodates 15 residents with dementia / special needs. Rose, Viola and Iris Hamlets each accommodate 6 residents. One named person with dementia is cared for on the mainstream hamlets. Iris Hamlet is also used to accommodate some respite care residents. There are two self-contained flats, which were used for intermediate care, however, on this occasion the inspector was advised that intermediate care is no longer funded and the flats are not in general use. There is also a 20 place Day Centre which is not subject to inspection. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. An Annual Quality Assurance Assessment (AQAA) was provided by the home prior to the inspection. Twenty residents provided “Have your Say” surveys. Ten relatives provided “Have your Say” surveys. Eleven staff provided “Have your Say” surveys. The inspection occurred on an afternoon and early evening in September 2007 and took six hours. The inspection was facilitated by a Team leader. Other carers and domestic staff contributed to the inspection. Three residents were tracked. Two small groups of residents were spoken with, one on a frail elderly hamlet, one on Poppy hamlet. Two residents were spoken with individually, one with their relative present who also participated. What the service does well: The home has a high number of staff qualified at NVQ Level 2 and above. Staff show residents respect and treat them with dignity, ensuring privacy. Comprehensive assessments are made of the needs of residents, and care plans in place are regularly reviewed. Residents enjoy a good quality of daily life. The home has a well-staffed catering service, with regular consultation with residents on their preferences and satisfaction. A programme of trips and outings are available to residents and a programme of daily activities. Poppy unit, for people with dementia, has a lively and positive atmosphere. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have the opportunity to visit the home and for their needs to be fully assessed prior to a decision being made for them to become a resident. EVIDENCE: A requirement was made at the previous key inspection that the registered person must ensure that the Statement of Purpose and the Service User Guide are accurate. The AQAA stated that these had been updated; the documents were inspected. The Statement of Purpose was displayed in the home and was dated February 2007; it included information about the condition of registration. The Service User Guide (SUG) dated July 2007 stated care was provided for 15 people with dementia; it should read 16. The SUG did not contain details of the total fee payable, which is required. It did not contain residents’ views. Three residents spoken with as a group on a frail elderly hamlet all confirmed that they had their own copies of the SUG. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 9 The carer who facilitated the inspection advised that intermediate care was no longer funded and that therefore the flats are no longer used, but that there was one person in one of the flats on an emergency basis. There was a lack of clarity about whether occupant of one of the flats was a resident. Carers spoken with did not consider them to be. The person had no personal care needs but they did have a Social Care Services assessment. The future of the provision in the flats needs clarifying and the Statement of Purpose/ Service user Guide amended accordingly. Seventeen residents answered the survey question “Did you receive a contract”. Twelve stated that they had, others thought that their family had received one. The AQAA states that in the next twelve months the home plans to ensure all residents or an advocate signs a contract. Two of the three files had signed terms and conditions for the resident on it, one did not, it had a copy signed by a manager, only, in October 2006. The AQAA states that prospective residents are fully assessed prior to moving into the home, have a fully informed choice about where they wish to live, and that no admission takes place without the home having received a Community Care Assessment of need and an assessment carried out by the home. All of the residents tracked had pre admission assesments. Two had community care assessments and the home’s pre admission assessment, one, who had been admitted as an emergency placement, just had the community care assessment. The AQAA states that in most cases people are asked to attend Mills Meadow for a day for them to assess if the service meets their needs and for the home to assess if the potential customer is suitable for the type of care provided. When the person is unable to go to the home, a manager or representative visits them for this purpose. A person attended for this purpose during the inspection. They arrived with a relative and were welcomed by the team leader. They were seen as they were leaving the home later and had decided that they did want to come to the home. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their health, personal and social care needs will be identified, monitored and reviewed regularly, with proper regard to their privacy. They cannot be fully assured that they are protected by the home’s medication procedures. EVIDENCE: A person who occupied one of the flats and was admitted for a short-term placement on an emergency basis had been at the home for several weeks. They did not require personal care, but otherwise used the facilities the home. Staff spoken with advised that the resident not have a full care plan. Much of the detail was confidential and maintained in the office, however, staff were aware of the need to encourage the resident and the circumstances where they needed to refer to the management team, whilst the resident’s longer term care needs were determined. The other two residents tracked did have full care plans in place, which were good basic documents covering all aspects of care.These contained Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 11 photographs of the residents, and risk assessment covered moving and handling, smoking, nutrition and weight loss as appropriate. Other agencies had been involved in these residents’ care, including a chiropodist, a community psychiatric nurse and a physiotherapist. On the AQAA, it was stated that residents receive an annual health check by their General Practitioner. A team leader spoken with confirmed that this was the case. A resident spoken with advised that if you ask to see the doctor you usually see them the same day. Another advised that the district nurse attends them on a weekly basis to dress a wound, and that they had had a new hearing aid within the last twelve months. The files of the residents tracked showed that they had appropriate contact with a range of health care professionals. In May 2007 the home had admitted one resident who required a peg feed; this person was in hospital at the time of the inspection. The home had consulted with the CSCI and district nurse prior to admitting this person. The home advised CSCI on their improvement plan that care plans now contain information on the use of, and reasons for, pressure mats. A team leader spoken with advised these were in place for all residents with pressure mats, and that they have ensured that the two residents with bed sides in place also have risk assessments and signed consent forms. One resident who has a diagnosis of dementia had a risk assessment for bed rails; the consent form was signed by the resident and there was a separate declaration from their partner to agree to this. The two care plans contained daily notes, which included some notes of activities undertaken. On the AQAA it was stated that staff need to complete daily activities better. Both had plans had been regularly and thoroughly reviewed on a monthly basis. Nine out of ten relatives who responded to the survey indicated that the home always or usually meets the needs of their relative. All residents who responded indicated that they received the care and support they needed. One of the residents had entered the home through intermediate care, and was hoping to move back into their own home, although they said that they had much appreciated the care they had received at Mills Meadow. Comments on relatives surveys concerning the way in which residents were treated included; “Kindness and friendly interaction have been terrific”, “Standards of respect are high.” Residents spoken with confirmed this, and stated that staff always knocked before entering their rooms. One relative commented on the survey that there were “Frequent baths and good standards of hygiene.” A resident spoken with said that one of the things they liked about the home was that they could usually have a bath every day. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 12 On the other hand, one relative’s survey comment was that whist the resident was always well presented, and their skin care was good, there had been issues around eyes and nail care. Four people with dementia were spoken with, including one person who had been admitted for respite care. The group were lively and chatty, and were nicely groomed. It was noticeable that on this unit, Poppy, the majority of residents were seen to be alert and interacting positively. A requirement was made at the last key inspection that the registered person must ensure that the home’s medication policy and procedures are followed, particularly in regard to signing after administration and leaving no gaps in the record. Since October 2006 the CSCI was notified on seven occasions of medication errors occurring, including one occasion when two residents missed a dose of a controlled drug, two incidents where a resident was given a double dose of a medication, and two incidents whereby the wrong medication had been given to a resident. The AQAA stated that the Suffolk County Council quality assurance manager conducted a review at the home over a number of weeks. A copy of this report was provided. This report noted a number of areas of concern and made recommendations. The carer who undertook the medications on the evening of the inspection was aware of this report and advised of some of the recommendations that had been actioned, for example team leaders were now the only care staff doing the medication administration. Not all of the recommendations had been implemented; the report stated that medication was to be stored in cabinets in each room. This was in place on Iris only. The home had, however, risk assessed the implication of following this recommendation on all units and found it not to be viable. Trolleys, containing a new monitored dosage System, (MDS), were therefore still in use for the other units. The last medication error reported to the CSCI was in May 2007. One resident has daily insulin injections. These are given by the district nurse who visits daily, and the insulin pens were stored appropriately. The home had changed to a Monitored Dosage System of medication. The Team leader responsible for the medication round on the evening of the inspection adhered strictly to the correct procedure. They had a good manner with residents, particularly those with dementia, engaging them with eye contact when dealing with each person. During the medication round, one resident on the special needs hamlet volunteered, “It’s a good place, they know us all by name.” The team leader was not distracted form their duties during the medication round. Records for medication for 15 residents on Poppy hamlet were inspected. A number of gaps in recording were found. One gap was found each day on the 16th, 15th, 13th,and 12th September; on 10th September 2 gaps, 30th August 3 Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 13 gaps, 28th August 1 gap, 27th August 3 gaps, 23rd, August, 5 gaps (for two residents medication), 22nd August 2 gaps, 21st August, 3 gaps, 19th August 4 gaps and 17th August, 4 gaps. The team leader advised that they kept a list of any gaps, and there is a system of cross checking and signing a record at every handover to ensure that the MAR sheets have been correctly completed. Staff also signed a record to indicate who has carried out any particular medication round, in addition to a specimen sheet that details signatures and initials. In response to a query about how any gaps in recording were dealt with, the team leader advised that on one occasion they were asked about a gap that had occurred when they administered medication two or three days afterwards and were asked to sign then. This, and the fact that there were gaps in records from as much as a month prior to the inspection demonstrates that any Quality Assurance in place is not adequate to ensure medication has been given correctly and any error quickly rectified. The AQAA stated that all relevant staff have received external medication training with Otley College. The team leader undertaking the medication administration of the day of the inspection advised that they had attended Otley college training on medication. A schedule of medication training provided was seen; this showed that all but one (night) team leader had received training from Otley College and that a number of carers were undertaking it. Controlled drugs were stored in a locked cupboard in a locked room. The controlled rugs were audited against the record and found to be in order. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that they can choose how to spend their time, with opportunities for social activities, and receiving visitors. They receive a wholesome diet suited to their needs. EVIDENCE: Just over half of the residents who responded to the survey stated that they always or usually had activities that they could take part in. Three specifically mentioned that they choose not to engage in activities, preferring to watch T.V. or stay in their room. In the AQAA, it was stated that the home does not have funds for an activities coordinator, and that activities have to be fitted in by staff around the personal care tasks. It was noted that the home had purchased many jigsaws as several residents were getting enjoyment from completing these. Weekly sessions of keep fit and Thai chi held at the day centre can be attended by residents in the home. There are occasional activities, at least monthly, that are put on jointly with day centre. One resident advised that they can go to the day centre to play Bingo, and that they sometimes did this. During the Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 15 week of the inspection there were four days with a scheduled activity people could choose to attend, these included a visiting performer, a choir session, a demonstration and keep fit. There were fortnightly church services, provided by two churches on an alternating basis. The activities folder in the reception area contained at list of outings available in 2007; these included a trip to a local cricket club for a match, a ride round the local area, a boat trip and a picnic lunch. A thank you card in the compliments book in the foyer from a resent dated May 2007 stated; “He had some great outings and parties whilst at Mills Meadow.” The AQAA stated that an activities committee had been set up to involve staff and residents in fundraising for activities. One relative commented that the home is good at organising outings. All but one relative who responded to the survey stated that they were always kept up to date with important issues affecting their relative. A group of residents spoken with said that their relatives were able to visit when they wanted to and were made to feel welcome. A relative spoken with also felt that this was the case. The group of residents spoken with advised that they had different times when they got up in the morning that suited their preferences. One advised that they had a cup of tea brought to them in the morning in bed, as that was their preference. All of the residents who responded to the survey stated that they always or usually liked the meals; one commented that if they don’t like something they are offered an alternative. A relative commented; “The food is excellent as any requirements are always available.” A resident spoken with in a group advised that there were two or three fresh vegetables every day, and that the food was always very good. On the AQAA it stated that the cook is included in residents’ meetings. The cook was spoken with about their involvement with residents, they advised that every day residents have an opportunity to comment on the food, the carers helping them complete a comment card. On the day of the inspection the main meal was shepherd pie, and the alternative fish, breaded or steamed, with fresh vegetables. For the evening meal the cook had prepared soup; they advised that the carers on the hamlets then also prepared something on toast to the residents liking to go with this. All toast and cereals are also prepared on the individual hamlets, but residents can order a cooked breakfast from the kitchen. The cook advised that there were no vegetarians and no residents requiring a liquidised diet, but that these are needs that they have to cater for at times. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to complain and feel able to complain, but are generally well satisfied. Residents’ complaints and concerns are treated properly and within the home’s procedures. EVIDENCE: All but one resident who responded to the survey stated that they knew how to complain, and all but one stated that the home had always or usually responded appropriately to any concerns that were raised. The AQAA stated that Service User Guides were being given to all new residents. Three frail elderly people, including the living in the flat were spoken with in a group, two of which had been at the home for some time. They all said that they had a copy. The group of residents were asked what they had do if they needed to make a complaint, one resident responded, “If you don’t like anything you should tell them, I do.” The were asked whether the home took onboard what they had to say, and the resident responded, “So far.” Another said, “ I like everything, the food, the people, all of it, I’ve no complaints.” The AQAA stated that six complaints had been received in twelve months, and one had been upheld. The home had a log which detailed the complaints received and which had been dealt with within the terms of the policy. Eight out of eleven staff who responded to the survey stated that they understood what the adult safeguarding procedure was, but that they had not Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 17 had training in it. This can be explained by the fact that the majority of care staff hold an NVQ, and also as staff files evidenced that carers had received training in abuse awareness as part of their induction/foundation training. The AQAA stated that managers and senior team leaders had received training from the safeguarding team, and that they plan to send one or two members on a training the trainers’ course for safeguarding adults. As noted under the Health and Personal Care section of this report, there was evidence that residents who required bedsides had risk assessments and signed consent forms in place. The AQAA noted that there had been one safeguarding referral; the CSCI had not received a regulation 37 in respect of this. This was discussed; the team leader thought that the entry related to the only safeguarding matter that the home had been involved in since the last inspection, and was with regard to abuse of a person outside of the home leading to admittance. There had been no safeguarding referrals since the last inspection, and the complaints logged did not indicate that there should have been. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a purpose-built, safe, and well-maintained building with comfortable communal areas and access to safe grounds. Facilities and equipment are provided to meet residents’ needs. Residents can be assured that the home provides a clean and hygienic environment. EVIDENCE: The home is a single storey building so all areas were accessible, including the gardens. A tour of the environment was made; bedrooms were seen during the medication round. Decoration throughout the home was reasonable, although in some areas it looked “tired”. One relative’s survey noted that all of the kitchens and hallways need redecorating. The AQAA stated that new windows and decoration was needed, and that this was within the home’s five-year plan. One relative commented on their survey; “ Not as homely as when it first opened.” Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 19 The reception to the home is welcoming. There is a settee and a number of documents on display including the Statement of Purpose, last inspection report and improvement plan. The public liability insurance certificate was on display, however it was out of date. In a main corridor there was a large notice on display about the role of the Joint Inspection unit, which had not been in existence for a number of years. This was removed when pointed out to the team leader. The kitchen was found to be clean and in good order. The home had a large laundry room with two washing machines each with a sluice cycle, and a tumble drier. There was a separate sewing room, used as a store and for ironing, and a linen room used for sorting residents’ clothes. All bedrooms were for single occupation and had en-suite toilet and washbasin facilities. There was a communal bathroom on each hamlet with some having assisted bathing and/or shower facilities. At the last inspection it was found that a toilet seat was missing. On this occasion the ordinary seat was found to have been reinstated. Bathrooms had liquid soap and paper towels, and supplies of protective clothing. A sample of hot water temperatures showed that all were within the safe range. Antibacterial hand gel was available at the entry to each hamlet. All doors marked keep locked or keep closed were fastened as required. There was a locked sluice room on each hamlet and a launderette with sluice facilities. Corridors were found to be spacious with radiators covered or of a low surface temperature variety. A risk assessment on the hot water in the flats had been put in place. Bedrooms were personalised with individual small pieces of furniture, ornaments and pictures. Most bedrooms had a door sign that included the name of the resident and in many instances a picture of their choice. In one bedroom where a resident was in bed, there was a large pack of incontinence pads on top of the dressing table, which is not in keeping with promoting dignity. The home was found to be well equipped with adaptations such as assisted bathing, raised toilet seats, grab rails and hoists. Whilst nineteen out of twenty residents stated on their surveys that the home was always or usually fresh and clean, one relative commented; “The standard of cleaning has deteriorated.” A member of staff commented on their survey, “Need more domestic staff to adequately clean the home”. Overall, on this occasion, the home was found to be clean, tidy and generally odour free. Room 37 was empty, and there was a notice on the door, stating, clean and ready to sue. There was a faint odour of urine in the toilet, where the window as open, such that it would not have been pleasant to be admitted to this room. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a staff group with a good level of basic skills and who have a good manner with them. There may be rare occasions when the planned staffing levels are not met, and residents experience the carers to be very rushed. EVIDENCE: Thirty-three people were accommodated at the time of the inspection. This included one resident in one of the flats. One of the residents based on Poppy hamlet in hospital. Overall staff ratios are good, but the structure of the building into units means that there are times when frail elderly persons may not have a carer on their unit, whilst the carer is assisting with personal care on another unit. The AQAA stated that the home has six carers on duty for 33 residents, with three of these working on Poppy, the special needs hamlet. Staff confirmed that the basic staffing levels throughout the day time was three carers on Poppy, and three covering Iris, Viola and Rose between them, supported by a team leader. However, that there are times during the day when there are only two staff to cover the 18 mainstream beds which are located on three hamlets. The AQAA stated that the home had used 170 agency shifts over the previous three months. The team leader facilitating the inspection advised that the Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 21 home had three vacancies, and that although the home has six relief carers that they are being used to cover the vacancies, with agency having to be used to cover any sickness. The member of staff who facilitated the inspection advised that the home had been two carers down that morning, an agency worker had been arranged to cover one of these vacancies but did not turn up. The rota shared that there was also a carer working a shadow shift on Poppy, so there were four members of staff, plus one shadow worker and one team leader on duty. A number of people require two people to give them personal care; the AQAA stated that this was eight by day and nine by night. This meant that the morning shift had been very pressurised, however a homes manager was also in during that period. One resident spoken with remained in their wheelchair during the day. They advised that this was their preference as they were comfortable and it was easier when they went to the toilet. The rota indicated that planned staffing levels had been achieved during the weekend prior to this for all shifts. During the afternoon of the inspection the home was fully staffed; in addition to the team leader there were three carers on the Poppy and one each the Viola, Rose and Iris. After 3pm there was no senior manager in the home, and the team leader was responsible for the medication round, admitting a new resident and welcoming and looking after a prospective resident and their carer. The AQAA stated that there is one frail elderly hamlet that has a lower dependency level than the other two, but that when short staffed care staff had been told that they must reguarly check all three hamlets equally when there are two staff to cover the 18 rooms. There was evidence that the manager monitored dependency levels. The home had recently been unable to accept a person who was unable to transfer or mobilise independently and therefore needed a hoist, due to the current dependency levels in the home. One of the residents spoken with said, “ If they are short of staff they look after us just the same, but they have to rush about, we feel for them.” One resident who requires assistance with personal care said; “If they are short of helpers, sometimes I have to go to bed a bit earlier. Not very often, I don’t mind helping them.” Residents spoken with stated that staff responded promptly when the call bells sounded and this was observed to be the case. The AQAA stated that over 50 of staff held NVQ2 or above, and that a further 18 were working towards it. The home had an NVQ training profile which showed that all senior staff including acting team leaders had NVQ 2 or above, apart from one who was a qualified nurse. The profile indicated that well over 50 of the carers held NVQ 2, and that some were currently undertaking it. There was evidence that on the two staff files inspected that the carers both held NVQs. None of the relief carers were indicated as having NVQ 2 on the profile. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 22 Seven of the eleven members of staff who responded to the survey stated that they had not had enough training. A record of manaul handling training showed that staff had received manual handling training and updates within the last two years, and that ongoing updates were scheduled. Again, there was evidence on the staff files that this had been received. A requirement was made at the previous inspection that staff must recive dementia training.The AQAA stated that “Several staff have started dementia training, and the training profile inspected within the home showed that the senior team leader, three team leaders and twelve, i.e. a third, of all carers had commenced demetia awareness training at Otley College.The home’s profile for dementia training showed that sixteen staff were undertaking the Otley course in dementia awareness, and that tweve had received Suffolk County Council dementia traiing. (Five of these were amonst the twelve undertaking the Otley course.) Several staff surveys indicated that there are those who work with dementia who have not had training. Staff are routinely involved in the preparation of snacks and teas o the individual hamlets. The AQAA stated that there was “ Inconsistencies in food hygeine training.” It noted that the home had anticipated that this was to be made available on line, but it had not been, and so that in house training was to be provided. A schedule of food hygeine training was provided which showed that the last refresher training provided was for one member of staff in 2005, and that the majority of staff had not had any training or refresher training in this area since prior to 2004. There was evidence of this training having been provided in 2004 for the two carers whose files were inspected. One relative commented on their survey, “I have seen staff on Poppy manage very tricky situations with great skill.” Eight out of ten said the staff always or usually have the right skills and experience. The AQAA stated that several staff have received Unisafe training. A requirement was made at the last key inspection that the registered person must not employ any person before receiving a completed Criminal Records Bureau disclosure certificate, or, if circumstances justify, without receiving a POVA clearance statement. On this occasion two staff files were inspected and they were found to contain all of the required information, including copies of CRB (Criminal record bureau) check. The team leader on duty stated that no new staff had been recruited since the last inspection. The AQAA stated that there had been an embargo on recruitment, but that interviews were due to start for vacant posts. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that their health and safety will be generally well protected, but cannot be assured that effective quality assurance systems are in place to support improvements. EVIDENCE: The home is managed by two Registered Managers, who job-share. At the time of the last inspection, only one of these was a Registered Manager, both are now registered. Staff providing pre inspection comments had mixed views on this arrangement. The AQAA states that both job-share managers have been completing NVQ level 4 which has taken a lot of extra commitment and time away from managing the service. Although a manager had been on duty Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 24 on the morning shift of the inspection, they were not on duty on the afternoon shift and this was not discussed. Three requirements made at the last inspection had not been fully met and were repeated at this inspection. One relative commented that their used to be regular newsletters and posters for functions and events, but that there were not now. Residents and staff were aware that there was a current review underway about the future of the Council residential care. Information received by the managers on these topics was shared through normal meetings and by notice boards. One relative’s pre inspection comment was that there is so much to read that they would prefer to have meetings. Staff comments on pre-inspection surveys showed a level of dissatisfaction with management, although one commented; “If they are in the building I can always speak to them and discuss issues”. Six out of the eleven pre inspection surveys received indicated that there was little or no support from management. Given that this is a home within a larger management structure, in some cases these comments could refer to the wider organisation. The ongoing residential review has meant that this has been an uncertain time for staff. However, concerns listed included not seeing enough of or hearing enough from the homes’ managers, especially about what is positive and whether concerns that have been raised have been responded to. One pre inspection survey confirmed they met their manager every 12 weeks. It was established that there is a senior team leader who has a role at the operational level to coordinate management activities, however, the team leader facilitating the inspection advised that because of staff shortages the senior team leader had been covering some staffing duties including night staffing duties. Two carers spoken with advised that they had attended a team meeting recently, but prior to that had not had one for about a year. A folder of team meeting minutes that they referred to was seen; the last notes on file were for a meeting dated 20/04/05. One said that staff meetings were held but concerns were not always actioned. The manager has subsequently evidenced that unit meetings occur regularly, that copies of minutes are available in the office and individual copies provided to staff. Additionally four full staff meetings are held each year. Apart from the food questionnaires, there was no evidence of effective quality control influencing service delivery. The Service User Guide does not contain residents’ views. The team leader also provided a copy of a customer satisfaction survey used for residents who attended the home for a short stay, but was not able to provide any summary of responses. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 25 The AQAA stated that visiting manager’s inspections are carried out on a monthly basis. The team leader on duty was aware of these taking place and advised that the last one had happened approximately two weeks ago but did not know where copies of the reports were kept. The team leader advised that no personal cash is held on behalf of residents, but that all residents are funded through Social Care Services and the personal allowances can be paid into a personal account administered by the County Council. A carer spoken with advised that staff were able to make small purchases for residents using petty cash. Staff asked residents to sign when distributing residents’ personal allowances and where this was not possible, two staff signed. A recommendation was made at the last inspection that the registered person should ensure that the schedule for staff supervision is followed. The home’s AQAA notes that the home could do better at ensuring all staff have 1:1 supervision every 8 weeks, and stated that some staff work limited shifts during a month and that this can cause problems (with supervision.) Some of the staff surveys returned stated that they did receive regular supervision. Two care staff were asked about supervision, one of them had had supervision recently, the other said that they couldn’t remember their last supervision. They advised that supervisions were carried out by team leaders and that it depended who your team leader was whether these were happening. Staff files for two care staff showed the last recorded supervisions to be in July 2007 for one and May 2007 for the other, that is five months ago. Despite this outcomes for residents remain good, apart from medication, and this is to the staff’s credit. The fire risk assessment had been updated and covers all parts of the home. Fire extinguishers had been serviced in January 2007, and there was a fire drill rota on the door of the staff room. Two residents spoken with confirmed that they had heard the fire alarm tested. A revised fire risk assessment was in place. There was a HACCP (Hazard analysis of critical control points) in place for food production. An Environmental Health report on the kitchen dated October 2006 was seen, there was only one critical comment, and this was to ensure that the floor was well maintained. This was seen to be in order on the day; the manager has advised that the floor had been replaced. The AQAA stated that there was no electrical circuit test; this was taken up with the manager following the inspection who advised that they had ascertained it had been done and forwarded a copy of the certificate to the CSCI to evidence this. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 26 The employers’ liability insurance certificate on display at the time of the inspection was out of date, having covered the period up until the end of July 2007. Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 27 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 2 2 3 X X N/A 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 2 3 Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5 Requirement Timescale for action 31/12/07 2 OP2 OP37 5(1)(b) and (c) 3 OP9 13(2) The registered person must ensure that the Service User Guide is accurate and contains all of the information required by regulation so that prospective residents have full information upon which to make a decision about moving to the home. accurate. This is, in part, a repeat requirement from inspection of 25/08/2006. The registered person must 31/12/07 ensure that every resident or their representative is given a contract, or if they are funded by Social Care Services, Terms of Residence, that has been signed by both parties. This is for the protection of both parties. This is a repeat requirement from the inspection of 25/08/2006. The registered person must 17/09/07 ensure that the home’s medication policy and procedures are followed, particularly in regard to signing after administration and leaving no gaps in the DS0000038816.V351034.R01.S.doc Version 5.2 Mills Meadow Page 29 4 OP30 5 OP37 record. This is a repeat requirement from the inspection of 25th August 2006. 18 All staff involved in the preparation and handling of food must receive update training in food hygiene, to ensure that they are appropriately trained for the work that they perform. Employers’ A valid employers liability liability insurance certificate must be (Compulsory displayed. Insurance) Regulations 1998 31/01/08 15/12/07 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 OP33 OP1 Good Practice Recommendations Residents’ views should be collected and complied on residents’ satisfaction with a range of aspects of life in the home and these views should be included in the Service User Guide. Efforts should be made to develop a variety of lines of communication with staff and relatives. A folder of team meetings that is available to staff should be maintained up to date or removed. 2 3. OP32 OP32 Mills Meadow DS0000038816.V351034.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Area Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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