Inspection on 12/04/07 for Milton House

This inspection was carried out on 12th April 2007.

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 16/12/08

Milton House 14/02/08

Milton House 28/08/07

Milton House 30/05/06

Milton House 23/01/06

Milton House 19/09/05

Milton House 06/01/05

Milton House 09/09/04

Milton House 19/02/04

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

CARE HOMES FOR OLDER PEOPLE Milton House 58 Avenue Road Westcliff On Sea Essex SS0 7PJ Lead Inspector Michelle Love Unannounced Inspection 12th April 2007 08:30 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 Milton House DS0000015457.V335915.R01.S.doc Version 5.2 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. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address 58 Avenue Road Westcliff On Sea Essex SS0 7PJ 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) 01702 437222 01702 436536 Mr Davie Vive-Kananda Manager post vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: Milton House is owned and managed as part of the Strathmore Care group of homes. Milton House provides accommodation for 28 older people. The home has 24 single and 2 double bedrooms. Not all bedrooms have an en suite facility. There are 2 lounges and a dining room. There is a car parking area to the front of the building and a small secure garden/patio courtyard style area. Milton House is situated close to central Southend and has good access to local bus and train routes. The home has an up to date Statement of Purpose, Service User Guide, and a copy of the last CSCI inspection report in the entrance hall. A resident’s handbook is placed in each bedroom. The current scale of charges as at May 2006 was between £427 - £476 per week depending on resident’s dependency levels. Extras charged are for hairdressing, chiropody, toiletries and newspapers. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced `key` inspection and was conducted by Michelle Love, Regulation Inspector over a period of approximately 10 hours. As part of the inspection process a tour of the premises was undertaken and a random sample of records pertaining to care planning, healthcare documentation, staff recruitment, training, complaint records and policies and procedures were examined. Additionally several residents, members of care staff, visiting professionals and relatives were spoken with. Following the site visit 10 surveys were forwarded to relatives requesting their views about Milton House. It is disappointing that out of 10 surveys sent out only 4 were returned to the Commission. The inspection was conducted with the assistance and co-operation of the acting manager and other staff members. What the service does well: What has improved since the last inspection? What they could do better: The Commission recognises that a new pre admission assessment and care plan format has been introduced over recent months, however improvement must be attained and records must clearly evidence staff’s knowledge about individual residents, what care is required and what care is given in relation to all the care they need for their health and wellbeing. The homes staffing levels, recruitment procedures and staff training must be robust and well maintained to ensure that staff have the skill and knowledge to provide appropriate care to individual residents. The deployment of staff Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 6 throughout the home must be better managed so that staff can attend to residents needs more promptly. Arrangements must be made to ensure that all staff working at the care home receive regular supervision. Residents require an activity programme, which enables individuals to participate in meaningful occupation. The activity programme must not solely cater for the more able person living in the home but also be appropriate to meet the needs of those residents who are complex and who require mental stimulation. Progress to formally register the acting manager with the Commission needs to be made as soon as possible. The registered provider should consider enabling the acting manager to have more autonomy in order to take on a more active role with the admission process of prospective residents and the recruitment of staff. 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. The summary of this inspection report can be made available in other formats on request. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 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 Milton House DS0000015457.V335915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Evidence suggests that prospective residents have a pre admission assessment carried out before they are admitted to the care home, however there is little or no evidence to indicate that they or their families are encouraged to visit the home or that the registered provider has confirmed in writing that it can meet the residents needs. There is little or no evidence to indicate that admissions to the care home are agreed in conjunction with the manager and/or staff team. EVIDENCE: The home has a Statement of Purpose and Service Users Guide, which reflect the services provided at the care home. Of those residents spoken to they were not aware of the Service Users Guide and in some instances lacked capacity to discuss the document. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 9 The acting manager confirmed to the inspector that all admissions to the home are arranged by the company head office and pre admission assessments are undertaken by the company’s placement co-ordinator. The acting manager advised that neither she or other staff are consulted and do not undertake an active role within the admission process. This is seen as inappropriate and not best practice as it is unclear that the placement co-ordinator has taken into account the dependency levels of existing residents within the home and/or their complex needs. Of those care files examined for the newest resident’s, pre admission assessments had been completed. It was observed that one assessment was completed on the same day as the person was admitted to the care home. No rationale was recorded as to why this had occurred i.e. emergency admission. As part of good practice procedures this should be recorded for the future. For one resident the medical history guideline and assessment tool for memory was not completed. There was little or no evidence to indicate that prospective residents and/or their representatives are enabled or encouraged to visit the care home prior to admission or to participate within the assessment process. There was no evidence to suggest that the registered provider has formally written to prospective residents and/or their representatives to confirm that it can meet the resident’s needs. The home does not provide intermediate care. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each individual resident has a care plan, however some information recorded is basic, not detailed or person centred. There is little evidence to suggest that residents are actively encouraged to be involved in its review or development and risk assessments are not recorded for all areas of assessed risk. Medication procedures/recording within the home were not satisfactory. EVIDENCE: On inspection of four individual care plans, it was positive to note that a plan of care was available within each file. The inspector was advised by the acting manager that a new care plan format has been introduced however not all care file information has been transferred into the new care plan format for some residents. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 11 All of the care plans examined had shortfalls, as they were not detailed, comprehensive and did not identify all of the individual resident’s care needs or how these were to be met by care staff i.e. the Pre Admission Assessment for one resident detailed that they were at risk of developing pressure sores, however no care plan was devised or implemented. The care plan also stated that the resident needed assistance of two carers for personal care/hygiene. No details were recorded as to what specific assistance was required and how this was to be delivered by care staff. The Pre Admission Assessment also detailed that the resident had a poor appetite and was unable to keep food down, as they often felt nauseated. This was not detailed within the person’s care plan. Not all of the areas detailed within the care plan format were completed for some residents i.e. Social Activities/Hobbies, Spiritual and Cultural Needs/Expressing Sexuality, Welfare/Finance, Night Care/Rest and Sleep and the Dependency Profile. A formal assessment relating to Manual Handling was completed for all residents, but did not include specific information relating to the type of hoist/sling to be utilised. There was evidence to indicate that care plans had not been reviewed regularly or updated to reflect changes to resident’s needs. The care plan for one resident indicated that they have their own telephone and have requested to have all their mail unopened. Risk assessments were not devised for all areas of assessed risk i.e. on inspection of one care plan this made reference to the resident having pressure sores. The care plan only detailed that the resident had a pressure sore on their sacrum and not on both of their heels. No risk assessment was devised detailing the area of risk, treatment/care to be provided and actions to be taken to minimise the risk. Daily care records for individual residents were observed to be written daily but not after every shift on several occasions. Records were noted to be inconsistent with some records being detailed and informative and others lacking specific information and evidence of staff interventions and care provided i.e. One record was noted to state “…… complaining of chest pain and they wanted to go to the hospital. Supper served taken well”. No evidence of staff interventions was recorded and there was nothing recorded to indicate that staff had taken appropriate action e.g. monitored the resident or sought advice from the GP. Another entry recorded “They was assisted with all personal care this morning. Breakfast taken well. Fluids given and encouraged. They continue to ask for the toilet after about every hour and doesn’t do anything.” There was no evidence to indicate that this had been investigated or any action taken by care staff. The home has a medication policy and procedure. On inspection of the homes medication storage facilities these were seen to be appropriate. On inspection of the homes Medication Administration Records (MAR) a number of omissions Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 12 of signatures were observed whereby staff had omitted to sign the MAR sheet to indicate that medication had been administered to and received by residents. This is unacceptable and must be addressed with immediate effect. An audit of Controlled Drug medication was undertaken and records/actual medication were observed to tally. No PRN (as and when required) protocols were observed for individual residents. The acting manager was advised that information needs to be recorded detailing the name of the PRN medication, clear instructions as to how much to give, when and the reason why. The acting manager advised the inspector that including herself there are six people who administer medication to residents. There was no evidence of medication training for one member of staff and the file for one employee indicated that their medication training was out of date (04). This is unacceptable and appropriate training must be undertaken for those staff who administer medication. One relatives survey forwarded to the Commission stated “sometimes staff do long day then have to stay on passed 8 p.m. to do medication as there is no night staff that can do this”. If this is correct then this is unacceptable and appropriate measures must be undertaken by the registered provider to ensure that there is a member of staff on night duty who is able to administer medication at all times. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A programme of activities for residents remains inadequate for the numbers and needs of residents. A varied menu is available for residents, however mealtimes do not appear to be an enjoyable event. EVIDENCE: An activities programme is available but as stated at the previous `key` inspection to the home, the provision of any activity is dependent on care staff being available and having the time to initiate activities. On the day of the site visit a game of bingo was played within one lounge, however the deployment of staff within the home (lounge areas) throughout the inspection was very poor and of concern as several residents were observed to be frail and immobile/have poor mobility. This places several residents at risk and must be addressed as soon as possible. Additionally residents must receive a programme of activities/meaningful occupation according to their needs and personal preferences. Little evidence within individual resident’s care plans suggests that information relating to social interests, hobbies and interests have been explored. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 14 The home has a rolling four week menu. On the day of the site visit residents were observed to be offered a choice of three possible meals for lunch. Meals served to residents were of a sufficient quantity and quality and looked appetising, however the actual delivery of the meal to residents was poor i.e. the meal was rushed and individual resident’s were observed to be hurried to eat their meal, tables were not laid, plates of food placed in front of residents without cutlery, drinks not available for some residents for 25 minutes and in some instances dessert was served at the same time as the main meal. Residents have the choice of being able to eat their meals in either the dining room, lounge or in their bedroom. The inspector was advised by the acting manager and care staff that the home does not employ a teatime cook. Tea for residents is prepared by 2x staff from existing staffing levels and this provides insufficient cover for residents elsewhere within the home. Food provided to residents does not always concur with the homes menu book, but a record of food eaten by residents is recorded. Comments from residents were generally positive. On the day of the site visit, two residents were overheard at lunchtime to state that their meal was cold and they would have liked more gravy. Surveys forwarded to the Commission recorded “food is good especially lunch. Teatime (supper) is only sandwiches as a cook is not here to cook suppers”, “food is good” and “food mostly good but the fish and chips on Fridays are cold and unpalatable (not cooked on premises)”. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints from people are not always fully recorded and appear to be dealt with very informally. Protection of Vulnerable Adults training has been provided to staff. EVIDENCE: The acting manager was advised that the homes complaints procedure needs to be amended to reflect that the Commission no longer has any statutory responsibility to investigate complaints. Any complaints received at the Commission will be referred back to the registered provider or to the local authority if they are contractually involved. As part of the inspection process inspectors will examine how the registered provider has dealt with issues and as to whether regulations are being met. On inspection of the homes complaints folder, it was observed that since the random inspection there have been three complaints. Evidence indicated that complaints are dealt with informally and there is not a formal system devised to include action taken by the acting manager/registered provider and the outcome. No Protection of Vulnerable Adults issues have been highlighted. The home was observed to have a policy and procedure for safeguarding people who use the service. On inspection of a random sample of staff training records, it was evident that most people had received POVA training in 2005 and 2006. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, tidy, well maintained and comfortable, but not particularly attractive in places. EVIDENCE: A tour of the premises was undertaken and it was positive to note that since the last inspection three resident’s bedrooms have been redecorated. A random inspection of resident’s bedrooms were undertaken and these were seen to be personalised and individualised with many peoples personal affects i.e. ornaments and photographs. The acting manager advised the inspector that she is looking to get rid of many of the old hospital style beds and to purchase divan beds instead. Additionally quotes have been received for new carpets and curtains. Some items of furniture were observed to either need replacing or to be mended as they were in poor disrepair. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 17 The acting manager was advised that the doorbell is not very loud and cannot be heard throughout the building and several professionals/visitors visiting the home were observed to have to wait for some considerable time before being let in. The ground floor sluice room was observed to be unlocked. The homes record of hot water temperatures was inspected and this evidenced that on several occasions, hot water temperatures (wash hand basins in residents bedrooms) were above 43° degrees Celsius and the wash hand basin on the ground floor bathroom was dangerously high at 70° degrees Celsius. The homes maintenance person/registered provider must ensure that this issue is addressed and that all appropriate measures are undertaken to reduce the risk of scalding to residents. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels do not always meet the needs of those people using the service and the current level of staff deployment restricts the ability of staff to deliver person centred care/support. The homes recruitment practices do not protect residents. EVIDENCE: The inspector was advised that staffing levels at the care home continue to be 4x care staff including a senior member of staff on duty each day between 08.00 a.m. to 20.20 p.m. and 3x waking night staff. The acting manager advised that her hours are supernumerary to the above but often she works 08.00 a.m. to 18.00 p.m. and this includes some weekend shifts. Staff rosters were inspected for the period 19.3.07 to 12.4.07 inclusive and these were noted to evidence on occasions that the above staffing levels had not been maintained. Additionally the staff rosters indicate that on 29.3.07 a member of staff completed a late shift and a waking night shift, a total of 18.20 hours. The rosters also indicate that some staff are consistently working long days (12.20 hours) and that some staff are working excessive hours i.e. 61.00 to 67.20 hours per week. It is also evident that some staff employed at Milton House also work within the company’s other homes. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 19 Staff deployment throughout the site visit was observed to be poor and this is seen to adversely affect resident’s welfare and wellbeing i.e. resident’s having to wait long periods before being taken to the toilet, staff not being attentive to residents needs and call alarms not being answered promptly. Relatives surveys forwarded to the Commission were noted to confirm the above i.e. “often no one on the floor-always told busy but I have walked around the whole ground floor and seen no one”, “staff often complain they are short staffed” and “insufficient staff are on duty sometimes”. In addition to the above staffing levels, the home also employs a laundry assistant 7 days a week, a cook to provide breakfast and the midday meal, a housekeeper 6 days a week and a maintenance person as and when required. One relative commented that laundry systems at the home use to be very good but since the laundry person has also been undertaking care duties, laundry standards have declined. The acting manager advised that no new staff have been employed since the last inspection. A random selection of staff files were inspected and the following observations were noted. Not all records as required by regulation were available pertaining to no job descriptions available within some files, inductions not in line with Skills for Care, references not always from current employers, medical questionnaires not signed and dated, no evidence of qualifications and training and no staff files/evidence of documents for those staff who work both at Milton House and other `sister` homes. Additionally no profile/record of induction had been received for one agency member of staff utilised at the care home. A random sample of training records were inspected and there was evidence to suggest that some staff do not have up to date training relating to Fire Awareness, Manual Handling, First Aid, Infection Control, Health and Safety, Food Hygiene and COSHH (Control of Substances Hazardous to Health). In some instances there is a lack of training relating to the specific needs of older people i.e. Parkinsons Disease, Sensory Impairment, Diabetes, Falls, Pressure Area Care etc. The homes housekeeper was noted to have no evidence of training on their file. The acting manager should consider devising a training matrix. The inspector was advised that currently 2x staff are currently undertaking NVQ Level 2. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home. Staff supervision for staff is poor. EVIDENCE: The acting manager has been in post since March 2006, however the inspector was advised that she previously managed Milton House from 1998 to 2001. It is evident from discussions with the acting manager that she has been employed as a nursing co-ordinator and nurse manager at a hospital abroad and is a qualified Registered Nurse. It is unclear as to whether or not an application has been received by the Commission to formally register this person. Relatives spoken with at the inspection were complimentary regarding the acting manager. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 21 It is concerning that the acting manager is not enabled or given autonomy to undertake the assessment of prospective residents or involved with the recruitment of staff to Milton House. The acting manager advised that she is given support by the training officer, placement officer, operations manager and registered provider. On inspection of a random sample of staff files, there was evidence to indicate that staff supervision is not being conducted in line with regulatory requirements or recommendations i.e. within one file it suggested that they had not received supervision since August 05. A random sample of records as required by regulation were inspected. The homes fire risk assessment checklist was evident but not completed, fire equipment checks were last conducted on 17.11.06 and the last recorded fire drill was 22.12.06. A record was available to indicate that all staff have signed to say that they have read and understood the homes fire precautions and procedures. The homes electrical installation certificate was dated 26.5.04. The acting manager advised that the homes gas safety inspection was undertaken the day before the site visit. A copy of the certificate to be forwarded to the Commission within 14 days. Residents accident records were readily available, however additional information is required detailing staff’s interventions and follow up action where required. Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 22 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 2 X 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 2 Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP3 Regulation 14 Requirement Ensure that the registered provider writes to the resident and/or their representative to confirm that it can meet the resident’s needs. Ensure that all residents have a plan of care which is detailed, comprehensive and depicts individuals care needs, how they are to be met, who by and how often. Ensure that the care plan is regularly reviewed and updated. Ensure that risk assessments are devised for all areas of assessed risk. Ensure that a record of pressure sores, their treatment, outcomes and equipment is recorded within individual resident’s care plans. Ensure that appropriate arrangements are made for the safe administration of medicines. This refers specifically to omissions of signatures on the MAR record. Ensure that those staff who administer medication to residents are appropriately DS0000015457.V335915.R01.S.doc Timescale for action 14/06/07 2. OP7 15 14/06/07 3. 4. OP7 OP8 13(4) 17(1)(a), Schedule 3 (n) 13(2) 14/06/07 14/06/07 5. OP9 14/06/07 6. OP9 18(1)(c) 01/07/07 Milton House Version 5.2 Page 24 7. OP12 16(2)(m) and (n) trained and have up to date training. Ensure that appropriate arrangements are made for all residents to participate within a programme of activities both `in house` and within the local community. Previous timescale of 30.4.07 not met Ensure that any complaints received into the care home are fully investigated and that there are records detailing the investigation, action taken and any outcomes. Ensure that the environment and equipment is maintained and in a good state of repair. 01/07/07 8. OP16 22 14/06/07 9. OP19 23(2) 01/08/07 10. OP19 13(4) 11. OP27 18(1)(a) Previous timescale of 30.4.07 not met Ensure that all areas of the home 14/06/07 are kept safe for residents. This refers specifically to the sluice room being easily accessible and some wash hand basins emitting hot water above 43° centigrade. Ensure that there are sufficient 14/06/07 staff on duty at all times to meet the needs of residents. Previous timescale of 30.4.07 not met Ensure that robust recruitment procedures are adopted and maintained at all times. Ensure that all records as required by regulation are available for inspection. Ensure that all staff working at the home receive appropriate training, which meets the needs of residents. This refers to both mandatory and specialist training. DS0000015457.V335915.R01.S.doc 12. OP29 19 14/06/07 13. OP30 18(1)(c) 01/09/07 Milton House Version 5.2 Page 25 14. OP36 18(2) Previous timescale of 30.4.07 not met Ensure that all staff receive regular supervision. 14/06/07 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. 4. 5. Refer to Standard OP3 OP5 OP14 OP15 OP27 Good Practice Recommendations Enable the manager and/or senior staff to undertake an active role within the pre admission assessment process of prospective residents. Enable prospective residents and/or their representatives to have the opportunity to visit the care home prior to admission. Ensure that residents are empowered and enabled to make everyday decisions and choices. Ensure that the delivery of meals to residents are unrushed and unhurried. Ensure that appropriate measures are undertaken to ensure staff remain competent to the work they perform. This refers specifically to some staff working long days/excessive hours. Ensure that appropriate measures are undertaken to deploy staff within the home so that residents are better supported. Enable the manager to have more autonomy in the day to day running of the home and to be part of and contribute to the decision making process. Ensure that accident records for residents include specific staff interventions and outcomes. 6. 7. 8. OP27 OP31 OP38 Milton House DS0000015457.V335915.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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