Inspection on 09/06/08 for Milton Court Care Centre

This inspection was carried out on 9th June 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 Court Care Centre 29/05/07

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Milton Court Care Centre Tunbridge Grove Kents Hill Milton Keynes Buckinghamshire MK7 6JD Lead Inspector Jane Handscombe Unannounced Inspection 9th June 2008 11:00 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 Care Centre DS0000068919.V364954.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 Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Court Care Centre Address Tunbridge Grove Kents Hill Milton Keynes Buckinghamshire MK7 6JD 01908 699555 01908 398150 enquiries@miltoncourt.co.uk 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) Restful Homes Group Ltd Vacant Care Home 148 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 148. Date of last inspection 29th May 2007 Brief Description of the Service: Milton Court Care Centre is located in a residential area close to the shops and amenities of the Kingston Centre, with central Milton Keynes just 3 miles away. The home is purpose built offering spacious accommodation for up to 148 residents in single en-suite accommodation. The main building accommodates up to 135 people over four floors in single rooms with en-suite facilities. A lift is provided. Each floor has its own communal lounges and dining rooms. There is a detached annex intended for independent living with 13 en-suite rooms, each with a kitchenette. There is a garden at the back of the home with a patio. The forecourt at the front of the building provides extensive car parking. The fees for this home range from £550.00 per week to £1000.00 per week. Additional costs apply for chiropody, hairdressing and beauty treatments, newspapers, magazines and toiletries. Milton Court Care Centre DS0000068919.V364954.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 was an unannounced key inspection, which took place over 1 day and carried out by two inspectors; Jane Handscombe and Chris Sidwell. The visit took place on the 9th June 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA, a thematic inspection undertaken by the Commission and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting professionals, relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. Comments received from those using the service and from family members include: ‘they cannot do enough for you… they are very good’ ‘I am glad I came here’ ‘they are very kind’ ‘I am happy here’ ‘I know my carer and she is often here. I prefer it when she is here but the others are also good’ ‘I am a new man’ ‘we made an excellent choice’ Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 6 The inspectors would like to thank all those who gave their time during the inspection process. What the service does well: What has improved since the last inspection? The emergency admission procedure has been reviewed to ensure residents are given sufficient information about the home before admission, or shortly after. There is now reference about this procedure in the home’s Statement of Purpose. A list of staff signatures with initials is now kept for those staff responsible for giving medication to ensure that in the event of a query the initials easily identify the member of staff involved. Opportunities for residents to take part in social and recreational activities have been provided, and the resident’s individual lifestyles have been considered in developing the programme Menu choices are kept under review to ensure people’s likes and dislikes are taken account of. The choice of menus are discussed in the recently formed resident forums to gain feedback on what service users would like and the Chef speaks regularly with users to gain such feedback and comments on the food provided. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 7 Individual foods, which are liquidised are now pleasing to the eye, they are now liquidised separately so that residents can enjoy different tastes and the meal looks appetising. 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 Care Centre DS0000068919.V364954.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 Care Centre DS0000068919.V364954.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, 3 and 5 Quality in this outcome area is good. People are provided with information about the home and undergo an assessment of needs prior to being offered a place, to ensure that their needs can be met at Milton Court Care Centre. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes service user guide and statement of purpose, provides both prospective and current users of the service with detailed information about the services that are offered at the home. Prior to being offered a place, an assessment of needs is undertaken to ensure both parties are confident that their needs can be met at Milton Court Care Centre. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 10 Files viewed during this inspection evidenced that a thorough pre admission assessment of needs is undertaken. Discussions with recently admitted residents ascertained that discussions had taken place with them and all relevant parties to ensure that all their health, personal and social care needs had been fully assessed. Visits to the home had been arranged so that they could meet with fellow users of the service, meet with staff members and gain a ‘feel’ of the home prior to making a decision as to whether the home was suitable for their needs. One family member informed us that their relative had been living at Milton Court Care Centre for some 5 months and that prior to moving in they had looked at a number of other homes, that their initial concerns were around that of the size of the home. She told us that since living here her mother has begun to put on weight and she felt that their chosen home was ‘an excellent choice’. The home deals with a number of diverse care needs and always ensures to offer a personalised service to meet the needs of their clients. There is a commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. Milton Court Care Centre DS0000068919.V364954.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): Quality in this outcome area is good Every user of the service has a care plan in which their care needs are identified and details the actions required to meet them. The residents’ health care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans were examined and this was followed up by meeting with the individual residents to confirm that their care needs were being met. On each occasion the care plans gave a good reflection of the person, their care needs and how these would be met. The plans were reviewed on a regular basis, and the daily records reflected the care given as set out in the individual care plans. Residents and/or their representatives are involved in the care planning and reviewing process. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 12 Risk assessments had been carried out and appropriate actions put in place where needed. Likewise nutritional assessments are undertaken and regular monthly weights are recorded. One service user informed us “I want to lose a bit of weight so I can still go out…..staff are helping me…the Chef has been to see me’ It was noted within this particular service users file that a dietician referral was in place with reccommendations. Likewise, an interview with the Chef informed us that the Chef is aware of this particular service users diet and has been making him/her special menus for him/her to choose from healthy options. The Chef was aware that this service user had lost 3 pounds the week prior to our visit and said “I am trying to encourage him…” Whilst it was noted that this service user is very independent and chooses to access the local community independently, we observed risk assessments in place to cover going out and the use of the bus. The home has good working relationships with healthcare professionals and evidence within care plans informs us that the service accesses them when required and records their visits appropriately within the individuals file. Whilst at the time of writing this report we have not received any completed comment cards sent out to healthcare professionals, we have received one from a care manager, who informs us that residents’ healthcare needs are always met, that service users are treated with dignity and respect and that the service always responds to their needs well. During a recent thematic inspection undertaken by the Commission, we observed poor movement and handling of a person living at the Home and a requirement was made to address this issue. During this key inspection visit we did not witness any further inappropriate moving and handling techniques taking place. We were informed that appropriate actions had taken place after the event; the carers involved were spoken to and provided with an immediate refresher by an in-house manual handling trainer coupled with a full refresher training session later that week and their competency was further observed by another manual handling trainer to ensure the health, safety and welfare of the service users. We observed staff members to be very attentive to service users’ needs, they were observed to be very gentle with the residents, were observed to sit with residents and interract with them on a one to one basis and were knowledgable about their individual needs. During our visit, it was noted that one particular user of the service was continually calling for attention all the time; the carers always responded despite the ongoing calls. They spoke to this person in a gentle manner and were seen to be sensitive to her needs telling us that ‘we know when (s)he only wants company and when (s)he needs something else, his/her voice changes’ This service user grazed his/her shin during our visit, the carers called for a nurse to attend to the graze. The nurse was seen to tactfully persuade the resident to their bedroom to dress the graze. A good dressing technique and standard of infection control was observed. The said service user calmed down after the event and appeared Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 13 happy with the interraction from the staff member in that he/she was smiling immediately afterwards whilst walking to the lounge dining area. Whilst this service user only sat for a short while to eat some lunch the carer guided him/her back and continued to encourage them to eat their lunch, after which (s)he finished most of it. As part of the inspection process we looked at the medication systems within the home. People who wish to maintain responsibility for their own medication are enabled to do so within a risk management process. Qualified nurses administer all medication; carers are not trained to administer medication. All medication was found to be stored appropriately and securely one each floor. Refrigerators used to store medications were maintained appropriately with regular recordings of temperature to ensure the medications were being stored at the appropriate temperatures. A sample of medication administration records were viewed as part of our case tracking; the medication administration records were completed and were generally signed appropriately, although on one floor the 12.00 noon and 14.00 hour medications that had been administered had not been signed for on the relevant medication administration records. Likewise on one other floor medication for one service user was signed for after finishing the medication round. We spoke to the registered nurses; one of whom said she had been called away when the doctor came to do a ward round and had not had time to go back and sign for them. The other explained that she had been distracted and signed for them after the event. A requirement has been made within this report to ensure staff observe residents taking their medication and sign for medication as they administer it. Upon speaking with the Director of Operations it was ascertained that there is a medication audit trail in place, although the results of these were not held in the home; he explained that whilst there is no manager at the home he has put a system in place in which a manager from another of their homes visits the home unannounced to undertake an audit. Arrangements were made for the audit to be faxed over whilst we were in the home which we observed – they were undertaken two weeks prior to our visit and provided evidence that no gaps on the MAR sheets were found. The unannounced visit was the second day of the medication cycle and the old charts had been removed and archived and were not seen, therefore it is not possible to say whether gaps in MAR charts is a recurring problem or a one off mistake. It is recommended that the medication audits be maintained and held within the home. Whilst auditing the medication on the second floor, it was noted that there was excessive stock of one particular controlled drug; discussion with the registered nurse informed us that the pharmacist had been informed that they had sufficient stock and requested that the pharmacist stopped supplying it. The medication administration chart was checked and it was ascertained that this particular service user needed regular doses on admission but now did not take it regularly. The home should ensure they do not carry excessive stocks of controlled drugs. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 14 Residents spoken to overall felt that the care provision was good and that the staff were kind and considerate, respecting their privacy and dignity at all times. Milton Court Care Centre DS0000068919.V364954.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): Quality in this outcome area is good. Service users have the opportuntiy to pursue their interest and take part in social and recreational activities should they wish to. People using the service are offered a wholesome and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service are supported to live as independently as possible, exercising their rights to make choices and decisions with assistance when needed. The home employs an activities co-ordinator who was not present at the home during our visit and no organised activities were observed to take place during our visit. The activities co-ordinator is an experienced NVQ care assistant who is aware of the needs of those using the service residents and creates an individual plan of activities with each resident. The Residents Forum plays an important role in the development of group activities such as visiting entertainers and has proved useful in the views of Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 16 those using the service and planning future activities which are of interest to them. Activities offered include art and craft, pottery classes, card games, a weekly gardening club and film afternoons. A local artist visits the home offering pottery, weaving and acrylic painting activities for those who require; she was in the home returning some of the pottery pieces service users had made and which she had taken away to fire. She informed us that she was generally in the home once a month. The home has introduced comedy afternoons playing classic comedy in addition to the regular film afternoons. There is also a shop within the home, which stocks essentials such as toiletries and confectionary for people to purchase when required and some of the service users choose and enjoy helping man the shop. There are regular visits from members of the clergy from the Church of England and a Catholic priest also visits to celebrate Holy Communion with those who require on a regular basis. The home also have also have regular visits from Pets as Therapy. There are two purpose built hairdressing salons within the home; two visiting hairdressers are in the home three times a week as well as a visiting beautician, all of whom provide a service for those who require. The beautician was present during our visit and one user from the dementia unit had a manicure whilst we were visiting and was brought back to the unit by the beautician. People using the service are able to access the local amenities at the nearby Kingston Centre and Milton Keynes itself within a risk management process, assistance is provided by staff members where required. One service user spoken to during this visit explained how he enjoyed visiting the local amenities and using the local ‘plus bus’. Planned trips are arranged according to people’s wishes and preferences; following a request for an outing to the theatre arrangements were made for people to go to the theatre to watch “Aladdin”. Due to the success and enjoyment of those who attended, a forthcoming return trip has been arranged to attend “The Rat Pack”. Special events during the year - such as Rememberance Day, May Day Celebrations, Valentines Day, Easter, Christmas and New Year are celebrated with a variety of external entertainers providing songs/music and reminisence. Posters are placed throughout the Home to invite all those using the service and their families to these events. We are informed that the home are continuing to further develop their activities programme and during the summer months will be incorporating more of the residents preferred outings such as “Pub Lunches” Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user themselves. Service users are able to entertain them in their own bedrooms or Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 17 in the communal areas of the home and meals can be provided for visitors who visit during mealtimes if required. The home’s bar and café area provides both users of the service and their visitors freshly baked cakes on a daily basis with a selection of hot and cold drinks. Both the service users and those visiting said that staff always make visitors feel very welcome. Service users spoken to during this visit spoke of their satisfaction with the meals provided at the home; that it was varied and tasty and they never went hungry. Discussions with the chef took place and it was ascertained that there is a four weekly menu, which can vary on occasions if local supplies are not available. Breakfast includes a cooked breakfast, cereals, toast and fruit juice. Lunchtime meals provide residents with a choice of cooked meals and there is a cooked supper or soup and sandwiches and home baked sweets and cakes for service users to choose from. Fresh fruit is made readily available to all those using the service, it is delivered to each floor in fruit bowls every day and replenished when necessary. The Chef knew the service users well and was able to describe their likes and dislikes, was aware of who was on any special diets or underweight and aware of the needs of all those using the service. He speaks with the residents and their families about their preferences, likes and dislikes and often goes onto the floor at mealtimes. Fresh good quality food is sourced from local suppliers who deliver to the home throughout each week. Special dietary requirements whether due to health, religion or cultural preferences are catered for. Mealtimes are seen as a social ocassion and service users are are encouraged to take at least one of the daily meals in the dining room with fellow users although can take them in the lounge or their own room if this is their preference. During our visit we joined service users for lunch, which was steak and mushroom pie, croquet potatoes and green beans. The portions were of good size and the meal was well presented and very tasty. We did not take a dessert although this was enjoyed by those who did. Each table, apart from those in the dementia unit, was covered with a table cloth and condiments were placed on each table on a tray. Through discussion with a staff member, we were informed that the previous manager had tried to encourage everyone to take a meal in the dining area but it ‘had not worked’, so they had gone back to serving meals in the service users’ rooms or at small tables in the lounge. On the remaining floors, the mealtime was seen as a social ocassion with service users observed to be chatting and talking to each other at their tables. The meals were served by staff from a trolley, who were observed to be calling across to each other with the meals they required which was a little distracting and could have been done in a more discreet manner. Residents were offered help in an unhurried manner where required. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 18 Satellite kitchens are on all units of the Home, which stock provisions for residents to access tea/coffee,juices and snacks at any time of day or night. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. The home has a satisfactory complaints policy and complaints are taken seriously. The home has procedures in place to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service tell us that they know how to make a complaint and are confident that any concerns that they may have would be dealt with appropriately. Likewise, a family member spoken to during our visit informed us that they knew how to make a complaint; that they had raised two concerns verbally in the last six months both of which had been dealt with immediately. People told us that the proprietor tours the home each morning and spends time talking to each of them and asking them if everything is to their satisfaction. It was noted during this visit that the proprietor was seen to be acknowledging service users and taking time to talk and enquire into their well-being. During the inspection we viewed the complaints log and found all complaints were logged appropriately with any actions taken and the resulting outcome. All staff receive training in adult protection during induction and regularly thereafter and members of staff spoken to had a clear understanding of adult Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 20 protection issues. Likewise they were aware of the homes whistleblowing policy and procedure and informed us they would not hesitate in using it reporting any concerns to the proprietor if the need should arise, although none spoken to were sure what happens after reporting such incidences. All were knowledgable upon who to report any concerns to if the concern was about the manager or proprietor and two were aware of the social services role in safeguarding issues. The staff training files showed that training had taken place and it forms part of the induction training for all staff. A recent thematic inspection undertaken by ourselves required that the homes policies and procedures around safeguarding be reviewed and updated in line with current practices. A copy of the ammended policy was viewed during this inspection which addressed the requirements made. A reccommendation was also made reccommending that the registered person find ways of informing service users of their rights and advocacy service, that the information provided must be in appropriate formats, is easily accessible and measures taken to ensure a far as reasonably possible that people who use the service understand the information. During this visit, we noted that each user of the service is provided with a service users guide, which is provided in formats suitable to the needs of those using the service detailing what they can expect from the service and the homes recognition of the following core values of care; privacy, dignity, rights, independence, choice and fulfilment. Likewise we noted a variety of Age Concern fact sheets and details of their advocacy service throughout the home, for service users and their family members to access. Since the last inspection undertaken in 2007 there have been three safeguarding incidences, which we were notified about, all of have been investigated appropriately using a multi disciplinary approach. We chose to view one of the service users files following one such incident and evidence within his/her file viewed during this inspection highlighted that that actions had been undertaken following the investigation and the homes recording and monitoring methods had been reviewed and improved to ensure the minimisation of such an incidence re-occurring. This particular service user was spoken to during this visit who informed us that he/she liked the home, was very happy with the care and feels the home staff are very helpful. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. People living at the home are provided with a safe environment which is kept to a good standard of cleanliness and well equipped to meet their needs appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors toured the premises and, overall, found that all areas of the home were cleaned to a good standard with no unpleasant odours. The residents’ private rooms were clean, homely and very individiual with their own posessions and pictures in place. Residents spoken to on the day informed the inspector that they were happy with their rooms and found them to suit their needs. All rooms are provided Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 22 with an en-suite and a call system with an accessible alarm facility, which allows residents to call staff in the case of an emergency. In addition to the en-suite provision, there are a number of bathrooms equipped with specialist equipment. Likewise, toilets are situated within close proximity to communal areas for the convenience of those using the service. All of the bedrooms were found to be extremely spacious and all were equipped with electric profiling beds. The size of the rooms allows for ample room to accommodate personal belongings along with enough room to carry out personal care with the use of a hoist etc. The corridors are wide enough to accommodate motorised scooters both inside and outside the home. The communal lounge/diners are equipped with large plasma televisions coupled with DVD players, games consoles and music systems for service users to enjoy. One user of the service was enjoying the games console during our visit. It was noted that whilst people’s personal bedrooms were decorated with pictures and personal belongings, the communal areas on the top floor of the home (the dementia unit) were decorated very sparsely with a lack of ornaments, pictures and flowers etc; The Director of Operations said that it was a deliberate decision not to have any pictures or decoration in the corridors and communal areas to help residents to personalise their rooms so that this was a clear contrast for them. That it was a purposeful decision to keep the environment clear of visual stimulus as it was felt this would promote a calm atmosphere since the residents in this unit have challenging behaviour. Therefore the decision was to keep the décor and facilities very simple and stresses that visiting healthcare professionals have noted a marked reduction in challenging behaviour. However, a recommendation has been made to seek specialist advice on the concept of having no visual stimulus or cues to ensure that the environment is decorated in line with best practice guidance for design in dementia. People using the service have access to the outside gardens; whilst the main garden area is not secure, a recent development has now provided for a secure patio area at the back of the garden. One service user explained how he had been involved in preparing and planting hanging baskets for the garden and patio area and escorted the inspector to view them. The maintenance man informed us that two users of the service like to help him in the garden. The gardens were well kept with seating arrangements in place and likewise the secure patio area contained tables and chairs for service users and their visitors’ comfort. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 23 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 adequate. Service users are cared for by competent staff who are provided with relevant training and support to undertake their roles competently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a staff rota, showing which staff members are on duty over the 24 hours, and there were sufficient people working at the home on the day of the inspection to meet the needs of the individuals. However, during our visit and speaking with staff members on one floor it was disclosed to us that it was apparent that a couple of staff are required to go into the kitchen to prepare the evening supper for all the residents, which left two staff on that floor. The Director of Operations informs us this is incorrect and leaves four staff on the floor and said that he was in the process of reviewing this and that the chef and cook would take turns in covering the evening suppers; he was not sure why this was not happening today and stated that it was possibly because staff were on holiday. It is recommended that the allocation of staff be kept under review to ensure sufficient carers are available to assist residents at all times. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 24 The homes policies and procedures around the recruitment and selection of staff are robust and serve to protect service users health and welfare. The inspectors viewed a sample of staff files, to check the recruitment procedure. It was noted that face-to-face interviews had been undertaken and generally two references were sought, although one file highlighted that whilst two had been sought, one of these was deemed unsatisfactory in detail – The Director of Operations assured us that this would be followed up accordingly. At the time of writing this report we have received confirmation that this has been followed up. Evidence of relevant POVA first and CRB Disclosures was seen on all the staff personnel files viewed and appropriate checks had been made to ensure that trained nurses PIN numbers were still in date. Whilst all of the files viewed contained a copy of their passports, none of the files contained an up to date recent photograph as is required. A requirement has been made within this report to address these shortcomings. Staff training is recorded in individual staff files and the home has a training matrix on which they record all training undertaken by the home’s staff and the due dates for refresher training. All newly appointed members of staff undergo induction training upon appointment to their posts, which involves watching a video and completing a workbook, which is assessed and marked accordingly. In-house training certificates are provided when the service is satisfied that the staff member has gained the appropriate skills and knowledge. Mandatory training was seen to be held those files viewed and these particular certificates had in fact been signed appropriately. Staff are offered ongoing training, which is updated as necessary and are encouraged to undertake the National Vocational Qualification (NVQ) in Care, which equips them to meet the assessed needs of the residents within the home and allow for personal development. Information provided to us prior to this visit informs us that of the homes 39 care staff, nine have attained their National Vocational Qualification in Care at level 2 or above and a further 18 are working towards it. During the inspection we were provided with an up to date training matrix, detailing the training that all the individual staff had undertaken and due dates for refresher training. From viewing the training matrix we note that only six out of sixty five staff have certificates for first aid with a further twelve staff awaiting their certificates following training undertaken the week prior to this inspection. It is recommended that the provider complete an appropriate risk assessment to decide their service’s first aid needs. Seven of the care staff have not yet received moving and handling training. The provider is aware that there are some gaps in the training programme and plans to deal with this. Staff are provided with regular supervision and support and regular staff meetings are held within the home all of which are minuted. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 25 Observations of the interactions between staff and residents indicated that staff clearly understood the individual needs of those using the service and showed skill in communicating with them effectively. Staff were observed to be spending one-to-one time with individuals as well as interacting with them in groups. Staff spoken to, during this visit, demonstrated an awareness of the individual needs of those using the service and were able to interpret non-verbal signals appropriately. Staff spoken with demonstrated a good understanding of their roles and described a supportive environment and a good sense of teamwork. The care staff team are valued by the people living at the home. Individuals and visitors spoken to on the day of the inspection visit made several positive comments about them. Staff were described as ‘very good staff, you couldn’t find better’, ‘they cannot do enough for you’, ‘they are very good’. ‘ I am glad I came here’ Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. The home is without a manager although interim management arrangements have been put in place with clear lines of accountability. The ‘pooling’ of service users’ monies does not meet with the regulations. Appropriate health and safety practices are carried out thereby ensuring that the environment is safe for people using the service and for those who work at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Owing to the recent passing of the registered manager, we are informed that the provider is using a recruitment agency to seek a new manager and interim management arrangements are in place in the meantime; the Director of Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 27 Operations is at the home on a daily basis and is supported by a manager from another care home in the group who is attending twice weekly. A newly appointed regional manager will be starting in 2 weeks whose remit will be to assist with the management of the home until the managers position has been filled. Residents and members of staff reported that the home is run in an open, positive, inclusive way and they would have no worries approaching the proprietor if they had any concerns and were confident that they would be listened to and dealt with appropriately. The home deals with a number of diverse care needs and always ensures to offer a personalised service to meet the needs of their clients. There is a commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. There are health and safety policies and procedures in place, however not all staff have yet had COSSH training. The inspector discussed health and safety issues with the maintenance man who is responsible for safety checks and saw maintenance records relating to maintaining a safe environment for residents and was satisfied that the home has good procedures in place. Regular fire drills are undertaken for all staff and their fire training was seen to be up to date. An environmental health visit was undertaken recently rating the home as 4 star, very good standard. Other records required by regulation were found to be in good order and accessible to staff. The kitchen was found to be clean and orderly and the necessary checks required by environmental health are in place. Confidential information was observed to be stored securely and in accordance with the Data Protection Act. Part of the inspection process included us looking into the procedures around the management of service users own personal monies. The administrator of the home discussed the procedures in place to safeguard service users monies. People’s personal monies were seen to be stored securely, accessible only to authorised persons. The details of service users monies were recorded on a spreadsheet detailing all incoming and outgoing payments with a running total of the balance of monies remaining; receipts of individuals’ purchases and deposits of cash are kept, although no receipt is given for cheque deposits and a reconciliation is undertaken every month. One services users personal allowance was checked and found to be accurate. However, service users monies is ‘pooled’; the practice of ‘pooling’ service users’ monies does not meet with the regulations. It was noted that service users’ monies are not held in a separate account to that of the organisations; Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 28 rather it is ‘pooled’ into the company bank account. The Care Homes Regulations 2001 clearly states that ‘the registered person shall not pay money belonging to any service user into a bank account unless a) the account is in the name of the service user, or any of the service users, to which the money belongs; and b) the account is not used by the registered person in connection with the carrying on or management of the care home’. A requirement has been made within this report to address this issue. The home has a quality audit process in place although this needs to be picked up again following the loss of the manager. Medication, care plans and home environmental audits were undertaken on 27/05/08 and action plans have been devised following the audits. Reports of monthly monitoring visits by the provider were not available at the home as required; the Director of Operations informed us that these were not being undertaken and told us that he had been given dispensation in another area not to do them as he was in the home so often. We advised that they should be undertaken, as is required under the Care Homes Regulations 2001 and to keep records of these visits in the home and available for inspection. For which a requirement has been made within this report. Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 29 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 X 3 X 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 2 3 X 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 2 X X 3 Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) • Requirement Ensure staff observe residents taking their medication and sign for medication as they administer it. Excessive stocks of controlled drugs must not be held in the home. Timescale for action 07/07/08 • 2 OP29 19 Schedule 2 3 4 OP33 OP35 26 20 (1) (a) (b) The registered person must 07/07/08 ensure to not employ persons to work at the care home until appropriate copies have been obtained of each of the documents listed under Schedule 2 of the care home regulations. Monthly monitoring visits must 15/08/08 be undertaken and records of these visits be held in the home. The registered person must not 31/07/08 pay money belonging to any service user into a bank account unless a) the account is in the name of the service user, or any of the service users, to which the money belongs; and b) the account is not used by the registered person in connection DS0000068919.V364954.R01.S.doc Version 5.2 Page 31 Milton Court Care Centre with the carrying on or management of the care home 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 OP22 Good Practice Recommendations It is recommended that the medication audits continue to be maintained and held within the home. It is recommended that the provider seeks specialist advice on the concept of having no visual stimulus or cues to ensure that the environment is decorated in line with best practice guidance for design in dementia The allocation of staff should be kept under review to ensure sufficient carers are available to assist residents, with particular attention given to busy times of the day such as mealtimes. It is recommended that the provider complete an appropriate risk assessment to decide their service’s first aid needs. 3 OP27 4 OP30 Milton Court Care Centre DS0000068919.V364954.R01.S.doc Version 5.2 Page 32 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. 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