Key inspection report
Care homes for older people
Name: Address: Milton Ernest Hall Milton Ernest Bedford Bedfordshire MK44 1RJ The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire
Date: 0 7 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home
Name of care home: Address: Milton Ernest Hall Milton Ernest Bedford Bedfordshire MK44 1RJ 01234825305 01234826830 miltonernesthall@majesticare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ross Healthcare Ltd care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Adults (26 -64) (10) Date of last inspection Brief description of the care home Milton Ernest Hall is a converted 1850s manor house. The house, a grade 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. The property retains it original character and the safety of the people who live at the home is reviewed by the risk assessments undertaken by the staff at the home. 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 people, 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 16 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 Care Homes for Older People Page 4 of 26 0 0 Over 65 29 29 Brief description of the care home bus route to Bedford and Northampton. Fees are between 549.00 and 936.00 per week depending on the individual needs of the person and the room provided. Care Homes for Older People Page 5 of 26 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection carried out on the th of April 2009. Two inspectors carried out the inspection, the duration of the site visit was 9 inspection hours. The care of three people was looked at in detail. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service.During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with some of the people who live at the home in one of the sitting areas. Observations of care practise and communication between the people living at the home and staff was also made at the inspection.The focus of this inspection was to look at the key standards. Care Homes for Older People
Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Areas that need to improve include the following: Earlier in the year one of the people living at the home had made a complaint and this was managed by Bedfordshire Social Services. Part of the complaint was that they had not received medication when they needed it. When we audited the medication at this Care Homes for Older People
Page 8 of 26 inspection we discovered that the same person on three occasions since their complaint had not received their pain relief as prescribed.On one occasion this was due to a staff error, on the other two occasions the home had run out of stock.We also discovered that stock had run out for two other people. We left what is known as an immediate requirement. This is when we have serious concerns that the company must put right straight away for the health and safety of the people living at the home. Another person had been admitted to the home and had dressings in place for pressure ulcers. Staff had not checked that there were dressings in the home to replace these if needed. The person had been incontinent of urine, and staff had not been able to replace this so had left the person until the following day. The documentation held at the home on complaints also still needs to improve. A complaint received just before this inspection did not make clear the actual events or what was done. We spoke with the Acting Manager at the time who explained this to us, but this needs to be documented. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission information on the home is sufficient to ensure people can make an informed choice as to whether to move into the home or not. Evidence: The care files examined included pre-admission assessment. As reported at the previous inspection assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person all areas had been completed. The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. All comments from people using the service indicated that they felt they had been given enough information, before they decided to move into the home. Care Homes for Older People Page 11 of 26 Evidence: Intermediate care is not offered at the home. Care Homes for Older People Page 12 of 26 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistencies in the management of wound care and medication place people at risk of not receiving the care that they need. Evidence: Care plans were detailed and written on individual sheets for the assessed needs of each person. One person for example needed assistance in relation to the management of their diabetes. This was detailed within their plan of care. Guidance to staff showed what they should do and the support that they should offer this person concerning their daily life, accessing medical assistance and providing emotional support. Through discussion with staff they showed a good level of knowledge of the content of the care plans, demonstrating that these documents were used by the staff team to ensure consistency in the care offered. Accident forms had been completed following any accident or incident. Documents and staff demonstrated that follow up had taken place and when needed medical attention had been sought in a timely manner. Care Homes for Older People Page 13 of 26 Evidence: Medication storage in the home was noted to be satisfactory. A requirement was made at the previous inspection concerning medication systems. In February 2009 one person had been subject to a safeguarding matter that included them not receiving a dosage of their prescribed medication.On auditing the person had not received their pain relief as prescribed on three occasions since that safeguarding referral. One occasion was due to a staff error, the other two were due to there being no stock. This person on speaking with them confirmed that due to a medical condition they needed their pain relief otherwise they felt in constant pain. Another person prescribed Levothyoxine had no tablets in the box, another person had not been given aspirin dispersible on one occasion as there had been no stock. All these errors were within the current 28 day period of medication. An immediate requirement was made. A person recently admitted to the home had a sacral dressing in place. Assessment information showed that the staff at the home were aware of this. An entry in the daily record at night stated incontinent of urine. Unable to remove sacral dressing because of lack of replacement. This is unacceptable that a person who had been incontinent had to remain with a wet dressing on as staff had not ensured that a replacement was available. The company responded to our report and feel that it was the responsibility of the hospital to ensure a replacement dressing was sent with them. However this should have been checked by the staff at the home when the person arrived, so arrangements could then have been made to secure one through the appropriate methods. People through their comments said that most staff treated them with respect and maintained their privacy. There had been incidences where some staff had not, however the management at the home had acted swiftly and followed the protocols for the safeguarding of adults and staff had been suspend. People spoken with confirmed that if needed they would receive a visit from a General Practitioner or District Nurse. Records of these visits and assistance given were seen. Care Homes for Older People Page 14 of 26 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in opportunities for social activities meets peoples individual preferences and needs in this area. Evidence: Everyone spoken with at this visit confirmed that they enjoyed the food offered to them at the home. Menus showed that people were offered a meal that included protein, carbohydrates and vegetables. The chef speaks to people to gain their views on the standard of food. Everyone spoken with stated that they found the chef and the food at the home to be very good. We saw people having varying things for their breakfast, one person in the lounge area was having a boiled egg with toast whilst another person in this area was having bacon and tomatoes. As previously assessed staff had made arrangements for daily activities. The activities co coordinator was absent at this inspection however management had made arrangements for someone to cover her absence so that the activity programme would continue. Activities that had taken place included garden club, magicians, Irish dancers, St Valentine day concert and pottery classes. Literature displayed in the front reception showed that there were plans for the following events for April and May, a French and Italian day, trip to Shuttleworth and a lunchtime concert at St Pauls
Care Homes for Older People Page 15 of 26 Evidence: church in Bedford. As assessed at the previous inspection people who lived in the home, confirmed that their relatives and friends visited them. None of the people spoken with were aware of any restrictions on visiting and all confirmed that they could meet with their friends and family within the privacy of their own rooms. Daily records also contained entries by staff to indicate when people had received visitors. Information was also available so staff would know whom to contact if a person had a change in circumstance. Options available to people in maintaining control, independence and choices in their lives included, choice of meals, voting, choice of clothing, access to a complaints procedure and access to community health care support. People living at the home and records confirmed that the choices associated with peoples daily lives were available to them whilst living in this home. Care Homes for Older People Page 16 of 26 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training of staff is sufficient to ensure they have a satisfactory level of understanding of the safeguarding protocols to protect the people living at the home. Evidence: The complaints procedure policy of the home on examination showed that it was clear in its guidance to management and staff and included timescales that the complainant should be responded to if they had raised a concern. Bedfordshire Social Services through the safeguarding process had looked into a complaint in February 2009, this had been following a referral. Documents were viewed of complaints received direct to the home. The most recent complaint had not been documented in a way that was clear, it did not detail the actual concern. This was discussed with the Acting Manager at the time and the need to record accurately. As previously assessed records examined at this inspection show that staff had undertaken training in the safeguarding of vulnerable adults, certification of this was seen at this visit. Through recent safeguarding referrals made by the home, staff have demonstrated a sufficient level of knowledge on the types of abuse including physical and psychological. In addition the homes procedure in this area was examined, it reflected the local guidance. The management and staff in place at the time of this visit had demonstrated through the recent referrals an understanding of the need to refer any allegation or suspected abuse and had done so correctly. Care Homes for Older People Page 17 of 26 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of cleanliness and decor is good and provides people with a pleasant environment in which to live. Evidence: The communal areas on the ground floor were observed to be furnished in keeping with the style of the building. In addition to a large lounge/diner people could use a library. As previously reported a feature of the home was the large staircase and the wide hallways. Extensive grounds could be used by people and their visitors and provided a pleasant view from many of the windows of the home. The ground floor communal rooms were clean and tidy and free of any odours when this visit took place. All the individual rooms seen at this visit were clean and tidy. Many had been redecorated since the last inspection. Bathrooms and toilets were clean and tidy and the people had the choice of a number of mechanical aids to assist them with bathing. Care Homes for Older People Page 18 of 26 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff systems have not been effective to ensure that all staff have the needed levels of competency to keep people safe at all times. Evidence: Examination of staff files to look at recruitment practises showed this area to follow national guidance as previously assessed. It was noted that the files contained proof of identity; verification of employment history and that Criminal Records Bureau clearance had been obtained. The system that had been followed was noted to be thorough when recruiting staff. Entries had been recorded when people had been interviewed and these documents had also been kept. Job descriptions, and initial confirmation of employment letters were also maintained on the personal file. The Acting Manager had audited the files and had made attempts to seek any information that was not completed in full for previous employees. Observation of the support given by staff to people during the visit was made. Conversation flowed freely between them and it was noted that staff used different forms of address for each person, some using their Christian name whilst other es preferred to be called by their title. Training records seen, showed staff had undertaken statutory training. Further training planned included Care of dying,infection control, person centred care,
Care Homes for Older People Page 19 of 26 Evidence: effective communication and whistle blowing. Certificates of qualifications are present within staff files alongside checks to the Nursing and Midwifery Council to check the registration status of nurses. However information relating to medication incidents and not ensuring a replacement dressing was available for one person as previously reported, shows that the level of competency held by some staff is not sufficient to meet the assessed needs of some people living at the home. Care Homes for Older People Page 20 of 26 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in some management systems within the home are still needed to ensure all people receive a consistent level of care to meet their needs and keep them safe at all times. Evidence: The company since the previous inspection had committed a high level of senior management time and support to the home. The Acting Manager in post at the time of this visit was the third manager in twelve months. On speaking with people at the home the amount of changes in the day to day management had been unsettling for them, however several commented that improvements were now starting to show. However there remains a need to improve in critical areas for example medication audits need to be more thorough to ensure errors are picked up a a timely manner. As assessed previously the policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment.
Care Homes for Older People Page 21 of 26 Evidence: Approved contractors had undertaken servicing of equipment and site visit paperwork to evidence that theses had been carried out were seen. Maintenance staff carried out the regular checks relating to water temperature checks for example and recorded the temperature on charts. An inspector also undertook random water temperature checks at this visit; all were to the required level. Stocks of aprons and gloves were noted to be available for staff to use, in relation to infection control. No staff at this visit were seen to use these items inappropriately. Surveys had just been sent out by the management of the home to seek peoples views of the service. The senior manager for the company confirmed that on their return an analysis would be made and these would then be reported upon, this is detailed within the homes own policy. A minimal amount of money is kept for some people living at the home. These were checked and the balances were noted to be correct and receipts were in place for any expenditure incurred. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 9 13 Sufficient stock of all prescribed medication must be maintained. This is to ensure that people receive prescribed medication and are free from pain. 08/04/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 13 People must receive acceptable levels of wound care treatment from staff. This is to ensure that they remain free of discomfort and their wounds are able to heal or improve. 30/04/2009 2 16 22 Written records of 08/05/2009 complaints received must be accurate. This is to ensure that how a complaint has been responded to is clear and people will feel that they have been listened to. Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 3 30 18 Training, support and 30/04/2009 monitoring must be sufficient to ensure sufficient levels of competency is held by all staff. This is to ensure all the assessed needs of people are met in a consistent way. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
