CARE HOMES FOR OLDER PEOPLE
Milton Ernest Hall Milton Ernest Bedford MK44 1RJ Lead Inspector
Carol Mitchell Unannounced 8th June 2005 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 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 I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Milton Ernest Hall Address Milton Ernest Bedford MK44 1RJJ Telephone number Fax number Email 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 Ltd Position vacant Care Home with Nursing 29 Category(ies) of PD(E) Physical Disability over 65 - 29 registration, with number OP Old Age - 29 of places Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Adults (26-64) (10) Date of last inspection 10/08/05 Brief Description of the Service: Milton Ernest Hall is a converted 1850s manor house. The house, a grade 1 listed building, is in a good sate of repair and retains many of its original architectural features, making it an interesting property with a stately feel. The owners and management team have invested time and money in ensuring that the property retains its original character, and that the safety of the service users is not compromised. External decoration, and internal refurbishment were being undertaken at the time of inspection. The accommodation is spead over three floors linked by passenger lifts or staircases. All the communal areas are on the ground floor. Each of the single occupancy bedrooms has en-suite facilities, some with baths. There is a garden, and a large patio area was under construction at the time of inspection. The home is registered to provide nursing care for up to 29 service users, ten of whom can be under 65 years of age, with conditions and needs similar to the majority. The property stands in approximately five acres of land with uninterrupted views of the North Bedfordshire countryside. The home is on a local bus route to Bedford and Northampton. There is ample staff and visitor parking. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours on 08/06/05. Several residents were spoken to, three residents at length, and their records were checked in detail. The inspector looked around some parts of the building, spoke to two visitors, and the Operations Manager. Five staff were interviewed, three staff records were checked, and other staff also helped with the inspection. The inspector is very grateful to all the residents, staff, and visitors who helped with this inspection. What the service does well: What has improved since the last inspection?
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 6 People living at and visiting the home will be able to go into the garden with ease once the patio is completed. The patio was due to be finished the week following inspection and was more than half done on the day of inspection. Decoration of the lounge and dining room, and some bedrooms has taken place. New furniture has been purchased, and new carpet for the dining room was to be fitted the week following inspection. The conservatory has been rebuilt, the glass replaced, and it is now heated. A mechanical sluice has been installed since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 standard(s) 1,2, 3, 4, 5, (the home is not registered for intermediate care). Visits prior to admission are encouraged, and the care needs of residents are carefully assessed, so that prospective residents can be assured that their care needs will be met. EVIDENCE: The relatives and friends of the residents spoken to had visited the home prior to admission, and residents reported that their needs were being met with care and attention to detail. Comprehensive assessments of care needs, and statements of terms and conditions were found within residents’ files. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9,10. Organised care planning, an informed staff group, the provision of equipment, and safe systems for the administration of medicines means that the health care needs of residents are met. EVIDENCE: Detailed, and regularly reviewed care plans covered expected areas, and included risk and nutritional assessments, and social activity records. Staff were familiar with, and able to discuss the care needs of residents. Equipment needed to meet nursing needs was in use, and specialist nursing advice had been obtained. A resident was very pleased with the way she had been cared for whilst very ill. When the meeting of care needs may become compromised by a deteriorating medical condition, this is identified, and monitoring and review are undertaken, with relatives and family doctor involvement. Access to services such as chiropody and optical care is provided. Residents spoken to were not self medicating. A resident described the administration of her medicines as being very well organised. The Registered
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 10 Nurse on duty was familiar with the residents and the medication system in use, and described safe procedures for the administration of medicines. Staff knock on bedroom doors and wait prior to entry, and residents are addressed as they would wish. Staff are polite, and a resident described the manner in which she is approached as caring and not in any way condescending. Residents detailed ways in which privacy is upheld during personal hygiene procedures, and a quiet room is available, in addition to the single occupancy bedrooms, for personal discussions. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 standard(s) 12, 13,14, 15 The lifestyle expectations and preferences of people living in the home are met because encouragement and support to continue with interests and exercise choice is given, the involvement of relatives is given priority, and nutritional and enjoyable meals are provided. EVIDENCE: Visitors are made welcome at any time, and are invited to be formally involved in the running of the home through relatives’ meetings. A visitor spoken to said that she is offered refreshments on arrival and is treated very warmly. Residents meetings take place, and residents also have regular contact with the Deputy Manager, or Operations Manager. Residents said that they enjoy trips out, and there are plans to increase the frequency of these soon. Staff support residents should they wish to take Holy Communion. Religious representatives visit regularly, and one stated that she is made to feel very welcome. Residents enjoy individual and group activities organised by the home’s activities coordinator. Care is taken to ensure that activities are matched to individual residents’ interests or needs. One resident described her interests in gardening and art being well supported. Residents reported that they choose where they spend time, for example where meals are taken, and exercise choice in personal matters such as
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 12 dressing. The majority of residents choose to enjoy the attractively presented and tasty meals in the very pleasant surroundings of the dining room. Feeding aids are used to help residents keep their independence, and staff assist with feeding when needed in a gentle, not rushed way. Choice is offered within the menu which is not currently available to residents in a written format. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 standard(s) 16,18 Policies, and the knowledge and attitude of the management and staff group mean that people living in the home can be confident that they will be protected from abuse, and that they will have opportunity to raise complaints, which will be taken seriously. EVIDENCE: Residents described being very satisfied with the care they were receiving, and were pleased with all aspects of living in the home. Although a resident was not familiar with the written complaints procedure, she was able to describe what she would do if she wished to raise a concern. Residents also indicated that they usually have at least daily contact with either the Deputy Manager, or the Operations Manager, and both were described as kind, friendly, and approachable. Staff questioned were able to explain their role on receipt of a complaint, were aware of the Whistle Blowing policy, and were able to detail action they would take if they become aware of concerns regarding the practice of a staff member. When kept, residents’ monies were stored safely. The home’s new training schedule includes Protection of Vulnerable Adults training and this is to be undertaken by all staff. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 23, 24, 25, 26 A commitment to investment in a programme of sensitive refurbishment, the employment of a maintenance man, and one hundred hours of cleaning time, mean that people living at the home can be assured of a well maintained and pleasant environment. EVIDENCE: A programme of maintenance, redecoration, and refurbishment is underway with recent works including the rebuilding of the conservatory, construction of a large patio to enhance the outdoor environment and improve access to the garden, redecoration of some bedrooms, refurbishment of communal areas, and painting of the exterior aspects of the building. The refurbishment is of a high standard. One resident enthused about the very high quality of the new curtains recently hung in her bedroom. Residents were very pleased with their rooms which were spacious, with high ceilings and furnished with many personal items. A resident was very pleased that some of her favourite pictures had been hung in her room prior to her
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 15 arrival, and indicated that the maintenance man efficiently attends to necessary jobs. The home was clean and there were no unpleasant odours. The management team and staff are exploring ways of improving bathroom facilities. Residents reported that they enjoyed their baths. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 29, 30 High priority is given to thorough recruitment procedures, staff training, and staffing levels. This means that people living in the home can have confidence that they are in safe hands. EVIDENCE: Residents praised the staff in glowing terms, and were able to confirm that their needs are met with kindness and care. Staff were questioned about the care of residents and were able to talk clearly about how they look after individual residents. The care staff on duty on the morning of inspection were one Registered Nurse (regular agency), and four care assistants for 16 residents. (Also on duty were the activities coordinator, the administrator, the operations manager, the cook, maintenance man, and cleaner.) Staff questioned reported that training opportunities were available, and staff had received recent updates including manual handling and fire training. One member of staff had been employed during the last month, and was undergoing a formal and comprehensive induction programme. National Vocational Qualification training is to commence soon for those who have not yet undertaken this. Robust recruitment procedures are in place including the seeking of references, and checks with the Criminal Records Bureau, Protection of Vulnerable Adults register, and the Nursing and Midwifery Council when relevant.
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 17 A new training schedule for staff was being introduced at the time of inspection. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 38 Although there is no Registered Manager, the home is currently being run by a competent and organised management team. As long as the same level of input from the Operations Manager is continued, people living at the home can be assured that they will benefit from the management ethos, and that their best interests will be served. EVIDENCE: At the time of inspection, the Registered Manager position was vacant. Strenuous efforts to recruit a manager have been made for some time. However, although interviews have taken place, no appointment has yet been made. A Deputy Manager position is filled, and the company’s regional Operations Manager currently spends at least three days a week at the home. Residents spoke highly of both the Deputy Manager, and the Operations Manager, and the way in which the home was being managed at the time of inspection. Staff questioned said that they were very pleased with the current
Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 19 management of the home, and that staff morale was now high. Positive feedback from relatives has also been received regarding the manner in which the home is currently run. The Operations Manager also has responsibility for other homes in the company, and efforts to recruit a Manager must continue. The running of the home is done in an open way. Information is shared informally, and formally through meetings for residents, relatives, and staff. The minutes of a relatives meeting detailed an issue which was later targeted for action at a staff meeting. Public reports from the Commission are available for people in the home to read. The home holds the money for some residents, and a check was made of one such case. Individual records were maintained and the money held tallied correctly. Staff supervision records are kept, and an appraisal system is in place for which senior staff have recently received training. One staff member questioned had just received training regarding the Control of Substances Hazardous to Health (COSHH), accident records are maintained, fire alarms are checked weekly, and emergency lighting every month. On the day of inspection electrical Portable Appliance Testing was being undertaken. Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 3 x 3 Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 21 no 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 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. Refer to Standard Good Practice Recommendations Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton Ernest Hall I51 S17681 Milton Ernest V230304 080605 Stage 4.doc Version 1.30 Page 23 - 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!
