Inspection on 25/01/06 for Milton Grange

This inspection was carried out on 25th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 13/02/08

Milton Grange 11/01/07

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 Judy Gossedge Unannounced Inspection 25th January 2006 10:00 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.V257886.R01.S.doc Version 5.0 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.V257886.R01.S.doc Version 5.0 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 East Sussex County Council Mrs Amanda Harris Care Home 10 Category(ies) of Dementia - over 65 years of age (10) registration, with number of places Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be acommodated is ten (10). That service users are sixty-five (65) years and over on admission. That service users admitted have a dementia type illness. Date of last inspection 3rd August 2005 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 ten 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 ten 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 a garden at the rear of the home. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and three quarter hours on 25 January 2006. This is the second statutory inspection for the year and should be read in conjunction with the first inspection carried out on 3 August 2005 to give an overview of all the standards to be assessed within this period. A tour of the home took place including communal areas and service users bedrooms. Rotas and care records were also inspected. There were eight service users resident and three were spoken with on the unit. Due to communication difficulties it was not possible to speak to all service users individually, and so the opportunity was also taken to observe the interaction between staff and service users in the communal areas. The Manager, three care workers, a member of the housekeeping team, and an assessor with the mental health team were spoken with. Service user and relatives/representatives comment cards were also left if people wanted to comment after the last inspection and two have been received in the interim period, one from a service user completed by their carer and another from a relative. The CSCI has previously sent separate correspondence to the Responsible Individual for ESCC to raise concerns at the recruitment processes and lack of evidence of recruitment documentation in place on site for all its registered services. ESCC stated that all the required documentation would be in place by 1 January 2006. The CSCI have also met with representatives of the organisation to discuss outstanding issues such as fire training and the collation of quality assurance information collected. Proposals have been put forward to address these issues. What the service does well: There is an established staff team working on the unit who were observed to deliver care to ensure dignity and respect. There is a detailed complaints procedure in place, The standard of the environment is good providing a safe, well-maintained environment. All the bedrooms have been redecorated and the large lounge ensuring that the communal areas are very pleasant areas to sit in. Service users are able to participate in regular and varied social activities during their stay on the unit. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 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 Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3 and 6. Although detailed information about Milton Court is available to be viewed prior to any admission to the unit, because of the type of service provided service users have limited choice of placement. Service users are protected by the completion of a written contract/terms and conditions. There are pre-admission procedures in place, which need to be followed to ensure that service users care needs can be met at Milton Court. EVIDENCE: A Statement of Purpose is in place. A copy of the Service Users Guide is kept for reference in each service users bedroom. Copies of the minutes from previous residents meetings are also included in the pack. It was recommended that the information be put into some order to make it more accessible and readable. A copy of the Statement of Purpose and the last Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 9 inspection report needs to be more accessible to service users and their carers to reference on the unit. ESCC has a written contract to be used and a number of signed contracts were viewed. The bedroom to be occupied was not recorded and should be. All service users are assessed by staff from one of ESCC’s Adult Services Department’s assessment teams and have an assessment completed. Staff spoken with and documentation viewed for four service users did not evidence a copy of this information for reference prior to an admission had been received in all cases. Intermediate or rehabilitative care is not provided. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. Staff are provided with the detailed information they need to ensure that service users’ health, personal and social care needs are met whilst resident on the unit. There are detailed policies and procedures in place to manage medicine, which are followed to ensure the protection of service users. EVIDENCE: A sample of the individual care plans were viewed. These demonstrated they continue to be developed to be more detailed describing service users’ care needs with supporting risk assessments. Medication policies and procedures are in place and being reviewed. Staff have received external medication training, and also confirmed they are in the process of receiving further medication training arranged by the organisation to meet the requirements of the standard. Staff were observed administrating medication after lunch. The storage and a sample of the recording of the administration of medication were also viewed, and were adequate. Staff Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 11 confirmed that a pharmacist now regularly visits, and it was possible to evidence this. Staff were observed to deliver care with dignity and respect. The carer responding on behalf of the service user commented they were ‘happy and well cared for.’ Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. There are frequent and varied opportunities for service users to participate in activities during their stay, so that service users social care needs are fulfilled. EVIDENCE: There are opportunities for service users to participate in a variety of activities on the unit. Some service users also join in the activities at the adjoining day care unit. During the inspection service users listened to music, play darts and had the opportunity to participate in a quiz. The care and support provided was seen to enable service users were possible to exercise choice whilst at Milton Court. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. There is a clear and effective complaints procedure in place, which enables service users and their representatives to raise any concerns that they might have. There are detailed policies and procedures in place to protect service users from abuse. EVIDENCE: ESCC has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. No complaints have been received since the last inspection. The CSCI have not received any complaints in relation to the service provided at Milton Court. There are detailed policies and procedures in place in relation to vulnerable adults. Two care staff spoken with demonstrated an awareness of the policies and procedures. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26. The standard of the environment is good providing a safe, well-maintained environment. EVIDENCE: The standard of décor on the unit is good. The bedrooms and lounge have been redecorated since the last inspection. There are plans to decorate the toilet areas but the corridor areas are also showing signs of wear and tear. A maintenance programme needs to be in place in the home to evidence how the environment will be maintained. 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 have recently been attractively redecorated. The smaller lounge was seen to be used by a visiting relative and a service user to meet in private. The larger lounge has also had new furnishings making the communal areas very pleasant areas to sit. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 15 Hot water in seven of the wash hand basins and one bath used by service users were tested, and seven were close to the recommended safe temperature of 43° C. Where one was much lower this was reported to the Manager on the day. Confirmation has been provided that the Water Supply Regulations 1999 are met. There were two members of staff undertaking domestic duties on the unit one of whom was an agency member of staff. One member of staff was spoken with and demonstrated a knowledge of the policies and procedures in place in relation to infection control. The home appeared clean and was free from offensive odours. The recording of routine fire checks were seen and were adequate. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Adequate staffing levels are maintained to ensure that all the care needs, the health safety and welfare of the service users resident are met. ESCC recruitment policies and procedures need to be followed in order to protect service users. EVIDENCE: Three care staff were on duty during the morning and two during the afternoon. This was adequate to meet the care needs of the service users resident. Staff also spoke of increasing staffing when required to meet individual service users care needs. Four care staff are on duty at night, one working on the unit and three working on the adjoining health care unit. The senior care officer for the unit holds NVQ Level 3, two care staff hold the NVQ Level 2 in care with one care staff working towards this qualification. All recruitment of ESCC staff is co-ordinated by the Personnel Section at the organisations head office. Recruitment documentation for staff employed by ESCC is now held at the home and a sample was viewed and in place. But the Manager was not able to confirm that all staff have a satisfactory Criminal Records Bureau (CRB) check in place. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 17 As no new staff have been recruited since the last inspection it was not possible to evidence if induction training has been provided. But ESCC have detailed induction and foundation training in place which new staff are expected to complete. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Service users and their representatives are enabled to give their views on the home and the care provided. Training and/or updates to ensure the health, safety and welfare and safety of service users and staff need to be maintained. EVIDENCE: The Manager of Milton Court has worked for East Sussex County Council for many years, has a number of years experience as a senior manager, holds the Certificate in Management and is working towards the Registered Managers Award with the intention on completion of starting NVQ Level 4 in Care. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 19 ESCC has a quality assurance system in place, which has been implemented in the home. There are opportunities for service users and their representatives to put forward their views about the home and the care received through forums during their stay and questionnaires completed at the end of a stay in the home. This informs ESCC and staff of the quality of the service being provided. Representatives from ESCC have confirmed that feedback from the quality assurance process is currently being collated to be available in April 2005. A formal process to gain feedback from other stakeholders has been developed and implemented. Regular quality assurance visits by a representative of ESCC are completed and recorded to meet the requirement under Regulation 26. Where a small ‘float’ of money is held for some service users the financial records to support this activity were adequate. The organisation has now implemented a system to evidence that the maintenance of equipment and services has been carried out. The Manager was unable to evidence on the day staff training completed but has subsequently provided this information. Individual staff training needs have now been collated and has shown that not all care staff have received moving and handling, first aid and basic food hygiene training/updates as required. The Manager has confirmed that two dates have now been arranged for moving and handling training. Representatives from ESCC have confirmed the fire training to be in place to meet requirements and the majority of staff had recently attended fire training. Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(2) 5(1) (d) Requirement A copy of the Statement of Purpose and a copy of the last inspection report is easily accessible for service users and their representatives. A copy of the initial assessment/review is available for staff to reference. This issue is outstanding since 30.09.05. That a maintenance and redecoration plan for the unit is in place. That evidence is provided to confirm that existing staff have completed a satisfactory Criminal Records Bureau check. This issue is outstanding since 30.04.05 and 30.09.05. That advice is sought from the Fire Brigade about the storage under the stairwell and is acted upon. That a system is in place to ensure that staff receive training/updates in moving and handling, first aid and basic food hygiene to meet requirements. Timescale for action 31/03/06 2 OP3 14 (1) (b) 31/03/06 3 4 OP19 OP29 23 (2) (d) 19 (1) (b) (i) 31/03/06 31/03/06 5 OP38 23 (4) (d) 25/01/06 6 OP38 18 (1) (a) 31/03/06 Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milton Court DS0000041305.V257886.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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