CARE HOMES FOR OLDER PEOPLE
Milton Ernest Hall Milton Ernest Bedford Bedfordshire MK44 1RJ Lead Inspector
Sally Snelson Unannounced Inspection 14th October 2005 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton Ernest Hall DS0000017681.V249328.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 Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Milton Ernest Hall Address Milton Ernest Bedford Bedfordshire MK44 1RJ 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) 01234 825305 01234 826830 Ross Healthcare Limited Vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability over 65 years of age of places (29) Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Adults (26 -64) (10) Date of last inspection 8th June 2005 Brief Description of the Service: Milton Ernest Hall is a converted 1850’s manor house. The house, a grade 1 listed building, is in a good state of repair and retains many of its original architectural features making it an interesting property with a ‘stately’ feel. Some of the improvements that the home planned and that are required to met the Minimum Standards have not been possible because it is listed as a grade1 building, however the management team have invested time and money in ensuring that the property retains it original character and the safety of the service users is in no way compromised. The accommodation is spread over three floors linked by passenger lifts or staircases. All the communal areas are on the ground floor. Each bedroom has en-suite facilities, some with baths. The home is registered to provide nursing care for up to 29 service users, ten of who can be under 65 years of age with conditions and needs similar to the majority. Four of the rooms are registered as double rooms but are currently used for single occupancy. The property stands in approximately five acres of land with uninterrupted views of the countryside of North Bedfordshire. There is ample staff and visitor parking; the home is on a local bus route to Bedford and Northampton. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Milton Ernest Hall was unannounced and took place on 14th October 2005. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the services provided. The process considers the home’s capacity to meet regulatory requirements and minimum standards of practice. The inspection, the second of the inspection year, was conducted by Sally Snelson Lead Inspector. During the previous inspection all of the core standards were inspected and met and there were no requirements or recommendations made, therefore this inspection covered only some of the core standards. The primary method of inspection was ‘case tracking’, which involved the selection of two service users, and tracking the care they receive through review of their records, discussion with them and staff, and observation of care practices. At the end of the inspection feedback from the assessments of the standards was given to Fritha Irwin the Regional manager and Barbara Mkosi, the manager. The inspector would like to thank all the staff and service users for the help and time they gave to this inspection. What the service does well: What has improved since the last inspection?
Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 6 Over the last twelve months the lounge had been decorated to a high standard in red and gold and the conservatory had been upgraded. The patio area had also been refurbished allowing service users the opportunity to easily access this area, although the manager stated that many of the service users preferred to sit at the front of the home where they could watch visitors come and go. On the day of the inspection builders were re-pointing and repairing one of the chimneystacks to ensure the service users safety. Since the last inspection a new manager, Barbara Mkosi, has been employed. Fritha Irwin the operational manager is currently supporting her but plans to reduce the time she spends at Milton Ernest Hall soon. Ms Mkosi will be applying to complete the registration process. 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 Ernest Hall DS0000017681.V249328.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 Ernest Hall DS0000017681.V249328.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): 1,4,5,6 The Statement of Purpose ensured that service users could make an informed choice to move into Milton Ernest Hall. EVIDENCE: A Statement of Purpose and Service User Guides were made available to service users prior to admission and were also displayed in the home. One lady could not remember seeing the Statement of Purpose but stated that her family had looked around and had made the decision that Milton Ernest Hall was a suitable home for her as they had heard good reports about it. The operational manager confirmed that service users could make a visit to the home before admission. She stated that in reality a family member usually made this visit on their behalf because of the service users frailty at the time of admission. Milton Ernest did not offer intermediate care at the time of the inspection. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The home was committed to promoting the health of service users by writing detailed accurate care plans and completing appropriate risk assessments, however all service users should have an activity and an end of life plan. Service users felt valued by staff and management as they were treated with a high level of respect. EVIDENCE: Appropriate care plans that had been sensitively written were in place, however there were some omissions such as a plan outlining the type of activity a service user enjoyed and how they responded to any activities provided. Also the plans sampled, despite one of the service users being frail, did not include an end of life plan. All of the care plans had been reviewed monthly or more frequently if changes occurred. Some assessments had been carried out using ‘old’ information from a previous placement. For example, a service users nutritional and tissue viability assessments had been written using a weight that had been recorded
Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 10 while she was in hospital. This weight could be incorrect, out of date, or recorded using weighing scales that were out synch with the scales in the home. All service users had been risk assessed for administering their own medication at the time of admission. Sampling of the medication records confirmed that staff correctly signed medication into the home and administered medications appropriately. Records examined confirmed that service users had access to a variety of healthcare professionals. Service users informed the inspector that staff treated them with respect and maintained their privacy and dignity at all times. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Activities were provided for service users, however, how these were planned was not obvious. Service users had the opportunity to enjoy a varied well-balanced menu in a pleasant environment. EVIDENCE: The home had soft music playing in the background, which had a calming effect. During the inspection a group of service users were playing bingo with the activity co-ordinator. It was noted that about 2.30 pm when the activity finished the majority of the service users choose to go to their bedrooms. One of the service users stated, “I am exhausted from the bingo and need to have a rest so that I can be up for tea”. Another service user who did not wish to go to her bedroom told the inspector that this was the longest time of the day as staff were busy with service users in their rooms and there was little to do. If service users were asked about their interests on admission the activity coordinator could attempt to leave an activity for service users to complete while she was off duty. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 12 Service users had regular meetings. It was recorded that 15 of the service users attended the last meeting where a number of issues were discussed including if the homes cat should stay or go. Risk assessments confirmed that service users made the choice to use bedsides, however the inspector was concerned that a service user had signed to have her bedroom door open at night. This had the potential of risk not only to the service users but also to other service users if a fire started and should be agreed with the fire service. The chef on duty was a temporary chef who had experience of working in care homes for the elderly. The permanent chef was on maternity leave and the position had been advertised. Service users reported having the choice of fish and chips or cottage pie with fresh toms and peas, followed by apple pie and custard and/or cheese and biscuits for their lunch that day. None of the service users had any complaints about the quality or quantity of the meals provided. Milton Ernest Hall DS0000017681.V249328.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): EVIDENCE: These standards were not assessed. Milton Ernest Hall DS0000017681.V249328.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): 26 The home provides an environment that is comfortable, pleasant and safe for all service users. EVIDENCE: There had been no major alterations to the environment since the last inspection so these standards were not assessed in detail. The home was clean and had no unpleasant odours. Fresh flowers throughout the home gave the home a friendly welcoming feel. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 15 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): 27,30 The management have a commitment to training ensuring that staff have the competencies and experience to care for the service users. EVIDENCE: At the time of the inspection the home had vacancies for a qualified nurse and for a cook to provide maternity cover. These vacancies were not impinging on the care provided as the home had a bank of staff who were prepared to cover vacancies. Also the home had not been running at full capacity for some months. At the time of the inspection there were 17 service users cared for by one qualified nurse and three carers during peak times and one qualified nurse and two carers at other times. The off duty record should include the last name of the staff member as these documents can be needed at a future date when a fist name may not easily be identified. Six carers had achieved a minimum of NVQ level 2 and as additional four were in the process of gaining the qualification. The home had a three-year training programme that included mandatory and specialist training. Most recently all staff had completed bereavement training and the trained staff wound care training. On the day of the inspection the operational manager had planned to spend time with the new manager ensuring that there was no training outstanding. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 16 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): 31,33,36 Service users and staff report feeling more settled now that a manager is in post. EVIDENCE: The home had a long period following the resignation of the previous manager and the recruitment of a new manager without a manager. During this time the operational manager had taken the lead in the home and a good standard of care had been provided. However service users stated that having a manager made them feel more settled. The manager must go through the registration process with the CSCI to become the registered manager and must also obtain the necessary management qualification either through the Registered Managers Award (RMA) or an NVQ level 4 in management. The operational manager reported that staff and service users meeting took place regularly and these were documented. She also reported that relatives
Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 17 meetings are beginning to take off but there was less interest in these than expected. Supervision systems had recently been updated with staff being put into groups led by a key-worker. These groups also corresponded to the groups of service users cared for by the staff. Consideration is now being given to updating the appraisal system. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 18 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 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 4 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X X Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP12OP7O P3 OP8 OP11 OP38OP14 OP27 Good Practice Recommendations All service Users plans should include an activity plan. Information recorded for any assessment should be accurate and current. All service user plans must include information about the service users wishes for the end of life. Service users decisions must be assessed to ensure other service users are not put at risk. Staff rotas should include the surname of the staff member. Milton Ernest Hall DS0000017681.V249328.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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