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Inspection on 09/05/07 for Millview Nursing Home

Also see our care home review for Millview Nursing Home for more information

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

What the care home does well

The home continues to provide good care and support to residents. Two units at the home provide care to residents who require `EMI nursing` care, two to residents requiring `general nursing` care and two to residents requiring `personal care`. Comments made during the course of the inspection (and in comment cards received by the CSCI prior to the inspection) by residents and relatives included `the staff are very kind and help with the things I can`t do for myself`, `all the staff are very good with my mum and tell me as soon as things change with her`, `I did have a few small problems when I first came in but my family went to the manager and they were soon sorted out and I am very happy here now`.

What has improved since the last inspection?

The requirements made at the last inspection have been complied with. There have also been improvements to some areas of the environment of the home, which can only help to improve the quality of life of residents. Residents also said that the range of leisure and social activities available has increased providing greater choice.

What the care home could do better:

There are a number of issues around care plans and how residents` medicines are managed that need to be improved by the home. How malodour is being managed on one particular unit is also in need of review. More details regarding these issues is contained within the main body of this report.

CARE HOMES FOR OLDER PEOPLE Millview Nursing Home Bridgeman Street Bolton Lancashire BL3 6SA Lead Inspector Mike Murphy Unannounced Inspection 9th May 2007 09:30 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 Millview Nursing Home DS0000005689.V301733.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. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millview Nursing Home Address Bridgeman Street Bolton Lancashire BL3 6SA 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) 01204 391211 01204 363246 www.bupa.com BUPA Care Homes (CFHCare) Limited Kathryn Bebbington Care Home 180 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (119), Physical disability (10) Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 180 service users, to include: Up to 119 service users in the category of OP (Older People). Up to 60 service users in the category of DE(E) (Dementia over 65 years). 1 service user in the category of DE(Dementia under 65 years) Up to 10 service users in the category of PD (Physical Disability) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 17th January 2006 2. Date of last inspection 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 general nursing and physical disabilities, palliative care and dementia care. The fees at the time of this inspection ranged from £355.39 to £609.00. For further details please contact the home manager. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted on the 9th of May 2007 between 0915 and 1800hrs. The manager did not know that the inspection was to take place. The CSCI inspectors had discussions with residents, their relatives, the manager and staff, visited each unit and inspected records maintained by the home in relation to how residents are cared for and supported and protected. What the service does well: What has improved since the last inspection? The requirements made at the last inspection have been complied with. There have also been improvements to some areas of the environment of the home, which can only help to improve the quality of life of residents. Residents also said that the range of leisure and social activities available has increased providing greater choice. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 6 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. Millview Nursing Home DS0000005689.V301733.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 Millview Nursing Home DS0000005689.V301733.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): 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their health and care needs assessed before their admission to the home and this gives an assurance both to residents, relatives and staff, that a person is only admitted if the home can meet their needs. EVIDENCE: Rutland and Martin units These 2 units provide care and support to residents who require a ‘EMI nursing placement’. Prior to residents being admitted to the Rutland or Martin units the clinical services manager, (who is a qualified psychiatric nurse) or senior member of the nursing care staff carry out an assessment of the prospective resident’s needs in consultation with the resident (if possible), their relatives and relevant health and social care professionals (for example doctors and social workers). Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 9 The purpose of such an assessment is to determine if the home will be able to meet the prospective resident’s needs appropriately. The assessment process for prospective residents to Rutland and Martin units pays particular attention to their mental health needs as well as general health and social needs. Discussion with 3 resident’s relatives revealed that the process of admission was dealt with sensitively and that they felt that they were consulted at all stages and also that their views were regarded as being important and that they felt they were part of the decision making process. The placement of all residents is subject to ongoing review and relatives reported they were included in these reviews. Victoria, Dove, Albion and Atlas units Victoria and Dove units provide care for residents who require ‘general nursing’ placement. Albion and Atlas units provide care to residents who require ‘personal/residential’ placement. Inspection of 8 resident care files, 2 from each unit, showed that before they were admitted to the home an assessment of their needs had been undertaken either by one of the senior nurses from the nursing units or a senior member of care staff from the residential unit. The resident files also had assessments undertaken either by the residents’ social worker or from the hospital they were admitted from. The assessment document that the staff complete is very detailed. One of the assessment forms on Victoria however, was not completed fully, although it did still give enough information to allow the staff to make the decision that her needs could be met. The section on the residents’ social interests and religious needs was also not filled in on two of the assessments on Victoria and on one assessment on Dove. Millview Nursing Home DS0000005689.V301733.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of residents were in the main being addressed appropriately. However some issues were identified in respect of record keeping and resident’s medication in some of the units at the home. EVIDENCE: Rutland, Martin and Atlas units 9 residents care records were inspected – 3 from each unit. All contained detailed information to say how a resident was to be cared for. Care records were organised in a standard format. All contained detailed pre and post admission assessments that clearly identified the care needs of residents. All areas of the resident’s life are considered in such assessments including their physical, mental and social needs. All care records contained a life and social history of the resident. This enables staff to relate the care and support they provide to an individual resident who is a unique person and not just ‘one of many’. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 11 Care plans clearly identified how resident’s assessed needs (including their religious and cultural needs) were to be met by identifying exactly what actions and support needs to be provided to care for these residents properly. Care plans were formally reviewed at least monthly. It is also noted that where specialist nurses have been consulted – for example tissue viability nurses in relation to wound care – their contributions are entered directly into the care plan by the that specialist. Particular areas of risk are formally ‘risk assessed’ on a regular basis to protect resident’s health and safety. Examples of such risk assessments included those completed in relation to preventing pressure sores, mobility and moving and handling and nutrition (including regular weight monitoring). Where a specific risk was identified, an appropriate and detailed care plan was developed to address and minimise that risk. All residents are registered with a local GP and it was evident that all were enabled to access opticians, chiropodists, district nurses and other specialist services that individual resident’s require (such as community psychiatric nurses and psychiatrists). Relatives spoken to (and in pre inspection questionnaire responses) indicated they were kept informed of all significant changes in their relation’s health. District nurses who visit Atlas and Albion units address the nursing needs of residents on Atlas unit. The management of residents’ medicines (including controlled medicines) was inspected on Martin, Rutland and Atlas units. The procedures for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were appropriate and safe. The medicines on the three units were kept securely stored in a locked room and the medicine trolley was secured to the wall when not in use. However the controlled drug cabinet on Martin unit was found to be being used to store items other than controlled drugs – namely hearing aid batteries and items of jewellery – this practice should cease. The qualified nurses on the EMI units and the senior care staff (who have received appropriate training) on the residential units are responsible for all aspects of looking after resident’s medicines that are under their care. The 9 residents medicine records inspected (3 on each unit) had been completed properly. Discussion with relatives and staff revealed that residents were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are very kind and help with the things I can’t do for myself’, ‘all the staff are very good with my mum and tell me as soon as things change with her’, ‘I did have a few small problems when I first came in but my family went to the manager and they were soon sorted out and I am very happy her now’. Victoria unit The care records of 3 of the residents were looked at. They contained detailed information to show how a resident was to be cared for. 2 of the care plans were not however, as up to date as they should have been. It was written down that 1 resident had 3 pressure sores but it was difficult to find out what treatment was in place for the 2 pressure sores on the heels and whether they were getting better or not. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 12 The care plan of the other resident showed that this resident had 2 pressure sores and another type of wound. Although there was a good plan of care for the treatment of all the wounds it was difficult to know how well the sores were healing however, because the information in the notes was not up to date. The manager told the Inspector that she would make sure that the nurse on duty that day would get the care plan up to date. There was a good plan of care for both residents about how to further reduce pressure, such as positional changes and care whilst sat out of bed and both residents were being cared for on pressure-relieving mattresses. The staff had also requested the advice of a nurse who specialised in wound care. The medicines on Victoria unit were kept securely stored in a locked room and the medicine trolley was secured to the wall when not in use. Controlled drugs were securely stored. It was noted however that staff had placed some controlled drug patches in a box that they were not dispensed in. This meant that the drugs in the box had a different batch number to what was written on the box. In the event of any drugs having to be recalled by the manufacturer this could cause problems. The areas in need of putting right were as follows: • Handwritten instructions for medicines (Transcriptions) were not always checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. • The date of opening was not written on 2 bottles of eye drops. It is important to do this, as they have to be disposed of 4 weeks after opening. • The temperature of the drugs fridge was not being checked on at least a daily basis. • Staff were not always signing that a medicine had been given. • 2 oxygen cylinders were left free standing in the medicine room. This presents a health and safety hazard. Dove unit. The care files of 2 of the residents were looked at. They were very detailed, up to date and gave a clear picture of the residents’ needs and how they were to be cared for. Albion unit The care files of 2 of the residents were looked at. They were very detailed, up to date and gave a clear picture of the residents’ needs and how they were to be cared for. The medicines on Albion unit were kept securely stored in a locked room and the medicine trolley was secured to the wall when not in use. Controlled drugs were securely stored, safely administered and accurately recorded. The areas in need of putting right were as follows: • Staff were not always recording the amount of medicines received into the home. This happened mainly when residents were being admitted from hospital. It is important to do this in case an accurate record of Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 13 medicines received or given, is required either by the residents GP or a pharmacist. • One resident was prescribed a painkiller. This painkiller was to be given 1 or 2,4 times a day. A handwritten note attached to the medication administration record sheet (MAR) gave the Inspector cause for concern. It stated (for various reasons) that the resident was only to be given the medicine if it was required. The care staff must not change a residents’ prescription. Any concerns must be referred to the residents GP. • Handwritten instructions for medicines (Transcriptions) were not always checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. • One handwritten prescription was not in accordance with what had been prescribed for the resident. • The date of opening was not written on 2 bottles of eye drops. It is important to do this, as they have to be disposed of 4 weeks after opening. The relatives of 1 resident had requested that she had eye drops (that could be bought “over-the-counter”) put in on a regular basis. The handwritten instruction only named the eye drops. There was no instruction about how often these were to be given although they were being given three times a day. There were no instructions on the eye drops bottle. • There were excessive stocks of paracetamol tablets in place. These had been prescribed for the residents but the majority of these residents had several boxes each. From checking the residents’ MAR sheets it was obvious that they did not need such a large amount of paracetamol. The inspector was told that none of the residents were able to take responsibility for managing their own medicines. All staff, responsible for giving out medication, had received the proper medication training. The daily reports on all the units were very detailed and gave a clear picture of how the residents had been throughout the day and night. The staff on each unit looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. The care plan for 1 of the residents on Victoria however did not have an up to date risk assessment for pressure sores and another did not have a nutritional risk or pressure sore risk assessment in place. The manager was made aware of this and said that they would be put in place that day. Staff also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. They also looked at and they wrote down, how any resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. From the care plans inspected it was evident that the residents were weighed at least on a monthly basis and any weight loss identified and acted upon. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 14 Equipment necessary for the prevention and treatment of pressure sores was readily available within the home. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use services are able to enjoy a stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. EVIDENCE: All units 3 activity co-ordinators are employed at the home providing a service to all the 6 units at the home. The home continues to provide a wide programme of social and leisure activities. Residents from all the home’s units are enabled to become involved in the varied group and individual activities provided. A record of the activities participated in is maintained for each resident. A programme of activities and events was prominently displayed in the home – this enables residents to be aware what is available and to choose what activities they wish to participate in. The programme of activities includes entertainers coming to the home and Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 16 a variety of outings that provide opportunities for residents to enjoy life and leisure in the wider community. Comments made in respect of social/leisure activities included ‘I always look forward to the outings and I particularly like it when we go for a pub meal,’ ‘you can just join in what you want to there is no pressure’, ‘my mum likes to do the craft type things and also enjoys the themed events like at Easter and Christmas’. The social and leisure programme covers the whole week and not just weekdays. Residents and their relatives said that there were no unreasonable restrictions to visiting at the home. Residents can receive their visitors in the privacy of their own room or in the communal lounge areas provided. Relatives said they were made welcome when they visited and that they were kept informed of changes or developments in the condition of their relative. They also said senior staff on each unit and the home manager are always accessible if they felt it necessary to discuss issues with them. Residents spoke very positively in respect of the food provided for them by the home. Menus are balanced and provide a varied diet, choice and are changed seasonally. Resident’s meals are prepared on site and these arrangements are regularly audited by the organisation that own the home. Lunch was observed on one unit during the inspection. At this meal residents were served and assisted appropriately and the food provided was well presented and sufficient in quantity. Residents throughout the home commented positively about the food provided. Comments included – ‘the meals are very good and you get plenty’, ‘you can always ask for something different if you don’t like a particular choice on the menu’, ‘I need some help with taking my food but the staff always help me’, “the food is in the main very good but not as good as at home!” The menu and catering in general are noted to be regularly on the agenda at the regular residents/relatives meetings held by the home manager. Issues are discussed and solutions/suggestions explored. Millview Nursing Home DS0000005689.V301733.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate complaint procedures and protection systems in place. EVIDENCE: All units The complaints procedure was prominently displayed in the home. This document explains in clear terms how to make a complaint and who to contact. Residents and relatives spoken to say they were aware of how to make a complaint if they felt it were necessary. Those spoken to who have had cause to make a complaint felt their issues were listened to, examined properly and responded to in a reasonable time. However in the main many issues are resolved swiftly and informally without going through the complaints process. The registered manager keeps a record of all complaints made, how they have been investigated, the outcome of the investigation and the response provided to the person who has complained. The record of complaints included those complaints initially made to the CSCI and subsequently referred to the home manager for investigation. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 18 Millview operates protection of vulnerable adults and whistle blowing policies that seek to protect elderly people. In addition, a copy of Bolton’s Inter agency protection procedure complements the home’s policies. Staff spoken to confirmed that they had received adult protection training (this was reflected in training records maintained by the home) and were aware of the whistleblowing policy. Appropriate pre-employment checks are conducted on all staff to ensure suitable people look after the resident’s. Millview Nursing Home DS0000005689.V301733.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home appeared to be structurally well maintained throughout and provides a suitable and comfortable environment for the care of residents. EVIDENCE: The home operates a planned programme of redecoration and refurbishment and the home environment is audited regularly by the organisation that own the home. The environment of Rutland, Martin and Atlas units were inspected on this occasion. Rutland unit New corridor carpets and new floor coverings to all residents’ bedrooms have been provided since the last inspection. The home manager informed the Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 20 inspector that a programme of refurbishment of the communal lounge/dining area was proposed for Rutland unit in the near future. This will significantly improve the environment for residents and their comfort generally. 3 residents bedrooms were inspected. These were clean, warm and adequately furnished. Whilst Rutland unit was very clean on the day of this unannounced inspection there was a strong malodour in the corridor areas furthest away from the main entrance to the unit. The arrangements to manage such malodours need to be reviewed – this was discussed with the home manager on the day of inspection. Martin unit The environment on Martin unit was clean and warm and odours were being managed quite well. 3 residents bedrooms were inspected. These were clean, warm and adequately furnished. The communal lounge/dining areas provide suitable and comfortable living space for residents. Atlas unit This unit was clean, warm and free of malodour. 3 residents bedrooms were inspected. These were clean, warm and adequately furnished. The communal lounge/dining areas provide suitable and comfortable living space for residents. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment, provision and training of staff employed at the home are being managed appropriately. This is important to ensure that residents are being cared for adequately and appropriately by staff who are able to deliver this support safely and competently. EVIDENCE: All units Examination of the duty rotas and a discussion with staff, relatives and residents showed that there was enough staff on duty to meet the residents’ needs. Inspection of 3 staff personnel files revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training and further training. NVQ training in health and social care is being provided for staff. Also a wide range of appropriate and ongoing training in moving and handling, abuse, basic food hygiene, fire safety and other relevant topics Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 22 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): 31,33,35 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is being managed very effectively in a way that seeks to protect and support residents appropriately. EVIDENCE: The registered manager is a qualified nurse who has many years management experience in caring for the elderly and also holds an NVQ level 4 qualification in management. The senior managers of the organisation who own and run Millview support the registered manager in her role. Within the home 2 clinical service managers and other senior staff support the registered manager. The registered manager operates the management and budgetary systems for the running of the home that have been developed by the organisation registered to operate Millview. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 23 The senior managers of the organisation regularly audit these systems. Discussions with residents, relatives, staff and responses in pre-inspection comment cards received form health care professionals and others who regularly have contact with the home were very positive in respect of how the home is managed. Comments indicated that the manager and her team are very accessible, approachable and respond to issues in a reasonable time. Residents and relatives are invited to regular meetings where they are able to discuss and express a view about any issues relating to the home. Staff meetings are also held regularly and those staff spoken to felt that they were comfortable enough to express their views about the home. The quality of the services provided and the way the home operates is measured by the home’s quality assurance system. The organisations head office regularly canvasses the views of residents, relatives and others. The responses are then analysed and the results given to the home manager. The home manager then has to develop ways to improve on any issues that had been identified. The manager and her team also conduct regular audits and risk assessments within the home – for example in respect of medication, care records, accidents and catering. This is to ensure that quality in these (and other areas) are maintained and improved. Robust and regularly audited systems to manage resident’s monies and items for safekeeping were in place. There is a sound system in operation to ensure that equipment (such as lifting equipment) and utility services (such as gas water and electrical systems) are serviced/inspected on a regular basis and records are maintained appropriately in respect of these. Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 x 3 X X 3 Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2) (b) Requirement The CSCI must be informed that Care plans have been updated so that they give a clear picture of the residents’ condition and needs at any one time. The CSCI must be informed that to make sure that the residents’ health and safety are always protected any risks to the health and safety of the residents are being identified, documented, and kept up to date. The CSCI must be informed that Staff are not changing prescriptions. They must refer the issue back to the prescribing GP. The CSCI must be informed that Staff record medications that have been given to residents. To make sure that the batch numbers on the container match the medication, medicines must be kept in the container they were dispensed in. That the CSCI is provided with a detailed progress report in respect of the refurbishment of Rutland unit DS0000005689.V301733.R01.S.doc Timescale for action 30/06/07 2 OP8 13(4)c 30/06/07 3 OP9 13(2) 30/06/07 4 5 OP9 OP9 13(2) 13(2) 30/06/07 30/06/07 6 OP19 23 30/06/07 Millview Nursing Home Version 5.2 Page 26 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 4 5 6 7 8 Refer to Standard OP8 OP9 OP9 OP9 OP9 OP9 OP9 OP26 Good Practice Recommendations Staff should make sure that assessment documentation is completed fully. To ensure the accuracy of a handwritten transcription they should be checked with another member of staff, signed and countersigned. To allow an audit trail of medicines, staff should document the amount of medicines received into the home. The date of opening should be written on eye drop containers. This is because they have to be disposed of 4 weeks after opening. Excessive stocks of medications should be returned to the agency responsible for their disposal. That designated Controlled drug cabinets are not used to store other items. To ensure that drugs are stored at the correct temperature the temperature of the drugs fridge should be checked and then recorded, at least on a daily basis. To minimise offensive odours in the home the arrangements to prevent/minimise such malodours should be reviewed Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. Extracts may not be used or reproduced without the express permission of CSCI Millview Nursing Home DS0000005689.V301733.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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