CARE HOMES FOR OLDER PEOPLE
Milton Grange 9 Milton Road Charminster Bournemouth Dorset BH8 8LP Lead Inspector
Sally Wernick Unannounced Inspection 10:40 7 December 2005
th 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 DS0000003963.V270540.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. DS0000003963.V270540.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Milton Grange Address 9 Milton Road Charminster Bournemouth Dorset BH8 8LP 01202 554351 NO FAX aeliseone@aol.com 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) Mrs Marie Lyzie Ah-Kan Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (16) DS0000003963.V270540.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd August 2005 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. DS0000003963.V270540.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 10:40 am on Wednesday, 7th December 2005. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. Mr and Mrs Ah-Kan registered providers assisted in the inspection, as did senior care staff. Methodology used included a tour of the premises, review of records and discussions with service users and their families. The inspector also reviewed the contact sheet for Milton Grange and Sec 37 reports submitted since the last inspection. Not all of the minimum standards were assessed on this occasion. Please note where a national minimum standard was not assessed the score is shown as X. What the service does well:
Milton Grange provides a service for older people with dementia and long term mental disorders in a well decorated and comfortably furnished house. The home has an informal and relaxed atmosphere where friends and relatives are welcomed and where there is a range of activities to suit resident’s needs. The registered provider and her staff provide very good levels of care based on individual health needs. There are good working relationships with community health care providers and a small stable staff team treat the residents with courtesy and kindness. Meals are varied, nutritional and well-balanced and time is spent with residents who maybe reluctant to eat. Individual preferences are taken into account and meals are planned around the likes and dislikes of service users. Staff, receive regular training and the manager is committed to good practice. Proper procedures are in place to protect residents and their financial interests are safeguarded. Milton Grange is very well maintained and health and safety policies demonstrate the homes commitment to keeping residents and staff safe. The home is clean and inviting and the many visitors that residents receive during the day contribute to the warm homely environment. DS0000003963.V270540.R01.S.doc Version 5.0 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. DS0000003963.V270540.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 DS0000003963.V270540.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): Not assessed on this occasion. EVIDENCE: DS0000003963.V270540.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): 8,9,10. The health needs of residents are well met with evidence of good support from a range of community health professionals. Prescribed medicines are safely stored and properly administered to residents by staff. Residents are treated with respect and their privacy and dignity are promoted at all times. EVIDENCE: Discussion with residents and their families, examination of care plans and direct observation during the inspection demonstrated that a good level of care is provided. All of the care plans seen were clearly set out, detailing the health and personal care needs of each resident and how these were to be met. Care plans are reviewed and reflect the changing needs of residents. They are detailed and give a good picture of the care provided, including visits by community health professionals. Records demonstrated that they residents have access to G.P’s , district nurses, chiropodists etc and attend for hospital appointments as necessary.
DS0000003963.V270540.R01.S.doc Version 5.0 Page 10 Appropriate referrals have been made to the falls clinic and all residents have individual moving and handling assessments. Risk assessments are also in place for residents and plans developed to minimise any risks identified. Accidents are recorded and included when updating care plans. Daily notes support and evidence the delivery of care to residents. These notes give a good picture of the daily lives of residents, and of the care that is provided to them by staff at the home as well as by visiting community health professionals. Since the last inspection the medication system has improved and records are properly maintained. The home has a system for monitoring records and medicine audit trails ensure that these are accurate and complete. Residents are treated with respect and their dignity preserved by staff at the home. The inspector observed how much care was taken and how staff and management strive to meet individual needs of residents. Despite the demands on staff time resident’s individual wishes were respected and their needs prioritised. It was apparent that very real care is taken. DS0000003963.V270540.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. The home offers a varied programme of activities, thus providing a stimulating environment for service users. Residents are assisted to exercise choice and control over their lives. Meals are appetising and of good quality and quantity. EVIDENCE: Milton grange is very much the home of the residents and is run in a manner that supports them to live their lives making the choices they can. On the day of the inspection a representative from extend was engaging residents in individual games and a group quiz. Activities are generally informal and in response to what residents want to do on that day. Both the registered manager and her staff have attended training, which has provided them with specific knowledge and game skills. Residents are stimulated mentally and encouraged to move around if they are able. A steady stream of visitors and friends throughout the day ensures good interaction socially and demonstrates very strong links with the local community. In addition to Extend both a local curate and orthodox priest attended at Milton Grange during the inspection as well as many family members. The atmosphere was warm, informal and relaxed whilst providing a stimulating environment for residents.
DS0000003963.V270540.R01.S.doc Version 5.0 Page 12 Regular parties are arranged and outside artistes/singers attend. A carol service and Christmas party is one of the events arranged for December. Records evidenced that one resident, was supported by an advocate from an external agency and financial and individual autonomy was promoted and respected for all. There is very good communication with relatives and service users are able to personalise their rooms. Menus at the home are based around the known likes and dislikes of residents and on providing a good wholesome diet. On the day of the inspection individual omelettes were being prepared with a good choice of vegetables. Food was plentiful, attractive and was enjoyed by the majority of residents. Individual tastes were readily catered for and for those who needed assistance this was given in a kindly manner. Meals are relaxed and unhurried. Staff working in the kitchen has appropriate food hygiene certification. DS0000003963.V270540.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): 16,18. A complaints procedure is in place. Relatives were confident that their concerns are listened to and acted on. The home does have a policy in place for protecting residents from harm and abuse. EVIDENCE: Milton Grange has a formal complaints procedure in place, and relatives spoken to felt that their complaints would be listened to and acted on by the registered manager. No complaints have been received by the home since the last inspection or by the Commission. In line with a requirement and recommendation made at the last inspection evidence was seen that all staff are now aware of the adult protection procedures in place at Milton Grange and are aware of the procedures that must be followed where there are allegations of abuse. DS0000003963.V270540.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): 19. The premises are maintained in a safe and clean condition, providing a pleasant environment for residents. EVIDENCE: Milton Grange is very well maintained with good access to communal areas. It is light airy and warm, well furnished and the atmosphere is homely. The building complies with local fire service requirements and there is an ongoing programme of maintenance, which is reflected in the home’s good standards. DS0000003963.V270540.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): 27,28,29,30. Sufficient care staff are employed and deployed to ensure that the care needs of residents can be met The target of 50 staff with NVQ level 2 qualifications by 2005 remains ongoing. Whilst progress has been made with recruitment procedures there are still omissions that could place residents at risk. The staff, training programme in place ensures that staff are trained and competent to do their jobs. EVIDENCE: The numbers and skill mix of staff at Milton Grange are sufficient to meet the present care needs of residents. There is always a senior carer on duty and new staff receive a detailed training and induction pack. Many of the staff at Milton Grange have come from abroad and although hold qualifications in their countries of origin are not yet qualified at NVQ level 2. More than half of the staff group are currently studying for this qualification, which should be completed by 2006. The registered manager and all of the staff team are currently undertaking distance learning modules in a range of health and Safety subjects including moving and handling, infection control and food safety. There is always a
DS0000003963.V270540.R01.S.doc Version 5.0 Page 16 member of staff who is qualified in First Aid on duty and staff development forms an inherent part of the philosophy. Each staff member has an individual manual, which charts progress and areas of learning, which is reviewed at the end of the working day. During their six-week induction programme senior members of the staff team monitor new staff closely. Recruitment procedures have improved at Milton Grange and CRB checks are in place for all members of staff. However, two written references must be obtained and verified for new employees from their country of origin at the time of the inspection this was not in place for all members of staff. Records are kept of training that staff, undertake and these demonstrate that staff have access to a good range of basic training. Records must also show however, that mandatory training has been completed and updated and that staff, have individual training plans. Induction records were seen and are thorough and well structured. DS0000003963.V270540.R01.S.doc Version 5.0 Page 17 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): 33,35,38. The home generally seeks the views of residents, staff and relatives to ensure the home is run in the best interest of residents. Resident’s financial interests are safeguarded. The health, safety and welfare of service users and staff are protected by suitable policies, procedures and practices at the home. EVIDENCE: Milton Grange is currently in the process of updating their annual development plan and each year distribute questionnaires to residents families whose views underpin and promote changes at the home. The inspector spoke to four family representatives who commended the spirit of openness at Milton Grange. Although it is not always possible to consult fully with residents, views are sought through their representatives and where possible acted, upon. In
DS0000003963.V270540.R01.S.doc Version 5.0 Page 18 addition the active involvement of the registered providers and their daily presence within the home means that they are available for consultation with all stakeholders. Whilst feedback is sought in an informal manner it is recommended, that the quality assurance questionnaires are distributed at least yearly and the results published in a written format. This will enable the home to demonstrate that they are engaged in self-monitoring using an objective method. Feedback from service users does underpin the good practice at the home and it is important to demonstrate that. Mrs Ah-Kan confirmed that in order to protect residents, the home do not have responsibility for their personal finances. Therefore all residents who are unable or who do not wish to handle their own affairs, have a relative or other representative to deal with their financial matters. The home has a range of Health and Safety policies and practices in place and records are appropriately maintained. Fire records, which included staff training and drills were examined by the inspector and found to be up to date. Water systems have pre-set valves to prevent scalding, hazardous materials are stored securely and details recorded in a COSHH manual. The owners have recently purchased new washing machine and drier and there is an on-going programme of maintenance, which is reflected in the high standards of cleanliness within the home. Accidents and injuries had been properly recorded and as part of their induction staff had received health and Safety training. Following a requirement from the last inspection all staff are currently undertaking Moving and Handling training through the local college and sufficient numbers of relevant staff hold food hygiene certificates. Staff training remains ongoing. DS0000003963.V270540.R01.S.doc Version 5.0 Page 19 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 x x 2 DS0000003963.V270540.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 The registered person must not employ a person to work at the home unless all recruitment checks have been completed including the obtaining of two verified references. The home must be able to show that all care staff have a current moving and handling certificate issued by a certified trainer.(currently ongoing) Timescale for action 1. OP29 19(1)(5) 07/03/06 2. OP38 13 07/03/06 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 OP28 OP30 Good Practice Recommendations 50 of care staff must be qualified at NVQ level 2 and qualifications gained by the extended date of 2006. All staff should have an individual training plan charting development and skill needs and reflecting the care needs of residents within the home. Further work must be undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meeting it aims and objectives as detailed in the home’s Annual development plan.
DS0000003963.V270540.R01.S.doc Version 5.0 Page 21 3. OP33 Commission for Social Care Inspection Poole Office 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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