Inspection on 25/08/06 for Mills Meadow

This inspection was carried out on 25th August 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mills Meadow 16/09/08

Mills Meadow 17/09/07

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 John Goodship Key Unannounced Inspection 25th August 2006 9.10 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 DS0000038816.V309382.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. DS0000038816.V309382.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@socservsuffolkcc.gov.uk Suffolk County Council Mrs Lucy Roughley 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 DS0000038816.V309382.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. 23rd January 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 - 20 of which are for residential care for older people and 16 of which are for dementia care for older people. 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 - self-contained units providing residential care. Poppy Hamlet accommodates 15 service users with dementia / special needs. Rose, Viola and Iris Hamlets each accommodate 6 residential service users. Iris Hamlet is also used to accommodate some respite care service users. There are two self-contained flats. These are used to support people who require a short-term focused admission to improve their confidence, capabilities, and skills, towards living more independently in the community. There is also a 20 place Day Centre which is not subject to inspection. DS0000038816.V309382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out under the commission’s “Inspecting for Better Lives” policy. It was an unannounced inspection and was aimed at covering all the key standards, which are highlighted under each Outcome Group overleaf. Two inspectors undertook the fieldwork visits, which took place over two days, all day August 25th and the afternoon of August 29th. A team leader was in charge on the first day, and one of the managers was present on the second day. Prior to the visits, the commission had issued a Questionnaire Survey to service users and relatives. Nine responses were received from service users and twelve from relatives. Their comments and responses have been included in this report, on this page and on relevant Outcome Group pages. The inspectors toured the building, spoke to many service users and relatives, and interviewed several staff. We also examined care plans, staff records, maintenance records and training records. What the service does well: “If I can’t be at home, there is nowhere else I would rather be.” “Mills Meadow is a wonderful home. When I came in, I was very ill. The wonderful carers have made me better.” “Staff always take notice of what I say and are always kind.” These comments reflect the overall satisfaction expressed by service users and relatives about the quality of care at the home. A similar comment was made by an NHS professional who visits the home regularly. Comprehensive assessments are made of the needs of service users. These are regularly reviewed with the person and their relatives. Staff show service users respect and treat them with dignity, ensuring privacy. The home is purpose-built and well maintained. It has several communal sitting areas, both large and small. They are comfortably furnished. The home projects an air of calm purposefulness. Staff manage their work to give the minimum disruption to service users. The home has a well-staffed catering service, with regular surveillance of the nutritional needs of service users. The meals are well-presented allowing choice and control by service users. The home has a high number of staff qualified at NVQ Level 2 and above. DS0000038816.V309382.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 DS0000038816.V309382.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. DS0000038816.V309382.R01.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 DS0000038816.V309382.R01.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): 1,2,3,4,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the home will assess their needs fully and show how they will be met either permanently, for short-term care and for intermediate care. Service users cannot be assured that the information they are given is accurate. EVIDENCE: The statement of purpose did not reflect the current registration of the home. The current version showed that the home is registered to provide care for older people with dementia, however it stated that the maximum number was 15. The home is in fact registered to provide for up to 16 service users with dementia (which includes one named person on the mainstream unit). This also needs to be updated in the Service User Guide. The admission records of a service user on a respite care break confirmed that a copy of the service user guide had been issued with the date recorded. This service user’s file included a copy of the pre-admission assessment both by staff at the home and a copy of a recent Community Care Assessment. DS0000038816.V309382.R01.S.doc Version 5.2 Page 10 A sample of care plans evidenced that contracts were given to all service users. This was confirmed by all respondents to the Questionnaire Survey by the Commission. However one care plan had a copy of the contract but it was only signed by the team leader, and not the service user or their representative. However records of a newly admitted service user on respite care confirmed that this information was given out as part of the Service user guide. The team leaders on duty confirmed that the home still provided intermediate care. At the time of the visit one of the two flats was being used for intermediate care and inspectors noted that a specific guide for those receiving this care was kept in the flat for the service user’s reference. Care records evidenced that the Intermediate Care Assessment Team had visited the service user whilst in the home and the Community Psychiatric Team had been involved. Physiotherapists and Occupational Therapists were also involved with assessments. One of the team leaders advised that whilst they did not have additional staff on duty when intermediate care was provided, a member of staff worked additional hours at core times. There was some lack of clarity between the home and the ICAT team over responsibility for medication. This is referred to under Standard 9. DS0000038816.V309382.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Service users 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. Service users can be assured that they will be treated with respect and dignity. EVIDENCE: Four care plans were examined. They all followed a similar range of contents. There were records of major reviews every six months with relatives and other appropriate professionals. Risk assessment covered moving and handling, smoking, nutrition and weight loss as appropriate. There was however no risk assessment for one service user who had had several falls. One plan did not have a photograph of the service user. The daily records contained good information to inform the care plan, such as changes in mobility, records of visitors, and which activities they had taken part in. However there was not always an entry for each day. Plans did contain instructions for staff on how to best meet individual’s care needs, regarding, for example, eating, smoking, DS0000038816.V309382.R01.S.doc Version 5.2 Page 12 maintaining mobility, and preferred routine for getting up. One service user confirmed that they liked to get up late and this was recorded in their plan. Discussion with two service users confirmed that staff ensured that they had access to health professionals as needed. This was also confirmed by the response to the Questionnaire Survey of service users. One service user confirmed that their doctor was contacted if they asked staff to do so, that they were able to have appointments with the optician and that a NHS Chiropodist visited the home. They advised that the private Chiropodist no longer visited the home. A district nurse was attending the home for part of the inspection. They expressed their satisfaction with the care that they witnessed. They commented: “this is the kind of home I would want a relative of mine to live in”. One relative commented: “The care of my relative is very good. If they are not well the doctor is called straight away. They are all very helpful and let me know if anything is not right with them. They are happy there which is worth a lot to me.” Medication records for one service user receiving a period of respite care and one service user receiving intermediate care were inspected. Two missing entries were noted in the records of one of the service users and a missing entry in the records of the other. It was also noted that the service user who was receiving intermediate care had run out of medication during their stay at the home. Records evidenced that staff had contacted the service user’s family to request that they bring further supplies in. Staff advised that the responsibility for ensuring that adequate supplies of medication lay with the Intermediate Care Assessment Team (ICAT). During the second visit a service user returned from a hospital stay. The team leader on duty was observed to check the medicines received in and was heard telephoning the hospital to query altered medications. Another team leader was observed administering morning medication to two service users on Poppy unit. The team leader sat with the service user, reassured one service user about what they were taking, ensured that they had a drink to take medication with and waited to ensure that they had been taken. On another occasion, however, the team leader was observed to sign the MAR sheet before administering the medication. There were some gaps in the signatures on the MAR sheets for service users in Iris unit. Two service users had medication audits in their drug folders, showing recent changes to medication made by the GP after a review. The medication is kept on each unit in a locked cupboard. The temperature of the cupboards was seen to be recorded daily. There is a central drug room where controlled drugs are stored. The MST for one service user was checked. The quantity in the cabinet tallied with the entries in the CD book. DS0000038816.V309382.R01.S.doc Version 5.2 Page 13 One carer spoken with confirmed that they were authorised to administer medication and advised that they were currently undertaking a modular distance-learning course with Otley College. One of the team leaders advised that a large number of staff were involved in this training and evidence of some of the completed modules was held in the office. But a complete record of training completed and underway was not available. Staff were observed to treat service users with dignity and respect. The sign on one service user’s bedroom door identified the service user’s names including the name they preferred to use. Staff were seen to kneel down in order that they could speak with a service user who was at the table and one member was heard to very discreetly ask if a service user wished to return to their bedroom in order that they could be assisted to the toilet. Staff were seen to knock at bedroom doors before entering, a practice which was confirmed by two service users. In one instance two staff were required to assist a service user with toileting, using a hoist. Staff were observed to close the bathroom door, come out of the room to give the service user time and privacy and to knock again before entering. Service users had access to a telephone located in a quiet area on one of the corridors. Two service users were sitting in the lounge area of one of the hamlets. They both said they went there every day. They liked watching television. “We are looked after very well, and the food is good.” Another service user was nursing an injury sustained during a visit to relatives. They said they needed help to go to the toilet. Staff had placed a call bell on their chair. “They come very quickly when I ring.” Three other people on different hamlets said they were looked after very well. “We enjoy ourselves.” One service user said that they had liked to visit the day centre to see old friends. This had been stopped as part of the provider’s day care review. However the home now organised a social event once a month for day centre customers and service users in the home. DS0000038816.V309382.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 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 available evidence including a visit to this service. Service users 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: Each of the units within the home had a lounge/dining area. In addition to this there is a reminiscence room called ‘Becket’s Parlour’ and a number of lounge areas within the wide corridors. Most service users were found to spend their time in the lounge/dining area on their unit or in their bedrooms, with no obvious signs that Beckett’s Parlour was used. The manager advised that it was mostly used by day centre staff and customers as a quiet room or meeting room. It was positive to note that several service users from one unit had gone to visit another unit for the afternoon and were all planning to join in with a crossword. Activities were co-ordinated by one of the team leaders who had instigated a monthly chart on each hamlet to record activities. Examples were seen, some more fully completed than others. There was no link between these charts and DS0000038816.V309382.R01.S.doc Version 5.2 Page 15 any record of activities in an individual service user’s care plan or daily record. The team leader commented that activities organised spontaneously were better supported than planned ones. The home had a wheel chair access minibus. One of the team leaders was qualified through the Minibus Drivers Assessment Scheme (MIDAS) to drive it. The majority of respondents to the Commission’s survey agreed that there was always or usually activities arranged by the home which they could take part in. Comments ranged from “excellent” to “ I choose not to take part”. Staff were observed to interact with service users at mealtimes and in passing by. However there was little evidence, other than when games of dominoes or doing a crossword, of staff being more involved in activities with service users. One of the service users commented that they still enjoyed a range of hobbies and was pleased to show the inspector one of their jigsaws, which had been framed and displayed in the corridor. Relatives of another service user had brought in an electronic organ and staff were observed to be spending time with this service user encouraging them to enjoy the music. One group of service users was seen to be enjoying a game of dominoes and a further game was planned on Poppy unit on the second day. One service user advised staff that they were going to go into town and others were seen to go out into the garden to enjoy a cigarette. There was a photo board in the hall recording the trip to Easton Farm Park in June 2006. Two service users spoken with confirmed that visitors were welcome and this policy was reinforced in the service user guide. A number of friends and relatives visited the home during the course of the inspection. A carer was seen pushing a service user in a wheelchair, together with another service user in their electric wheelchair, through the garden. The carer told the manager they were on their way outside the building for a walk. Two visitors said how good the home was, and how their relative had improved since being admitted. This was evident to them by the behaviour, cleanliness and weight gain of their relative. One of the internal gardens was due to be re-furbished as a sensory garden by the local Rotary Club. Some visitors were sitting in this garden. They told the inspector: “My relative has been very well cared for and has had a varied and fuller life with all their disabilities than they ever would have had alone in their cottage.” The lunchtime routine on Poppy was observed. The atmosphere was relaxed and calm with music being played quietly in the background. Whilst meals were plated up from a trolley, service users were able to serve themselves vegetables from a vegetable dish placed on the table. A choice of peas or baked beans was offered as well as mashed potato. A carer was observed to offer assistance to one service user asking if they wished to have help with cutting their meal up, after helping them to sit closer to the table. Fruit juice DS0000038816.V309382.R01.S.doc Version 5.2 Page 16 was available with the meal. Two service users on Viola advised that they had a choice of meals and that they enjoyed their food. The menu of the day was displayed on each unit. On the first visit, the lunchtime meal was Chicken Kiev followed by gooseberry tart, with chilli con carne and banana cake for tea. Service users confirmed that they were offered a choice if they did not like the main menu and the inspector was shown a list of the regular alternatives on offer. The lunchtime meals list identified any service users who were diabetic or had special diets. One service user advised that they were able to make a drink themselves if they wished to and hot drinks were regularly offered. There was evidence in care plans that nutritional screening identified at-risk service users. The home had a weighing chair, allowing all service users to be weighed. Care review records contained information on action to be taken on nutritional needs. Two visitors commented how well their relative had progressed now that they were being properly fed. There were also instructions to staff explaining when and what kind of support should be offered at mealtimes. There were two cooks on duty on the first day of the inspection. The kitchen served the home, the day centre, and provided six domiciliary meals. The head cook was up-to-date on food hygiene training as seen from their training records, and was also an NVQ assessor. On one hamlet, there was a Customer Comments sheet on the noticeboard for comments about meals. The one seen on Poppy had been filled in by staff, and included comments such as “everyone enjoyed the meal”, “the veg were hard”, “ all plates were cleared” and “the pie was a bit dry”. These sheets were used by the cooks as a quality assurance tool to maintain and improve the catering service. DS0000038816.V309382.R01.S.doc Version 5.2 Page 17 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): 16,17,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ complaints and concerns are treated properly and within the home’s procedures. Service users’ legal rights are not fully protected without their consent to any reduction in liberty of movement. Service users can be assured that allegations of abuse will be dealt with promptly but cannot be assured that all incidents will be reported to the commission. EVIDENCE: Service users spoke with confirmed that they were aware of how to complain or raise concerns. One service user commented that they would have no problems with raising issues with any of the staff whilst another stated that they would speak in the first instance to their key worker. The complaints procedure is summarised within both the statement of purpose and service user guide and reference is made to the broader procedure detailed in the Suffolk County Council ‘Having your say’ leaflet. Records of a newly admitted service user on respite care confirmed that this information was given out as part of the Service user guide and copies were found on the notice board near the offices, although somewhat hidden amongst other leaflets. The homes complaints/compliments log was viewed. Since August 2005 there had been 6 compliments and 2 complaints. The log included a brief summary of the complaints’ outcome and identified that issues had been appropriately addressed. DS0000038816.V309382.R01.S.doc Version 5.2 Page 18 Two service users were in beds fitted with bedrails for their protection. Another service user had a pressure mat by their bed to alert staff if they got out of bed. The service users’ files contained no consent to the bedrails and the reasons for the pressure mat were not explained either. Another care plan recorded two instances of inappropriate behaviour by the service user towards staff. There was no evidence of a risk assessment to control and reduce the incidence of this behaviour, identify possible trigger points, or set out guidance for staff on how to react to further incidents. From discussion with three carers and one team leader it was evident that they were aware of what is meant by the term ‘abuse’ and each was able to state what action they would take if they had any concerns. Staff files evidenced that all three carers had received training in abuse awareness as part of their induction/foundation training. The file of a relief carer did not include any evidence of abuse awareness training although the team leader on duty believed that they were due to be trained that week. One carer advised that they had undertaken a 1 day ‘Unisafe’ training course as part of their foundation training and this was confirmed by their records. A copy of the Suffolk Vulnerable Adults Protection Committee document ‘Protecting Adults at Risk of Abuse’ dated June 2004 was on display in the team leaders’ office. At the time of the second visit the inspectors were made aware of an allegation of abuse, which was discussed with the manager. They confirmed that contact had been made with the POVA (protection of vulnerable adults) team; however CSCI had not been notified as required. DS0000038816.V309382.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users 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 service users’ needs. The home can be assured that the home provides clean and hygienic environment. EVIDENCE: All bedrooms were for single occupation and had en-suite toilet and washbasin facilities. There was a communal bathroom on each unit with some having assisted bathing and/or shower facilities. There was a locked sluice room on each unit and a launderette with sluice facilities. Corridors were found to be spacious with radiators covered or of a low surface temperature variety. There was a single wardrobe in one corridor on Poppy with the door ajar, containing a variety of hanging clothes. The manager later advised that this was used for spares, and was normally kept locked. The home was found to be well DS0000038816.V309382.R01.S.doc Version 5.2 Page 20 equipped with adaptations such as assisted bathing, raised toilet seats, grab rails and hoists. The home is a single storey building so all areas were accessible including the gardens. Service users were free to move around the home as they chose with staff alerted to anyone going into or leaving Poppy, the special needs unit, as an alarm was sounded. There were several courtyard gardens which were accessible to service users. One was due to be upgraded by a local Rotary Club. Another had a small pond carefully fenced round for safety. Bedrooms were found to be personalised with service users having brought in small pieces of furniture, ornaments and pictures. One service user commented that the storage space was limited as they had only a single wardrobe, in addition to their chest of drawers. All bedrooms seen, with the exception of one, had a door sign which included the name of the service user and in many instances a picture of their choice – for example one incorporated a picture of a Spitfire in accordance with the occupant’s interest in planes. One service user advised that they had a room key although they stated that they never chose to use it. It was noted that the WC in one room had no seat on it. The manager explained the reason for this, but agreed that it was undignified and that there could be an alternative way to meet the occupant’s needs. Three carers on different units were spoken with. Each was able to describe how they managed the cleaning of commodes and the management of soiled laundry. They confirmed that where a service user was assisted by hoist as part of their care plan, a hoist sling specifically for their use was kept in their bedroom. Staff had good access to protective clothing including plastic aprons and latex gloves, with supplies of each being held in bedrooms where needed and bathrooms. 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 service users’ clothes for distribution. Every bathroom was found to have liquid soap and paper towels and bath towels and flannels were given to service users as needed to avoid cross infection. A sample of hot water temperatures showed that all were within the safe range. At the entry to each unit, staff and visitors were reminded to use the antibacterial hand gel to minimise the risk of infection in line with the home’s policy. During the morning of the first visit it was noted that a bedroom smelt strongly of urine during the morning. One of the domestic staff confirmed that they deodorised the carpet on a daily basis with a full clean on a fortnightly basis. The odour had gone by the afternoon. Overall the home was found to be clean, tidy and generally odour free. A copy of the Department of Health ‘Infection control guidance for care homes’ dated June 2006 was available in the office together with the county council’s policy on infection DS0000038816.V309382.R01.S.doc Version 5.2 Page 21 control/safe working (2005) and guidance regarding MRSA (2001). There was also a COSHH biological assessment dated June 2006 in place. The hot water in the kitchen area of the Garden Flat measured 60°C. The manager advised that this was in keeping with the rehabilitative aims of the flat. However a risk assessment for each service user admitted to the flat had not been undertaken. One of the vacant short-term care rooms had been cleaned ready for the new occupant. There were flannels and towels laid out on the bed, and a notice on the door “Room cleaned and ready for use”. DS0000038816.V309382.R01.S.doc Version 5.2 Page 22 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 available evidence including a visit to this service. Service users are cared for by appropriately trained staff whose numbers are sufficient for their needs. Service users cannot be assured that safe recruitment practices have been followed in all cases. EVIDENCE: It was evident at the first visit that the team leader was under pressure to meet a wide range of needs. One of the managers was not on a working day with the other on annual leave and there was no administrative support. As a result the team leader was responsible for the morning medication round, answering the telephone and senior responsibilities. This situation was improved at the second visit with one of the managers being on duty and the administrative assistant being back from annual leave. In view of previous episodes in the home which lead to the manager asking staff and residents not to interrupt the person doing the drug round, it was concerning to note that staffing arrangements could not allow the team leader to complete that morning’s round without interruption. The staff levels had been increased since January 2006 to cater for the three additional rooms on Poppy hamlet. The cover throughout the day time now was three carers on Poppy, and three covering Iris, Viola and Rose between them, with a Team Leader. During the week, one of the managers would normally be present also. DS0000038816.V309382.R01.S.doc Version 5.2 Page 23 Service users spoken with stated that staff responded promptly when the call bells sounded and this was observed to be the case. Two staff were available when a service user required assistance with toileting. In their interactions with service users staff were observed to be unhurried and helpful and service users spoken with commented that they were helpful and caring. One service user commented on the fact that it was the care of the staff that had helped them to get better rather than any medical help when they first arrived at the home. One carer confirmed that they were responsible for getting drinks and serving lunches and teas and for putting clean laundry away. This carer was putting away the clean laundry, taking advantage of the fact that the service users from the hamlet in which they were working had gone to another hamlet for an activity. Recruitment records for three carers were viewed. In one instance there was only a partial application form, which meant that it was not possible to assess whether there was a full employment history. Not all files contained a copy of the criminal records disclosure (CRB) although a list of these was made available at the second visit. The recruitment records of one carer indicated that they had started work two months before the CRB (and the included Protection of Vulnerable Adults –POVA check) had been received. One staff member had gone from being a volunteer to being a carer, however the home had not requested a further CRB when the person was changing role. Training records were found to be patchy. Staff spoken with confirmed that they received training and all those spoken with confirmed that they were up to date with moving and handling training. One of the team leaders was the designated workplace handling co-ordinator. Five staff files were viewed and four of these evidenced that receipt of moving and handling training. One staff member was booked to attend training the following week although there was no other evidence of training on this file – that of a relief worker. The other files evidenced training in areas such as induction, foundation and fire safety. One carer advised that they had undertaken dementia awareness training through the Alzheimer’s Disease Society prior to starting work at Mills Meadow. There was no other evidence of dementia awareness training on the other staff files seen although one of the team leaders had advised that there had been some in-house training. It was positive to note that one of the team leaders had undertaken ‘Basic dementia care mapping and person centred care’ through Bradford University. There were two staff doing NVQ Level 2 and one on Level 3. All other care staff had completed their NVQ at various levels. DS0000038816.V309382.R01.S.doc Version 5.2 Page 24 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): 31,33,34,35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the management arrangements operate in their best interests. The home has systems to help run the home in the best interests of the service users, including their financial interests. However the systems of record keeping cannot yet evidence that this is the case. Some staff are not yet appropriately supervised, although all staff are competent to care for the service users. EVIDENCE: The home is managed by two managers on a job-share basis. Staff spoken with had mixed views on this arrangement with suggestions from one that two managers brought a range of differing skills whilst two others indicated that the arrangement led to some decisions being made and overturned by the other manager. The managers used a communications book, together with a DS0000038816.V309382.R01.S.doc Version 5.2 Page 25 shift overlap in mid-week to provide continuity. Although able to fully cover each other, each manager also took specific responsibilities, both on a geographical basis for parts of the home, and on specialist issues. At the time of inspection, one of the managers was acting as a deputy manager pending the filling of a vacancy. One manager had been registered by the Commission in 2005. The other manager had applied to be registered in July 2006. The home used several methods to assure itself and the service users that quality was continually improved. The Customer Comments sheet for catering has already been referred to under Standard 15. Residents meetings were held about every two to three months but the manager said service users made more comments informally. In the Survey by the Commission, all respondents said that they knew who to go to if they had any concerns. The provider was implementing a revised scheme for monthly visits and reports by senior managers and colleagues from other homes to meet Regulation 26. The most recent report seen was for July 2006. Service users who were spoken to all expressed their satisfaction with the home. The home received information from the Medical Devices Agency warning of possible faults in equipment. A record was not kept of any action taken on relevant alerts. There was a Fire Risk Assessment for the home but it was not up-to-date and did not cover all parts of the home. One of the team leaders confirmed that they encouraged service users to look after their own money and the home provides lockable storage to enable them to do so safely. Where service users did require assistance with managing their finances and there was no one to assist them, money was paid into a County Council imprest account. Staff were able to make small purchases for service users using petty cash. Staff asked service users to sign when distributing service users’ personal allowances and where this was not possible, two staff signed. The home’s imprest account demonstrated that service users received interest on monies held on their behalf. At the time of these visits staff were holding a small amount of money in safekeeping for one service user on respite care, and appropriate records were found to be maintained. The home is owned and managed by Suffolk County Council. It is governed by accounting and financial procedures set by the government for public authorities. The home was given an annual budget and business plan. Service users and staff were aware that there was a current review underway about the future of the Council day services, and a review about the future management of residential care. Information received by the managers on these topics were shared with staff and service users, through normal meetings and by notice boards. In discussion one of the team leaders stated that they did not receive regular one to one supervision although they did have team leader meetings. All carers DS0000038816.V309382.R01.S.doc Version 5.2 Page 26 spoken with confirmed that they received regular supervision from one of the team leaders and one of the carer’s supervision files was viewed and provided confirmation of regular supervision. A list of planned supervision was also viewed. Carers also spoke about their annual PDR (professional development review). A current and valid certificate of employer’s liability was displayed with the certificate of registration in the entrance hall. From a tour of the premises it was evident that hoists and assisted baths had been recently serviced (August 2006). During the inspection a service user had had a fall. Staff were seen to respond promptly and an accident report completed in a timely manner. Alarm calls leads were positioned to ensure easy access if a service user needed assistance in the bathroom. Staff were provided with appropriate protective clothing and infection control procedures were well established (see section on infection control). The home’s record keeping was not always complete or easy to access. The home was unable to provide full and comprehensive records of training and staff information. Some service user plans did not contain all the required items of information, nor were daily records completed every day. DS0000038816.V309382.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 3 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 2 2 DS0000038816.V309382.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 and 5 Requirement The registered person must ensure that the statement of purpose and the service user guide are accurate. The registered person must ensure that every service user 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. 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. The registered person must ensure there is a record of any limitations agreed with the service user on their liberty of movement. The registered person must inform the commission of all incidents covered by this Regulation immediately. The registered person must not employ any person before DS0000038816.V309382.R01.S.doc Timescale for action 30/09/06 2. OP2 OP37 5(1)(b) and (c) 30/09/06 3. OP9 13(2) 30/09/06 4. OP17 17(1)(a) Schedule 3 (3)(q) 37(1)(g) 30/09/06 5. OP18 OP37 29/08/06 6. OP29 OP37 19 29/08/06 Version 5.2 Page 29 7. OP30 18 8. OP37 17 and Schedule 3 23(4) 9 OP38 receiving a completed Criminal Records Bureau disclosure certificate, or, if circumstances justify, without receiving a POVA clearance statement. The registered person must ensure that staff receive training appropriate to the work they perform, in particular the care of people with dementia. The registered person must ensure that all records listed under this Schedule are kept in the home. The registered person must provide a complete and up-todate Fire Risk Assessment for the home. 30/09/06 30/09/06 30/09/06 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 OP7 OP37 OP8 OP9 Good Practice Recommendations The registered person should review the current practice where the daily record is not always completed on every day for some service users. The registered person should ensure that risk assessments are completed appropriately for the safety and care of service users. The registered person should agree with the Intermediate Care Assessment Team a protocol defining clearly the responsibilities of all parties for service users admitted for intermediate care. The registered person should review the way information on activities is recorded in the plans of individual service users. The registered person should ensure a risk assessment of the hot water hazard in the intermediate care flats for each new admission is done. This aspect should also be covered by Recommendation 3. The registered person should ensure that staffing numbers DS0000038816.V309382.R01.S.doc Version 5.2 Page 30 4. 5. OP12 OP25 6. OP27 7. 8. OP30 OP36 and skill mix on each shift are sufficient to allow the medication round to be conducted without undue interruption. The registered person should review how training is planned and recorded. The registered person should ensure that the schedule for staff supervision is followed. DS0000038816.V309382.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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