Inspection on 10/05/05 for Milton House

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milton House 14/10/09

Milton House 15/10/07

Milton House 20/12/06

Milton House 28/06/06

Milton House 04/10/05

Milton House 25/01/05

Milton House 08/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Milton House West Street Bridgwater Somerset TA6 3RH Lead Inspector Caroline Baker Unannounced 10th May 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 House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Milton House Address West Street, Bridgwater, Somerset, TA6 3RH 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) 01278 422235 01278 451511 Somerset Care Limited Mrs Audrey Pursey Care Home with nursing 51 Category(ies) of Old age (51) registration, with number Physical disability (51) of places Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to three persons of either sex, between the ages of 50-60 years, who require general nursing care. Registered for a total of 51 places in Categories OP and PD. When the home reaches provision of care for 40 service users requiring nursing care, 2 Registered Nurses must be provided at night to comply with the staffing notice in line with Somerset Health Authority. Staffing levels are monitored on a monthly basis to suit the dependency levels of individual service users. Staffing should not fall below 1-10 at night and 1-5 during the day. Date of last inspection 25th January 2005 Brief Description of the Service: Milton House is a purpose built care home situated in the town of Bridgwater, within walking distance of the town centre. It is owned by Somerset Care Ltd, the registered manager is Mrs Audrey Pursey. The home is registered with the Commission for Social Care Inspection (CSCI) for 51 people over the age of 60 years; it is a care home providing nursing care for older people and those with physical disabilities. Within the registered numbers the home can provide care for up to 3 people ages 50-60 years who require general nursing care. The home is arranged on two floors with two passenger lifts. All the bedrooms are single. The home has a selection of small lounges and a large dining area. A telephone is available for service user use. There is a patio area and a garden which is being landscaped to ensure safe level access for service users. The home has been enlarged and refurbished recently to a high standard to provide the 51 beds. Car parking space although increased is minimal. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 25th January 2005. Four requirements from that inspection had not been complied with at the time of this inspection. This inspection was also unannounced and took place over one day (8 hrs) and was conducted by three inspectors including a pharmacist inspector. Fifty service users were residing at the home including one short stay. Staffing levels appeared adequate on the day of inspection. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least twenty-five service users were spoken with and three staff were interviewed. The registered manager was available throughout the inspection. The area manager was available at the end of the inspection to hear feedback. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. What the service does well: Milton House provides a well-maintained, secure and comfortable environment, which meets the needs of the current client group. Service users were observed using all communal areas and appeared comfortable and relaxed in their environment. Service users spoken to stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users praised the food. A good choice of wholesome food was given. Consideration should be given to the length of time service users normally wait for their lunch. Staffing numbers and the skill mix of staff were sufficient to meet the needs of current service users on the day of inspection. Staff spoken with stated that they felt well supported and happy working at the home. Staff training was well documented and the provision of training for staff is good. Staff looked and acted in a professional manner. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 6 The home appeared appropriately managed by the registered manager who is supported by a suitably qualified deputy manager. Staff and service users praised the support of the manager. Any complaints the home had received had been taken seriously and appropriate action had been taken. What has improved since the last inspection? What they could do better: Care planning needs to be assessed and monitored on a regular basis to ensure current care needs are reflected and that plans of care are appropriate to the individual service user. Service users should have input where possible into there care plans on a regular basis. Many service users spoken to were not aware of their care plan. Registered nurses should examine their own practices in regard to medication administration, storage and recording in line with the Nursing and Midwifery Council (NMC) and Royal Pharmaceutical guidelines. There have been issues Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 7 raised at this inspection and the previous two putting service users at risk. A further immediate requirement notice was issued. The use of bed rails should be closely monitored and assessed on a monthly basis to ensure appropriate use. The home should ensure that staff understand and ensure that communal areas, fire escapes and corridors are not cluttered with wheelchairs or hoists, that substances hazardous to health should not be accessible to service users and that they should adhere to infection control guidelines at all times. Staff recruitment must be more robust and evidence recorded of risk assessments, supervision and the rationale for employing staff before adequate information is gained as to their fitness. When a service user summons assistance via a call bell care staff should strive to answer them straight away. The home had not gained service users views on the conduct of the home for some time and the management stated that this was due to building works and the refurbishment of the home. This should be actioned sooner rather than later to confirm that the home is being run with the service users best interests at heart. 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 House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 8 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 House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 9 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, 3, 4 and 5. NMS 2 was not assessed on this occasion and NMS 6 is not applicable to the home. Prospective service users are provided with information to allow them to make an informed choice. The home takes appropriate steps to ensure the needs of prospective service users can be met prior to a decision being made about admission. EVIDENCE: An up to date Statement of Purpose and Service User Guide was available and displayed in the reception area of the home. Service users spoken to confirmed receipt of a service user guide to the home. Evidence was seen in the five care records examined that a full pre-admission assessment had been undertaken to ensure the home could meet individual service users needs prior to admission. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 10 It was evident that the staff individually and collectively had the skills and experience to deliver the services and care which the home offers through staff files examined and training records seen. Some service users spoken to confirmed that they had been able to visit the home prior to admission. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 11 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 and 11. Although each service user had a care plan the processes needed improving and there was no evidence of service user input. The privacy and dignity of service users was respected. The home had failed to improve their procedures for the management and administration of medication, potentially placing service users at risk of harm. EVIDENCE: On examination of five individual care plans and meeting with the service users it was noted that current care needs and interventions were not always recorded. There was no evidence of service user input. Nutritional assessments had not always been completed or reassessed to reflect loss of weight and action to be taken. Types of pressure relieving equipment were not reflected in the care plans as required at the last inspection. Bed rail care plans were generic with no risk assessment or rationale for use. Consent had not been gained for the use of a floor alarm pad, which can be seen as a form of restraint. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 12 On examination of medication administration, storage and recording by the pharmacist inspector gaps in signatures were noted on Medication Administration Records. Hand transcribed medications did not always carry two signatures. Variable doses did not always reflect the amount given. Prescribed creams were stored inappropriately in service users rooms without a name in some cases and all without dates of opening or expiry. The temperature of the medication fridge had not been recorded appropriately and the CD cupboard was not secured correctly. Unlabelled medicines were found in both medicine trolleys and the fridge. Oxygen was found to be stored incorrectly. An Immediate Requirement Notice was issued. Issues had been raised in regard to medication recording at the last two inspections. In regard to maintaining privacy and dignity service users spoken to praised the staff stating that they were always kind and caring and treated them with respect. The Inspectors noted that the interaction between staff and service users was kind and friendly throughout the inspection. The inspectors were able to assess the care and provision for service users when they are very ill through case tracking. It was evident that a high standard of care was delivered and comfort was assured. However as discussed care plans should reflect the funeral arrangements for individual service users should they become very ill. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 13 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, and 15. The home’s arrangement for meeting service users social needs was adequate. Service users benefited from a wholesome diet. EVIDENCE: Many service users were spoken to during the course of the inspection including five who were case tracked as part of the inspection process. All of the service users stated that they were happy at the home and felt it met their individual needs. It was evident that a choice had been given to service users for the time they got up in the morning – some were still getting up at 11:45 hours and later. The routine of the home appeared to be dictated by service users choice. Social interests were seen recorded in the five care plans examined. Up to eighteen service users were seen playing bingo on the afternoon of the inspection. An activities record was kept and examined which highlighted oneone activities with those who could not join in. Once the garden is made safe for service users they will also be able to enjoy the summer months outside. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 14 Visitors were seen taking service users out on the day of inspection and relatives spoken to expressed their satisfaction of the care provision at the home. The visitor’s book indicated many visitors to the home. The lunchtime meal was assessed. Inspectors were concerned that service users arrived at the dining tables in wheelchairs from 12 o’ clock onwards and some had not been served a drink until 13:00hrs and some had waited for their meal until 13:40 hours. Service users did not complain and told inspectors that the food is very good one saying that it was better than a “1st class hotel”. Evidence was seen that choice was given and that staff saw each service user individually to ask what vegetable they would like to accompany their dinner. Records of service user choice were seen in the kitchen. The inspectors concerns regarding lunchtime were discussed during feedback with the registered manager, nurse in charge and area manager. It was agreed that a survey would be distributed to obtain the individual views of service users in regard to times of waiting and the position of the tables. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 15 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, 17, and 18. The home has a satisfactory complaints system in place with evidence that views were appropriately acted upon. The home’s procedures for ensuring that service user’s legal rights are protected were good. The home’s recruitment procedures for staff did not fully protect service users from the risk of abuse. EVIDENCE: Service users, staff and relatives spoken to were aware of the homes complaint procedure and who to talk to with any concerns. The procedure named ‘Seeking Your Views’ is found in the service user guide and is displayed in the reception area. The home had received two complaints since the last inspection one from a service user and one from a nurse agency. Both had been dealt with appropriately. The CSCI had received one anonymous complaint since the last inspection with regard to staffing levels. Service users had been registered to vote at the most recent election and service users spoken to confirmed this. Postal votes were mainly used and some were taken to the polling station to register their vote. The home had the multi-agency policy on Safeguarding Vulnerable Adults. The home had a Whistleblowing Policy (Confidential Reporting), which is comprehensive and details outside bodies that staff can approach. Some staff Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 16 spoken to on the day of inspection were not sure of the Whistleblowing Policy and lines of communication to be taken if necessary. Service users financial records and any monies were kept in a secure facility. Service users may access their personal financial records, if they wish to do, so at any time. Service users spoken to stated that they felt safe at the home. Somerset Care Ltd is a registered umbrella body and signatory for the Criminal Records Bureau (CRB). Five staff recruitment files were examined as part of the inspection and issues were raised that compromised the protection of vulnerable adults as detailed later in the report. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 17 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, 21, 22, 23, 24, 25 and 26. Service users live in a safe and comfortable environment, which is able to meet he assessed needs of service users living there. Building works compromised this during lunchtime. Service users have access to specialist equipment where there is an assessed need. There were no malodours in the home; the standards of cleanliness were generally good. EVIDENCE: On assessment of the premises it appeared safe and well maintained. Building works continue which could compromise the safety at times. Service users spoken to stated that the building works had not bothered them unduly. At lunchtime it was noted that levels of noise made by the builders was unacceptable. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 18 Maintenance records had been recorded. The building complied with the local fire service and environmental health department according to records seen. The home was well ventilated on the day of inspection. Windows were restricted and radiators were guarded in line with HSE guidelines. Lighting is domestic in character. Bath temperature records were seen in bathrooms assessed. Hot water outlet temperature records indicated that they were last checked on 21/04/05 and the homes policy states they should be checked weekly. The grounds are in the process of being landscaped and are not safe to be accessed by service users until completion. Communal space has increased with the new build giving service users more choice of where to sit and meet others. Wheelchairs were stored in one lounge, which compromised access to books and a table. Storage was discussed at inspection with the area manager who told the inspectors that more storage space was being made available. The new build has provided en-suite toilets to many rooms and access to communal toilets is adequate for the size and layout of the home. Service users spoken to were happy with the provision of communal baths and toilets. It was evident on assessment of the premises that specialist equipment is available to service users and being used appropriately at the home. All of the new rooms had profiling beds and all service users receiving nursing care were provided with adjustable height beds. Adaptations were made to include grab rails in all areas to maximise service users independence. All service users spoken to were happy with their rooms and felt that they were adequate to meet their needs. Room sizes are reflected in the homes Statement of Purpose and meet NMS. Rooms seen were furnished to a high standard. All rooms at the home are single. Infection control systems were in place at the home. The cleanliness of the home was generally very good at this inspection and there were no malodours. Sinks in some of the sluice areas assessed were in need of a deep clean. Tablets of soap were found in two bathrooms and soiled items had been left exposed in a bathroom and a sluice assessed. There was a new laundry room with adequate equipment for the size of the home. Hand washing facilities for staff were not available in the area. The airing cupboards were sited in the reception area, which was discussed as not being practical at inspection with the area manager. It was agreed that the communal toilet next to the laundry could be refurbished and used as a clean Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 19 area and airing cupboard. Service users spoken to were pleased with the provision of laundry care and all looked well attired. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 20 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) 27, 29 and 30. NMS 28 was not assessed on this occasion. The home’s recruitment procedures for staff were not robust and did not fully protect service users from the risk of abuse. The numbers and skill mix of staff were appropriate to meet the needs of current service users. Staff morale had improved. Agency staff were used to cover any shortfalls. The safety of service users was compromised by the time it took to answer call bells. EVIDENCE: Service users spoken to at inspection indicated that they felt that staffing levels were adequate at this time. The inspectors were concerned to hear from some service users the length of time staff take to answer call bells. Some indicated it can take up to six minutes and some stated that they nearly had accidents when waiting desperately for the toilet. Inspectors monitored the length of time it took staff to answer the bells during the inspection and on three occasions it took more that 2 minutes. It ranged from 2 – 5 minutes. This needs to be monitored closely without delay. Staffing was adequate on the day of inspection. There were two registered Nurses on duty morning (including one agency nurse) and afternoon excluding the registered manager. There were nine care staff during the morning including two agency staff. Staff spoken too told the inspectors that staffing Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 21 levels had improved and were being maintained by the use of agency staff to cover any shortfalls. Staff stated that only on occasions do levels drop to seven care staff during the morning due to sickness or unforeseen circumstances. The CSCI should be informed of these shortfalls and difficulties when they arise as it could compromise the provision of care at the home. The copies of duty rotas given to the inspectors indicated that minimum staffing levels have been maintained over the past two weeks. Care support staff are extra to the care staff numbers to provide drinks to service users. The manager informed the inspectors that domestic staff hours are being increased given the size and layout of the home. Catering staff have not increased however the manager informed the inspectors that they do work extra hours now. Six staff recruitment files were examined at this inspection of recently employed staff. The Registered Nurses had up to date Pin No’s. Evidence was seen of induction and mandatory training. One did not have a record of an application form or Criminal Records Bureau (CRB) disclosure or POVAfirst being applied for in this country. Management stated that the application form might be with the HR department. It is asked that all items required by regulation be kept on file at the home. Photo identification was missing in three. Four had commenced employment prior to receipt of a POVAfirst or CRB disclosure. Gaps had also been found at the last inspection resulting in an immediate requirement being issued. This was discussed with the registered manager who informed the inspectors of the difficulty in obtaining POVAfirst checks and that the staff are always supervised prior to receipt of them. It was agreed that this must be evidenced in the individual staff files with a rationale for why the home employed the staff member before obtaining a POVAfirst check for the protection of vulnerable adults. Staff training records and speaking with staff and service users indicated that staff employed at the home are skilled and competent to do their job. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 22 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, 36, 37, and 38. The registered manager and her deputy effectively manage the home. The home is committed to staff training. The systems in place for ensuring the health and safety of service users and staff are generally good though some further improvements are required. EVIDENCE: Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 23 Mrs Audrey Pursey has been the registered manager at Milton House since November 2000. Mrs Pursey has completed the Registered Managers Award at NVQ level 4 and I.O.S.H training in health and safety. It was evident having spoken to staff and service users on the day of inspection, that the manager communicates a clear sense of direction, and leads the staff in a way that they understand. Staff morale appeared lifted at this inspection. A recent staff meeting covered many issues in regard to staffing levels, morale, excessive use of agency staff, communication and telephone calls, continuing building works and disruption and safety of service users. It was evident that action was being taken to resolve many of these issues. Staff spoken to felt well supported by the team and were happy working at the home. Agency staff on duty indicated that they enjoyed working at Milton House and had done so on many occasions. Staff had been supervised on a one to one basis; records were kept, and were seen in the staff files examined at inspection. There have not been any recent service user meetings or surveys distributed to gather views on the running of the home. The management were well aware of this and had plans to distribute anonymous surveys very soon. This will be followed up at the next inspection. The area manager had recorded monthly Regulation 26 visits. Action had not been progressed within agreed timescales to implement all requirements identified in the last two CSCI inspection reports. The majority of the records that were seen at this inspection were comprehensive, well maintained and up to date. Medication records and care plans were not maintained in line with Schedule 3 of the Care Home Regulations 2001as at the last inspection. Staff spoken to were aware of the homes health and safety policies and had received mandatory training in health and safety. Food was stored correctly in the kitchen. Fridge and freezer temperature records for May 2005 could not be located. COSHH Regulations were compromised at this inspection when inspectors noted substances hazardous to health accessible to service users in sluices and bathrooms and one cleaning cupboard was unlocked and a sluice door was wedged open. An immediate requirement notice was issued. All service histories were found to be up to date. Hot water outlet temperatures according to the records had not been tested since 21/04/05. The home has had one incident reported to RIDDOR since the last inspection Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 24 and must forward a Regulation 37 notification to the CSCI. All accidents and injuries had been recorded. Two had involved bed rails and nine had involved wheelchairs. There were 47 recorded since the last inspection on 25/01/05. It was noted that some service users spend long periods in their wheelchairs and given the number of accidents where service users have fallen from their wheelchairs, this practice should be reviewed. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 2 x x 3 2 1 Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 26 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 OP7 Regulation 15(1) and 17(1)[a] Schedule 3 (k) 17(1)[a] Schedule 3 (n) 17(1)[a] Schedule 3 (q) 13(2) Requirement All individual service user care records must reflect current care needs. Pressure relieving equipment must be reflected in all individual care records. (Previous timescale of 14 February 2005 not met). Risk assessments and the rationale for the use of bed rails must be reflected within the individual service users records. The amount of administered variable dose medication must be recorded,(an immediate requirement notice was issued.) All hand transcribed medications must carry two signatures. (Previous timescale of 25 January 2005 not met - a further immediate requirment notice was issued) All medication administered must carry a signature or a definition if not administered. (Previous timescale of 25 January 2005 not met - a further immediate requirment notice was issued) All medications including creams must be stored securely within individual service users rooms Timescale for action 27 May 2005 27 May 2005 27 May 2005 10 May 2005 10 May 2005 2. OP8 3. OP8 4. OP9 5. OP9 13(2) 6. OP9 13(2) 10 May 2005 7. OP9 13(2) 10 May 2005 Page 27 Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 8. OP9 13(2) and a risk assessment must be in place if they are accessible to service users. (An immediate requirment notice was issued) The medicine fridge temperature recording must comply with legislation. The Controlled Drugs cupboard must be correctly secured. Flu vaccines found in the fridge must be returned and oxygen storage and labelling must comply with current legislation. 27 May 2005 9. OP18 and 29 12(1){a} and 19 10. 11. OP19 and 25 OP20 12. 13. OP26 OP27 14. OP38 The home must safeguard and protect service users at all times by ensuring the fitness of CSA S89 persons before their (1){a}{b} commencement of employment, in line with company recruitment policies. (Previous timescale of 25 January 2005 not met - a further immediate requirment notice was issued)) 13(4)[a] Hot water outlets must have [c] their temperatures recorded in line with company policy. 13(4)[a] The grounds must be safe and and accessible to service users and 23(2)[o] communal space must not be used to store wheelchairs or mobile hoists. 13(3) and All areas of the home must be 23(2)[d] kept clean and hygenic. 13(4)[c] The registered manager must ensure systems are in place for monitoring the amount of time call bells are answered and take action to ensure that service users are not waiting for care provision. 13(4)[a] All substances hazardous to [c] health must be stored in line with COSHH legislation.(An requirment notice was issued) D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc 10 May 2005 27 May 2005 20 June 2005 27 May 2005 27 May 2005 10 May 2005 Milton House Version 1.30 Page 28 15. OP38 13(4)[c] The length of time service users stay in their wheelchairs must be reviewed and rationalised. 27 May 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP11 OP33 OP38 Good Practice Recommendations Funeral arrangements should be reflected in individual service users care plans. Anonymous surveys should be disributed to service users to obtain their views on the conduct of the home by end of June 2005. Up to date fridge and freezer temperature kitchen records should always be available for inspection. Milton House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 House D53 - D02 S3271 Milton House V225267 100505 Stage 4.doc Version 1.30 Page 30 - 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. 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