Inspection on 13/02/08 for Milton Grange

This inspection was carried out on 13th February 2008.

CSCI found this care home to be providing an Good service.

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

Milton Grange 11/01/07

Milton Grange 25/01/06

Milton Grange 03/08/05

Milton Grange 08/02/05

Milton Grange 10/08/04

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

CARE HOMES FOR OLDER PEOPLE Milton Court Milton Road Eastbourne East Sussex BN21 1SL Lead Inspector Mary Cochrane Unannounced Inspection 11:30 13 February 2008 th 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 Milton Court DS0000041305.V357927.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. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Court Address Milton Road Eastbourne East Sussex BN21 1SL 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) 01323 731695 01323 532217 janice.knight@eastsussex.gov.uk www.eastsussex.gov.uk/socialcare East Sussex County Council Mrs Amanda Harris Care Home 9 Category(ies) of Dementia - over 65 years of age (9) registration, with number of places Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is nine (9). Service users must be older people aged sixty-five (65) years or over on admission. One place is available for a service user aged between fifty-five (55) and sixty-four (64) years of age. Service users with a dementia type illness only to be accommodated. Date of last inspection 11th January 2007 Brief Description of the Service: Milton Court is run by East Sussex County Council (ESCC), but is operated in partnership with the Health Authority and provides a base for a range of services and facilities for older people. Milton Court is a purpose built property on two floors; set in its own grounds located approximately half a mile from Eastbourne town centre. There is a nine bedded respite care unit and a day care service, which operates seven days a week staffed by employees of ESCC and an eighteen-bedded health unit staffed by employees from the Health Authority. Service user accommodation within the respite care unit comprises of nine single bedrooms, which all have en-suite facilities providing a toilet, wash-hand -basin and shower. Assisted bathing facilities are also available. A separate dining area and two lounges are available for the use of the service users on this unit. There is level access facilitated in the home with the provision of two passenger lifts in the building, one of which is sited within the respite care unit. There is an attractive garden at the rear of the home. Fees charged for respite and short-term care provided are in accordance with ESCC policy and procedures and at the time of the inspection the charges are £98.60 to £523.03 a week. The level of fees charged will depend on the outcome of a financial assessment. Additional charges are made for hairdressing and chiropody. A copy of the last inspection report is available to view on the unit. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This visit to the service was an unannounced “Key Inspection” which took place over one day. All the core standards were looked at during the visit. This visit forms part of the key inspection. At the time of the site visit the seconded manager was not available. The senior care officer was on duty was available the day. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. The following methods of inspection and information gathering were used: At the time of the site visit there was one-to-one discussion with people who use the service, care staff and management. Staff interactions with residents, care interventions and activities were observed. Individual support plans risk assessments were looked at and discussed. Selected policies, medication charts, training matrix and training programmes and financial arrangements were looked at. There was in depth discussion with the senior care officer during the site visit. A tour of the building was undertaken. Information received from the home since the last inspection was used in the report. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. We got good information from the AQAA. It was very detailed with clear evidence on the how the home is supporting and meeting the needs of the people who stay there for respite care. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. During this visit the Short Observational Framework for Inspection (SOFI) was used. This involved us being in a communal area and observing the lifestyles, engagement and staff interaction people were experiencing. The views and experiences of people who live at the home are included throughout this report. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 6 People coming to stay at Milton Court do not stay any longer than eight weeks. Some only stay for one or 2 weeks. What the service does well: What has improved since the last inspection? The admissions process has now been improved and developed so that staff are now provided with adequate and up-to-date information prior to any admission. This will then help ensure that each resident’s care needs can be met on the unit and prepare for any specific care needs prior to admission. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 7 The organisation has now ensured that all of the staff team have received training updates in moving and handling. A system are also in place to make sure that all staff has attended a fire drill as required to ensure they are kept aware of the procedures on the unit. 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. Milton Court DS0000041305.V357927.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 Milton Court DS0000041305.V357927.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 People who use the service experience good outcomes in this area. Prospective residents have the information they need to make an informed choice about living in the home; their needs are assessed; and they will only be admitted if the home are confident of meeting these needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service users guide (Welcome Pack) contains all the necessary information to assist residents their representatives to make an informed decision as to whether the home is suitable and able to meet their needs. The statement of purpose is displayed on a notice board in the downstairs hallway. Residents have a copy of the service users guide (Welcome Pack) in their bedrooms. This is kept up to date to reflect the present situation in the Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 10 unit. The service users guide is well presented and well written. It includes how to make a complaint. All new residents are provided with a contract. It gives clear information about fees and extra charges. Service users have an initial assessment completed by an assessor working for one of East Sussex County Councils (ESCC) Adult Social Care Departments Assessment Teams. 3 assessments were seen. All of the files viewed had a copy of an initial assessment/up-to-date review. They contained information on the different levels of need and support required to look after the person at the home. The information is looked at and carefully considered before a decision to offer a service is made. They contain the necessary information for developing care plans. The senior care officer told us that the staff from the home who have received the necessary training are now assessing some of the prospective residents in their own homes. This is usually the people who have more complex needs or who are new to the service. Milton Court DS0000041305.V357927.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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. Residents have an individual plan of care; their health care needs are met by the home supported by a multi-disciplinary health care team. The ethos of care ensures that residents throughout the home are treated equally. They are treated with respect and their dignity is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has just started to use a new format for care planning. 3 plans were looked at. The plans are person centre and are developed from the resident’s perspective. They reflect what people can do for themselves as opposed to what they can’t do. They are of a good standard easy to follow and are accessible. The plans are kept reviewed and up to date. Some staff have received training in person centred planning. If the person receives regular respite, the plan is reviewed on each occasion. The home told us that the plan Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 12 is developed with the person coming to stay. Staff said that they use the plans on a daily basis and up date them as necessary. This was observed at the time of the visit. Accurate daily records are maintained and give a good picture of the how the person spent their time during the day. Risk assessments were individualised and recognised that risk assessments should be in place to enable people to live in the way they choose and not act as a restriction. There are plans and risk assessments to identify patterns of behaviours and triggers to identify signs of deterioration. If possible residents remain under the care of their own G.P however sometimes this is not feasible in these case residents are temporarily registered with the local GP. The home makes sure that people receive any medical treatment required during their stay. Resident’s physical and mental health conditions are well monitored. The staff take prompt action when concerns are identified. Residents also have access to specialist nursing, dental, pharmaceutical services and have regular visits from a chiropodist. Visits from professionals are recorded. The service told us that a new Adult Social Care Medication policy for Residential Services is now in place and the homes medication policy has been updated to reflect his. All staff who administer medication have received training and their competency are regularly assessed. The home also receives a 6 monthly pharmaceutical audit and also carries out its own weekly audits so that any problems or shortfalls are addressed promptly. The prescription sheets were all signed and no gaps were identified. The recording and administration of controlled drugs was undertaken according to requirements. Medication policies and procedures are in place. Medication is stored safely. Some of the people staying at the home are prescribed medication (this includes topical creams) on a when required basis. It is recommended that medication prescribed ‘when required’ needs have written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. Through observation and talking to the residents and staff there was evidence to show that privacy and dignity is upheld. Observations of staff offering personal support was good. People were spoken to discreetly and with respect Staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Staff were observed demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to this aspect of care. One lady said, “Its as good as it can be here. The staff are good and patient and I have no complaints “. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 13 Another said, “They treat you well”. They will try and get whatever you ask for.” Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use the service experience good outcomes in this area. Residents are enabled to exercise choice and control over their lives. There are good opportunities to participate in social and recreational activities. There is varied, healthy diet provided which offers choices at every meal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents who stay at Milton Court are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. At the time of the visit residents were involved in reminiscence discussion and a music quiz. Most people were actively involved in these sessions and enjoyed them. Residents were animated and interacted with each other and staff in a positive and beneficial way. People who did not want to join where offered alternative things to do. One person said ‘its good to hear what other people have done we have all lived such different lives’. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 15 Another said ‘I like to talk about the old times’. Staff were readily available and were seen to be able to anticipate the individual needs of all the residents’. The home does offer and activities programme and residents can if they wish join in with the day centre activities, which take place next door to the unit. Residents are also encouraged to continue to things they did before coming to the home. The staff told us that one lady always goes to bingo every week so when she comes to stay home makes sure this activity continues. The service also makes sure that anyone who wishes to continue the religious practises can do so. Residents are encouraged to retain their independence as much as possible, and to be able to decide their lifestyle on a day-to-day basis. All residents are invited to users forum meetings, which are held every 8 weeks. The Forums give people the opportunity to express their views and make suggestions regarding their care at Milton Court and also to make any suggestions on how the service can be improved in any way. Suggestions are listened to and acted on. Residents are encouraged to maintain contact with family and friends. Residents are able to receive visitors in the privacy of their own room if they wish or they can make use of Milton Court’s quiet lounge. The staff were observed making visitors welcome and involved. There is the facility to receive telephone calls in private. The service told us if a resident expressed a wish not to see or speak to a particular person, this would be respected and recorded as their preference. A new 4-weekly menu has been introduced including a mid-week roast. The home also offers a cooked breakfast once a week. Breakfast and Tea are prepared on site. An off- site company provides lunch. Special diets are catered for and help is always on hand for those who might need assistance during mealtimes. Adult Social Care has produced new guidance for the Provision of Soft, Soft-Fork, Mashable and Pureed Diets. The service told us that if a person wishes to have breakfast in bed or to eat at a different time, this is noted on the service plan and every effort is made to meet this request. Refreshments are available throughout the day and fresh fruit is available. At the time of the visits residents were regularly offered cold and hot drinks. The fruit bowl and biscuits were offered and staff made every effort to meet the requests of the residents. A lunchtime meal was observed. The dining room is homely and comfortable. There was a friendly, relaxed and sociable atmosphere. The tables and the food were well presented. The residents were individually offered a choice of main course and puddings. Staff were available to offer discreet assistance if required. One lady said ‘ that was delicious’. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 16 A record is kept of food eaten by individuals this is so any problems can be quickly identified and the appropriate action taken. Milton Court DS0000041305.V357927.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 People who use the service experience good outcomes in this area. The people who use the service can be sure that their complaints will be dealt with. The staff have the skills and knowledge to keep residents as safe as possible. People are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A “Comments, Compliments and Complaints” information leaflet relating to the Complaints Procedure is included in the service users guide (Welcome Pack) The service has systems in place to ensure residents or their representatives can raise any concerns about the home. Residents indicated that they could speak to the staff if they had any concerns. Milton Court has received 2 complaints since the last inspection. These had clear documentation, with copies of letters sent in response to complainants, and the outcomes of complaints. All concerns and complaints are taken seriously, and dealt with appropriately. It was clear that the manager and staff use any complaints as an opportunity to learn how to do things more effectively, and action is taken to prevent similar occurrences from happening in the future. The home had also received several compliments. One said ‘My husband has been very happy here, he has had wonderful care.’ Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 18 Another said ‘I have happy memories of Milton Court’ There are also detailed policies and procedures in place in relation to the Safeguarding of Vulnerable Adults and a Whistle blowing Policy. The home has all the necessary policies and procedures in place to protect service users from abuse. The manager ensures that staff have read these during their induction training. Staff have an awareness of what constitutes the more common forms of abuse and reported that they would have no problem whistle blowing if the need arose. The majority of staff have now received training in safe guarding adults. The home manages the pocket monies of the residents. A sample of this was checked and incomings and outgoings balanced. Milton Court DS0000041305.V357927.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, 20,21,22,24 and 26. People who use the service experience good outcomes in this area. Resident’s benefit from a well-maintained, comfortable and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The unit is clean, safe and comfortable. Decor on the unit is of a good standard and furnishings are of a good quality and domestic in style. There are two lounges, a dining room and kitchen. The home has a maintenance plan and there is a maintenance man on site 3 days a week. There are 9 individual bedrooms. All bedrooms have en suite facilities and all rooms (including en suites) have an emergency call bell. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 20 Residents are only in the unit for a short period of time, but a few had added personal touches to their rooms. There is also one communal assisted bathing facility. There is a good range of specialist equipment and aids available for those who need them. All the areas of the building are heated by a central heating system and service users are able to control the temperature in their own bedroom. There is a separate dining room to seat all service users, which is attractively furnished and homely with flowers, co-ordinating tablecloths and napkins being used. There is one lounge and a further small room both of which are well redecorated and are pleasant areas to sit comfortably. The small lounge now has a good selection of books (some of which are in large print) for residents to borrow if they want to. There is a passenger lift between the ground and first floor. The service told us they have created a store for Manual Handling equipment, which means it is no longer, stored in corridors. On the day of the visit the home was clean and free from any offensive odours. Staff said that the home is always fresh and cleaned to a high standard. The housekeeping team maintains this standard. The service told us there is an improvement in staff awareness of Infection Control through training. They also said the laundry facility is sited well away from any food preparation areas and foul laundry is placed in dissolvable bags and all laundry is washed appropriately to thoroughly clean and control the risk of infection. Policies and procedures are in place in relation to the control of infection: including the safe handling and disposal of clinical waste, dealing with spillages and provision of protection clothing. Evidence of this was seen during the inspection. An NHS Infection Control Nurse also annually inspects the Laundry and main kitchen, There is an attractive garden to the rear of the building, which is accessible to residents. Milton Court DS0000041305.V357927.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): 27,28,29 and 30 People who use the service experience good outcomes in this area. For the majority of the time there adequate numbers of staff with sufficient training and experience to meet he needs of the residents. The staff have a good understanding of the service users and positive relationships have been formed. Recruitment practices are generally sound, but one area does need tightening up to ensure the service users are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a good skill mix of staff during the day on a daily basis. There are 3 Care Officers on the early shift, 2 Care Officers on the late shift each of these shifts is supported by a Senior Care Officer. The service told us they keep the rota and ratio of staff under constant review so that adjustments can be made if required to increase the numbers to meet the needs of residents at any given time. The home only has 1 care officer on duty at night. The service told us that if they have residents who are assessed as needing 2 people to assist them then extra staff are brought in to work Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 22 nights. However there are no robust policies or procedures in place to ensure the safety of residents and staff in the event of an emergency or unpredictable incidents. The senior care officer told us that they could seek assistance from staff on the in the health unit but this could not be guaranteed and it is not written down as a procedure. The commission recommends that the service develop an agreed protocol to ensure this issue is addressed. The home also employs an administration assistant to support the day-to-day running of the unit. The staff reported they have developed good relationships with the residents and they are able to anticipate and meet the individual needs of the client group. Residents responded positively to staff. It was observed that the staff are accessible and approachable. They are able to exhibit good listening and communication skills. It was evidenced that the staff on duty put the needs of the service users first. A member of staff did say ‘there is too much paper work. I would like to spend more time with the residents’. A resident said ‘The staff are very good, they give me all the help I need’. The service told us at times they have difficulty in accessing some of the training courses for staff. They are keeping a record of this as evidence and actively look for other sources for the training. Currently over 50 of the staff group are NVQ trained. 2 staff members have recently completed the Common Induction Standards. 1 staff member is trained in chair-based exercises. The home told us and evidence was seen to show all new staff receive a thorough induction into their role and responsibilities in the workplace as well as undertaking the Common Induction Standards. Records were seen of staff training. Training is well organised and is updated at the required intervals. Any gaps in mandatory training are quickly identified and the necessary training is then accessed as soon as possible. Staff are in the process of undertaking in the Mental Health Capacity Act training. 3 staff files were looked at. All recruitment of ESCC staff is co-ordinated by the Personnel Section at ESCC’s head office. Evidence of the recruitment process followed for staff is now to be held at the home, but there is some information missing from the files. 2 of the files only contained 1 written reference and 2 files did not have application forms. One CRB was without a POVA request. It was not possible to evidence the organisation’s recruitment practice had been followed. The manager needs to make sure that all these are in place including a full employment history. Any gaps in employment need to be explored at interview and evidence kept. The service told us all the missing information was kept at head office. They said they would ensure that it is put on the files kept at the home. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 23 The staff reported that they feel valued by the management and they said that they are listened to and any ideas or concerns are acted on. Milton Court DS0000041305.V357927.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People who use the service experience good outcomes in this area. The people staying at Milton Court benefit from a well run home. Quality assurance systems are in place these now to be used to improve services for the residents. Systems are in place to ensure the Health, safety and welfare of the residents. This judgement has been made using available evidence including a visit to this service. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager of the unit moved to another post within the organisation nearly 12 months ago. A seconded manager has been in her place since this time. On the day of the visit the seconded manager was not available. The service did tell us that she has worked for ESCC for sixteen years and has previously worked in administrative and bursar type roles all within Older Peoples Services. They said the manager is undertaking continual professional development by attending training courses, seminars and has recently completed an Open University Openings Course. “Understanding Management”. The seconded manager told us that she does not have an NVQ4/RMA. She would need these qualifications or be working towards them to enable her to become registered with the commission. The seconded manager is aware of this and is going to discuss the issue with senior management. The commission recommends that the ESCC makes a decision about the position of the registered manager of Milton Court to ensure there is a registered manager on site with the knowledge, skills and experience to run the home effectively and in the best interests of those who stay there. The area manager of the unit did say that this matter was going to be addressed in the near future. The service needs to inform the commission of the out come of this. At the time of the inspection the home was well managed and run in the best interests of the residents. ESCC has quality assurance systems in place. There are opportunities for the residents and carers to put forward their views about the home and the care that they receive through service users forums. There are questionnaires for residents. The home did tell us that they sent out questionnaires to other stakeholders involved with the service but the return response was very poor Feedback from the quality assurance process undertaken at Milton Court has been collated and is available to read. This details how the service is monitored and feedback from consultations with the residents. It should be ensured that this information is fully accessible for residents and their representatives to reference. Regular quality assurance visits by a representative of ESCC are completed and recorded to meet the requirement under Regulation 26 There are procedures in place to ensure the finances of the residents are safeguarded. Small amounts of money are held for some residents and the financial records to support this are accurate and adequate. Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 26 All staff group are appropriately supervised, with regular individual supervision sessions, usually every two months. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. All fire checks are done. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. Environmental risk assessments are in place. Milton Court DS0000041305.V357927.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 3 3 3 X X X 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 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Milton Court DS0000041305.V357927.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 OP29 Regulation 19 Requirement The service needs to make sure that application forms and 2 references are kept on staff files in the home. They must also ensure that POVA checks are applied for and a full employment history is obtained for each applicant Timescale for action 31/03/08 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. Refer to Standard OP9 OP27 Good Practice Recommendations Individual guidelines to be developed for residents prescribed ‘when required’ medication. The service needs to make that they have robust policies procedures in place to make sure that residents and staff are safe at night and that all the needs of the residents can be met during this time. There needs to a registered manager working in the home on a regular basis. 3. OP31 Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Milton Court DS0000041305.V357927.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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