CARE HOMES FOR OLDER PEOPLE
Milton Grange 9 Milton Road Charminster Bournemouth BH8 8LP Lead Inspector
Gill Kennedy Unannounced 23 August 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 Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Milton Grange Address 9 Milton Road, Charminster, Bournemouth, Dorset, BH8 8LP 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) 01202 554351 aeliseone@aol.com Mrs Marie Lyzie Ah-Kan Care Home 16 Category(ies) of 18 November 2004 registration, with number of places Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18 November 2004 Brief Description of the Service: Milton Grange is a care home providing personal care and accommodation for 16 older people – over the age of 65- with dementia or mental disorder.It is owned and managed by Mr and Mrs Ah-Kan.The home is located in Charminster, a residential area of Bournemouth, close to local amenities such as shops and the post office.The home has been open since 1989 and is a large converted house. Service users live on the ground and 1st floor. Fourteen of the 15 rooms are single with the fifteenth being a double room. Ten single bedrooms have en suite facilities and the double room also has an en suite bathroom.There is a passenger lift. The home has an attractive rear garden that is well maintained and easily accessible. The garden is visible from the lounge allowing service users to enjoy it from the inside as well. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. Mrs Marie Lyzie Ah-Kan, one of the proprietors, was available throughout the inspection, and Mr Ah-Khan was present during part of the inspection. Both were informative and answered questions as required and were helpful and co-operative. Three residents files were read during this inspection and the views of five residents and one visitor were sought. Three residents chose to be spoken to in the communal lounge and one person was seen in his/her bedroom, whilst another resident was seen in the garden in the company of a relative. A selection of resident’s rooms and the communal areas were seen during the inspection. The time taken on this inspection was 5 hours, and 7 standards were inspected and Standard 38 was partially inspected. The terms resident and service user used in this report are interchangeable. What the service does well:
Mrs Al-Kan and her husband are committed to providing a homely environment for residents and it is apparent that they are successful in this. The home was found to be clean and comfortable with a well-kept garden. It was observed that staff treated residents kindly and with respect. In discussion with three staff members it was clear they were committed to working with service users suffering with dementia. All the residents spoken to expressed satisfaction with the care provided and appeared contented. Comments included ‘No matter what you want they will get it if possible’, ‘They really look after you’, ‘I’m happy here’, ‘Quite good – do the best they can’. This person also noted that the proprietor was ‘Very caring.’ There are detailed care plans providing information that are used by staff so that they are aware of residents’ individual needs. The home welcomes visitors and one visitor calling on a relative confirmed this and said she is able to have a meal at the home if she wishes.
Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Milton Grange D55 S3963 Milton Grange V229085 230805 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 Grange D55 S3963 Milton Grange V229085 230805 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) 3 Standard 6 was not assessed as the home does not provide intermediate care. Service users are assessed prior to admission and the proprietor provides an assurance that their needs will be met. EVIDENCE: The majority of residents are funded by Social Service Departments and are assessed by care managers. On the files of two residents recently admitted, community care assessments were noted and the proprietor had signed the assessment along with the prospective resident and the family, plus the social services assessor. Where residents are privately funded Mrs Ah-Kan would complete her own assessment. In all cases Mrs Ah-Kan states that she would visit the in-coming resident either in hospital or at home and they and their family would be able to make a preliminary visit to Milton Grange. Many residents suffer with short-term memory loss and those spoken to were unable to recall their admission to the home. Milton Grange D55 S3963 Milton Grange V229085 230805 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 There is a clear, consistent care planning system in place, which provides staff with the information they need to meet service users’ needs. EVIDENCE: Three care plans were seen during this inspection. The care plans provided comprehensive information about residents’ needs and how staff were to meet those needs. All three staff spoken to confirmed that they refer to written care plans to guide them on the care to be delivered to residents. They showed a sensitive understanding of residents needs and this was confirmed in discussions with residents. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 10 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) 13 Residents are encouraged to retain contact with friends, family and the wider community. EVIDENCE: The literature provided by the home supports an ‘open door’ policy where visits to service users are concerned. A visitor confirmed that she calls in daily and is always made welcome and is able to have a meal with her relative if she wishes. She particularly enjoyed the festivities at the home last Christmas. There are regular visits from the mobile library and a catholic priest visits the home weekly and provides Holy Communion and there are also visits from clergy of other denominations. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 11 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) 18 Guidance for staff in the event of concerns about possible abuse of a vulnerable adult could be improved and all staff must be conversant with this procedure to ensure the protection of residents. EVIDENCE: There are policies in place and the home has a copy of the ‘No Secrets’ guidance published locally by Social Service Departments in line with Department of Health guidance. However, information for staff in the event of any concerns coming to light could be improved to provide a basic step-by-step guide on any action they should take. Two new staff were unaware of the policies and one person could not imagine anyone would mistreat elderly people. An experienced member of staff had a good understanding of the issues but accepted there were areas of the procedures she needed to re-familiarise herself with. Mrs Ah-Kan is making arrangements for the two new workers to undertake NVQ 2 training where adult abuse issues will be covered, and in discussion with them they confirmed they were enthusiastic about this training. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 12 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) 26 The home is clean and free from unpleasant odours. EVIDENCE: On the day of the inspection, which was unannounced, the home was found to be clean and free of any odour. This is a credit to the staff at the home given the levels of incontinence that service users experience. Mr Al-Kan explained that the home is re-carpeted every three years due to the wear and tear it receives. A new industrial washing machine has been purchased and the laundry is situated separately in the grounds of the home. Policies in respect of infection control have been developed. However, the home was advised that hygienic hand washing facilities should be provided in the staff lavatory to prevent the spread of infection. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 13 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) 29 Whilst progress has been made with recruitment procedures there are still omissions that could place residents at risk. EVIDENCE: The files of four staff members were seen during this inspection. These included two files of staff who had recently commenced employment with the home and were from overseas. As required at the last inspection the proprietors were now able to demonstrate that appropriate permission to work in the home had been obtained. All staff had been issued with contracts and copies of these were seen. Whilst there was a record of the referees for the new staff, copies of their references were not on file. CRB and ‘POVA first’ checks had not been sought, although police clearance from their countries of origin were on file this does not meet the required standard. The proprietors were directed to the CSCI website for information to providers about their responsibilities regarding CRB checks prior to staff appointments. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 14 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 The home is managed by a committed person who has a good understanding of her residents needs. EVIDENCE: Mr and Mrs Ah-Kan both originally trained as Registered Mental Nurses. Mrs Ah-Kan has overall management responsibility for the day-to day running of the home, supported by her husband who takes the lead in certain aspects of the running of the business. Mrs Ah-Kan is still on the professional nursing register, which counts as an equivalent to level 4 NVQ in care. Mrs Ah-Kan is also qualified as a D32 – 33 assessor. Since the last inspection she has successfully completed the NVQ4 in management.
Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 15 Standard 38. This standard was only partially assessed. The home was unable to demonstrate that all care staff had a current Moving and Handling Certificate nor all staff who handle food have a current Basic Food Hygiene Certificate. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 16 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x x x x x x x Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 17 YES 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 18 Regulation 13 Requirement All staff must have relevant training to ensure that they are aware of adult protection procedures and what action to take in the event of an incident being reported. It is required that staff records be kept for all staff according to the Care Homes Regulations – Regulation 19 and schedule 2. Timescales 01.09.03 and 01.01.04 and 1.4.04 and 01.11.04 and 01.04.05 not met. It is required that the records required by regulation 17 (2) schedule 4 (other records to be kept in a care home) (6) be kept. Timescale 01.04.05 not met. The home must be able to show that all care staff have a current moving and handling certificate issued by a certified trainer. All staff who enter the kitchen and handle food must have a current Basic Food Hygiene Certificate. Timescale for action 23.10.05 2. 29 19 23.10.05 3. 29 17 23.10.05 4. 38 13 23.11.05 5. 38 13 23.11.05 Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 18 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 18 26 Good Practice Recommendations A simple guide should be available for staff to lead them through the procedure required if an issue concerning the alleged abuse of a resident is reported. Hygienic hand washing facilities should be provided in the staff lavatory to minimise the risk of infection. Milton Grange D55 S3963 Milton Grange V229085 230805 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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