This inspection was carried out on 25th August 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOMES FOR OLDER PEOPLE
MILLVIEW - (Victoria Unit) Bridgeman Street Bolton Lancs BL3 6SA Lead Inspector
Mike Murphy Unannounced 25 August 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Millview Address Bridgeman Street Bolton BL3 6SA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01204 391211 01204 363246 Care First Group PLC Kathryn Bebbington CRH N - Care Home with Nursing 180 Category(ies) of OP Older Persons - 120 registration, with number DE(E) Dementia over 65 years - 60 of places PD Phtsical Disabilities - 10 MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 120 OP, up to 60 DE(E) and up to 10 PD The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 7th March 2005 Brief Description of the Service: Millview is a Care Home providing nursing and personal care for mainly older people. It is situated in Great Lever about half a mile from Bolton town centre. It is close to main bus routes, the local railway station and the motorway network. The home is purpose-built, single storey and comprises of six separate houses, each with 30 single bedrooms. There is plenty of car parking to the front of the home and there are garden areas around each unit for residents to sit out in. All the houses allow level access for wheelchair users and people who have problems climbing steps. Each house has a large lounge, a designated smoking area and a dining room. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem.The home is registered to provide care for up to 180 residents with a variety of nursing and residential needs. These include physical disabilities, palliative care and dementia care. Victoria House is registered to care for residents who require fulltime nursing care. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place. This was an unannounced inspection. The Inspector spent 3 hours on Victoria House. During this time she looked at care and medicine records to ensure that the health and care needs of the residents were being met. The inspector then visited some residents in their own bedrooms to check out the care that was being provided for them. In order to obtain information about the home the inspector spent some time speaking to 2 residents, a relative and 2 care assistants. Not all the National Minimum Standards were looked at on this visit. During the next inspection the inspector will look at the rest of the Standards that are considered to be important for residents safety and wellbeing. These are the Standards that have to be inspected at least once a year. What the service does well: What has improved since the last inspection? What they could do better:
MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 6 Staff must make sure that they continually assess every resident to check if there could be any problems with eating and drinking or problems with weight loss. If staff know that there are some concerns, then they may be able to prevent the problems from becoming worse. 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. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The system for ensuring that all prospective residents had a detailed assessment undertaken before their admission to the home, gave an assurance both to residents, relatives and staff, that a resident was only admitted if the home could meet their needs. EVIDENCE: Before any resident was admitted to the home an assessment of their needs was undertaken either by a senior member of the nursing staff from the home or from the professional i.e. care manager, requesting their admission. A detailed pre-admission assessment form had recently been introduced. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 &11 The care plans reflected the support needs of the residents. Care practices ensured that the residents’ health care needs were met, that they were treated with respect and their dignity was upheld. The medication system in place ensured that the residents received their medicines safely. EVIDENCE: Individual care plans were in place for each resident. The care plans of 2 residents were examined. The care plans gave clear instruction and guidance on how, when problems had been identified, the care needs of the residents were to be met. . The daily report was kept with the care plan. This is good practice. The care plans were evaluated as and when necessary, but at least on a monthly basis. Risk assessments were in place and covered such areas as moving and handling, pressure sores, nutrition, the use of bed rails and falls. The nutritional risk assessment for one resident however, had not been evaluated for several months. The residents were weighed at least on a monthly basis and the weight recorded on a chart kept in their care plan. The inspector found it was difficult at times to access the above information. This was because there was no division between documents, various
MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 10 documents were mixed together, such as risk assessments and reviews and a lot of information was kept within the file that could probably have been archived. A discussion with the residents identified that they had access to other health care professionals such as opticians and chiropodists. NHS Dental services were available but management explained that there could be problems at times, in accessing the services. Equipment necessary for the prevention and treatment of pressure sores was available within the home. Continence aids were in use and the staff were aware of how to contact the continence nurse advisor for advice, if deemed necessary. The Inspector looked at the care being provided for residents with intensive nursing needs. They were extremely well cared for, nursed on an appropriate bed and mattress and all the necessary equipment needed for their care was available. A safe system of medication management was in place. The medicine room was kept locked and medications were securely stored. The qualified nurses on the unit administered the medications. It was identified however that when a prescription stated that one or two tablets were to be given, staff were not documenting just how many tablets had been administered. Staff must always record the exact dose of medication administered. The procedure for ordering medications was not in accordance with the good practice guidelines advised by the local Primary Care Trust. Once a medication has been ordered the prescription should be returned to the home for checking and then sent out to the pharmacist for dispensing. This good practice is known as the “ figure of eight” procedure. Due to changes in legislation, a new system for returning medications was in operation. The home was complying with the new requirements, however it seemed a cumbersome and time consuming operation for the staff. Whilst the new arrangements for disposal of medicines no longer required are in themselves satisfactory it is advised that the size of the containers used for this are reviewed. The residents said that the staff treat them with kindness and respect. During the inspection staff members spoke with residents in a kindly and respectful way. Staff spoken to gave examples of how privacy and dignity were promoted. They also gave good practice examples of how they would care for a resident who was terminally ill. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13. The home enabled residents to exercise as much personal freedom and choice as possible and find enjoyment with the range of activities available. EVIDENCE: The residents spoken to said that they were satisfied with the way they were allowed to spend their day, more or less as they pleased. A discussion with the residents indicated that they were satisfied with the range of activities provided by the home. The home employs three hobby therapists. They undertake the following activities with the residents: Trips out to places of interest. (The home uses community transport). Various board games and bingo, video shows, visiting entertainers, big screen movies and pub/restaurant lunches. In addition the hobby therapists have a sweet trolley that is circulated around the units on a Monday and Friday. Mill View publishes a newsletter to keep residents and their relatives informed about what is happening throughout the Home. Residents told the Inspector that they are able to have visitors at any reasonable time and they can see their visitors in private. A relative confirmed this. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. Staff have a good knowledge and understanding of adult protection procedures thereby reducing the possible risk of harm or abuse. EVIDENCE: A copy of the Local Authorities Vulnerable Adults Procedure was in place and a discussion with staff identified that they were very aware of the procedure to follow in the event of any allegation of abuse. Training in the protection of vulnerable adults has been undertaken by some staff and is ongoing. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Although the inspector did not look at all of the building on this inspection she noted that each bedroom door now had an overriding door lock. Standards 19 and 26 will be a looked at in detail during the next inspection. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The residents were cared for by sufficient numbers of staff that were suitably qualified and trained and therefore had the knowledge and skills to meet the residents’ needs. EVIDENCE: Examination of the duty rota and a discussion with staff showed that there was enough staff on duty to meet the care needs of the 24 residents. 24-hour nursing care continues to be provided by qualified nurses. Suitably trained care assistants support them. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Standards of 33, 35 and 38 will be looked at during the next inspection. MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x x MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 8 9 Regulation 12(1)(a). 13(2) Requirement Nutritional risk assessments must be undertaken for all residents. Staff must document the actual amount/number of tablets being given. Timescale for action 30/9/05 26/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations Consideration needs to be given to making the information in the care plans more accessible. This could be done by archiving information that is no longer relevant or by devising some way of separating information. Once a medication has been ordered the prescription should be returned to the home for checking and then sent out to the pharmacist for dispensing. 2. 9 MILLVIEW - (Victoria Unit) F56 F06 S5689 Millview (Victoria) V232015 250805 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich Bolton, BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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