Inspection on 14/02/08 for Milton House

This inspection was carried out on 14th February 2008.

CSCI found this care home to be providing an Adequate service.

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 28/08/07

Milton House 12/04/07

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 Ms Vicky Dutton Unannounced Inspection 14th February 2008 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.V359850.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.V359850.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.V359850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th August 2007 Brief Description of the Service: Milton House is owned and managed as part of the Strathmore Care group of homes. Care and accommodation is provided for up to twenty eight older people. The home has twenty four single and two shared bedrooms. Not all bedrooms have an en suite facility. There are two spacious lounge areas and a dining room. There is a car parking area to the front of the building and an enclosed secure courtyard garden towards the rear of the property. Milton House is situated close to central Southend and has good access to local bus and train routes. Milton House has both a Statement of Purpose and Service Users Guide available. It was confirmed that the current fees at the home are £362.46 to £441.00 There are additional charges for chiropody, hairdressing, and other personal requirements. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are facilitated to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. Two inspectors undertook this site visit and they spent seven hours at the home. On the day of the site visit the home had ten vacancies and eighteen people were being accommodated. A partial tour of the premises took place, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at Milton House and talking to staff and visitors. In January 2008 the manager completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to people living at the home, staff, relatives and involved professionals. At the site visit a notice was displayed advising people that an inspection was taking place, and with an open invitation to speak with an inspector at any time. The views expressed at the site visit and in survey responses have been incorporated into this report. Assistance was given at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. The inspectors would like to thank people living at Milton House, the manager, staff team, and relatives for their help throughout the inspection process. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new manager is in post at Milton House. They are having a positive impact, and making improvements that will continue to improve the lives of people living there. The manager is now actively involved in visiting and helping to assess people’s needs before they decide to move into Milton House. This will provide continuity, and help to make sure that people do not move into the home unless it is suitable for them. Before people move into Milton House their needs are assessed. This information is used to make a plan of care to ensure that people’s needs and preferences are understood and met my staff at the home. Care plans, and other documentation used at the home to show how people are cared for have been greatly improved. This means that people living at the home can now be more confident that they will receive good care based on their individual needs and preferences. To help this process further a ‘key worker’ and ‘link worker’ system has been recently developed. This provides people living at the home with two identified members of staff that will take a special interest in their care. This development will hopefully further encourage a person centred approach to meeting people’s individual needs. The management of medication has improved. Staff are trained and aware of how to assist people safely with their medication. Aspects of the environment have been improved for the benefit of people living there. Redecoration has taken place and a small hairdressing facility has been developed. Staff recruitment has improved. People can now be confident that new staff are properly vetted before they start work at Milton House. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000015457.V359850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be sure that their needs will be fully assessed to make sure that the home is suitable for them. They may not however always have good written information about the home to help them to make an informed decision about moving in. EVIDENCE: A Statement of Purpose dated September 2007, and ‘Service Users Guide 2007’ were available. These were noted to need some revision. In particular the Service Users Guide did not contain details of fees charged. Although the service users guide referred to a copy of the last inspection report being available in the home, it was not available as part of the service users guide that could be given out to people to assist them in decision making. It was stated that the Statement of Purpose and Service Users Guide were currently being further updated. It was agreed that copies of the updated documents Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 10 would be sent to the Commission as soon as possible. The Annual Quality Assurance Assessment (AQAA) completed by the home said under this section that what they could do better was to ‘update the home’s brochure.’ When people move into the home information is available to them in the form of a ‘Residents Handbook.’ These were noted to be available in people’s rooms. Only one person has moved into the home since the previous inspection, they did not recall having been given any written information prior to moving into Milton House, and had not visited. They felt that they had been given enough verbal information to make a decision. Of five service users surveys returned two said that they had received sufficient information. Three said that they had received no or limited information to help them to make a decision. The Company employs an admissions co-ordinator to carry out pre-admission assessments for a group of homes owned by the Company. It was positive to learn that the manager of the home now accompanies the admissions coordinator on assessment visits. This ensures that the manager with responsibility for the home, and an overview of the current occupancy, has a say in whether a person’s needs will be able to be met, and if the home will be suitable for them. Only one person has moved into Milton House since the previous inspection. Their pre-admission assessment, undertaken by the manager, had been well completed and provided a good level of detail to ensure that their needs would be understood when they moved in. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be sure that their health and care needs will be planned for, and that they will be able to be involved in this. Risks associated with care will be recognised and generally appropriately assessed and managed. Their medication will be managed safely. EVIDENCE: People spoken with at the site visit generally felt that they received good care. On five surveys returned two people felt that they ‘always’ received the care and support they needed. Two said that they ‘usually’ did, and one felt that they ‘sometimes’ did. One of these said ‘I feel sometimes I don’t get enough help.’ All felt that staff listened to them and acted on what they said. Both inspectors present at this site visit viewed some people’s individual care plans and associated care documentation. Four care plans were viewed in detail and aspects of others were sampled. It was clear that much effort and care had been put into improving a previously poor situation in relation to planning and providing care based on individual needs. In a newly introduced Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 12 system, each person living at the home is now allocated a key worker and senior link worker. This is to encourage a more individual and person centred approach to meeting people’s needs. Care plans viewed provided a generally satisfactory basis to ensure that people receive the care they need in line with assessments carried out. Care plans were quite person centred and gave staff good information and instruction on how to meet peoples identified needs in a sensitive manner. Staff spoken with were knowledgeable about peoples care needs, and had an awareness of the detail of individuals care plans. People had signed their care plans to indicate that they had been involved with the process. Care plans were seen to be regularly reviewed, and are audited on a monthly basis by the manager to pick up on any areas that needed improvement. Risk assessments were in place for relevant areas such as moving and handling, and challenging behaviours. Risk assessments were also in place for people using bedrails, but these had not been competed involving other relevant professionals using a multidisciplinary approach. No staff at the home had undertaken training to ensure that their practice relating to the assessment for the use of bedrails was up to date and in line with best practice, although the manager said that she had attended a seminar. In one persons room no ‘bumpers’ could be found to use with the bedrails as stated should be the case in the care plan. When the manager looked into this it was discovered that bumpers were not available, and that staff had been using a duvet to provide for cushioning and safety instead. Another person was in the same situation. This practice has the potential to place people at risk. The shortfall had not been reported to the manager through the staff team. The manager undertook to address this situation urgently. Care files incorporated generally good records of people’s care, although there were some gaps in consistency of recording on some ‘elimination records’ and ‘bathing and bed change records.’ Daily notes viewed were sufficiently detailed to show that people had received care and attention. People’s healthcare is monitored. On surveys three people felt that they ‘always’ received the medical support they needed and two felt that they ‘usually’ did. On the day of the site visit observations showed that staff were alert to peoples’ wellbeing, and a Doctor was called out to attend to two people who had said that they felt unwell. On a survey one visiting professional felt that staff were not always equipped with sufficient information about the person that they had been called out for. However on the day of the site visit staff were noted to be prepared to facilitate a doctors visit, taking the care file with them when assisting. Professional visits were well recorded in care files, and showed that appropriate referrals were made to different practitioners, for example a continence assessor and a community psychiatric nurse. Records showed that regular visits are also received from an optician and chiropodist. Care plans showed that assessments were in place relating to people’s nutritional and tissue viability needs. The risk of falls had also been assessed. Where people, as a result of an assessment, were deemed to be ‘at risk,’ appropriate ‘control measures’ were identified and care plans were in place. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 13 On files viewed people’s weight was being monitored. It was seen that good nutrition records were being maintained. Staff spoken with about medication issues and systems were experienced, professional and competent. Medication rounds observed during the day were carried out in a way that demonstrated good practice and sensitivity to people’s needs. Staff who administer and manage medication are all fully trained to do so. The AQAA stated that all staff dealing with medication have completed a training course and are competent in the administration of medication. Records examined confirmed that staff have received training around the safe storage and administration of medication. The home’s system for checking, monitoring, ordering, disposal and booking in of and accounting for medication are all to a good standard. Records regarding the administration of medication were up to date and accurate so people receiving medication are less likely to experience mistakes. During the site visit staff were noted to treat people with kindness and sensitivity. A visiting professional felt that staff sometimes had to be reminded about providing people with privacy and dignity during consultations. However this was not noted during the site visit and people’s privacy was respected at all times by staff. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 14 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, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People will have some opportunities for occupation and stimulation, but this may not be frequent enough, or relevant to their individual needs and choices. People cannot be sure that the food provided will meet their preferences or expectations. They know that they will be able to maintain contact with friends and family through the home’s open and welcoming approach to visitors. EVIDENCE: The displayed activity programme offered a variety of social activities that might be suitable to the needs of the people living at Milton House, for example bingo, board games, and reminiscence for people with dementia, craft sessions and sing-a-long sessions. These are planned to take place at set times in both the morning and afternoon. It was positive to note that a computer had been provided for people living at the home to use. Care plans sampled did not always fully detail the social and leisure needs of the individual, but it was positive to note on one persons care plan that their religious and cultural needs had been identified and planned for. During the site visit we saw people spending time in various parts of the home including communal areas and their bedrooms. People spoken with said that the home did not provide a variety of Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 15 activities in line with what they enjoy doing. People said, ’I like watching other people playing the games,’ ‘not much to do here it is a bit hit and miss,’ ‘the things that they do here I am not interested in. It is not very imaginative, just recently I went to the shops with member of staff first time in two years. Staff always seem to be too busy to do proper things with us they have outside entertainment but it all seems to be done on a budget and it is boring, then I get down and feel depressed,’ and ‘I prefer not to do the things they do here.’ One relative commented, ’my [Mum] has lots of things to keep her occupied and she seems to enjoy herself.’ At one point during the site visit there was music in the background, songs from the 40s and 50s, and one person was joining in with the songs. Staff spoken with did not demonstrate an awareness the importance of a structured, relevant activity programme, but did show a willingness to spend time with people. The activities planner is displayed on the notice board and shows the range of individual activities that are planned for each day, including bingo, afternoon tea, hairdressing, board games. The planned activity due to take place during the morning of the site visit did not happen, and a member of staff put on a video that was far too loud and drowned out all other sound. During the afternoon scheduled activity time nothing was observed to be happening. A member of staff was sitting in the lounge with people writing up daily notes. Although the home is not registered to provide dementia care there are clearly people living there who may have dementia. Care plans did not show a structured approach to assessing and meeting their social or occupational needs. Visiting is open with no restrictions, visitors were seen to come and go during the day. This ensures that people living at the home can maintain contact with their friends and families. Peoples’ rooms were personalised, showing that they could bring their personal possessions into the home with them. All rooms had locks and people are able to have keys to their room should they so wish. People’s keys are hanging on a hook on the doorframe and are there for use if required. People spoken with said they were provided with choices in their daily lives (e.g. time in getting up, going to bed, where and what they ate, where they spent their time, etc.) Preferred routines were recorded in care planning information. Information on advocacy services was available for people. People’s care files had some information regarding their nutritional needs and dietary preferences, and the staff spoken with are fully aware of these. Kitchen staff spoken with showed that good practice regarding hygiene and Health & Safety. The home has a menu that offered two choices of main and teatime meals. The chef stated that she uses mainly frozen vegetables except on Sunday when some fresh are used. The kitchen is well maintained and food stocks are sufficient. It was noted that there was a high quantity of ‘ready type meals’ available to people. The lunchtime meal on the day did not look particularly appetising and the chef was observed serving dinners and then Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 16 pouring large amount of gravy on every single dinner before they went to the dining room. Two people attempted to eat their meals and then refused stating ‘the food is always covered in gravy, I don’t like it.’ The staff attempted to offer these individuals another meal but they refused. While the lunchtime meal was being served it was noted that one of the menu choices was Shepherds Pie, this was found to be re-heated leftovers from another day. This issue was discussed with the manager who then went to discuss the matter with the chef. Liquidised food is provided for people who have difficulty swallowing or chewing their food. The menu of the day was observed displayed handwritten on the notice board in a dining room, however the notice was not clearly written and would have been difficult for people to read who have poor eyesight. The menu was also written up on a board in the lounge area, but this showed the menu from two days previous to the site visit. Relatives and people who completed surveys said, ’We sometimes have good food,’ ‘I like the food,’ and ‘they will always have snacks at times suitable to people.’ People spoken with during the inspection stated that the food ‘was not imaginative and that we don’t really get to choose the menu.’ A relative spoken with said that their relative enjoys the food. The kitchen is clean and well organised with appropriate cleaning schedules in place that are adhered to. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 17 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, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that they will be able to raise any concerns, and that these will be listened to. Staff will be aware of how to safeguard people from abuse, but may not be supported by good policies, and information being available to manage any incident effectively. EVIDENCE: A complaints procedure was on display in the entrance area. It was noted that the complaints procedure should be updated to include details of the Local Authority who have the statutory authority to investigate any complaints about the service. It was discussed with the manager that the format and location of the procedure on display might not be ideal for people to view easily. Most people spoken with, or on surveys, said that they knew who to speak to if they were not happy, and knew how to make a complaint. The AQAA completed identified that 12 complaints had been received in the previous year, and that a new recording system was in place that provided better recording and management of complaints or concerns. Complaints records were viewed. Only one complaint had been recorded since the previous inspection. This had been properly recorded and managed effectively. Each care plan viewed was noted to include a ‘POVA risk care plan.’ This indicated any potential areas of concern and strategies to minimise the risk of any incidents occurring. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 18 A training matrix showed that all staff had undertaken training in safeguarding adults, but that some would benefit from this training being updated, as it was last undertaken in 2005. The Company’s policy is for this training to be undertaken every two years. Staff spoken with demonstrated a good understanding safeguarding but did not have access to up to date policies and procedures. The AQAA completed by the home indicated that their Safeguarding Adults and the Prevention of Abuse policy was last reviewed in January 2002. When staff were asked about policies and procedures they indicated the Southend on Sea Protection of Vulnerable Adults Procedure that was distributed in 2002. Relevant and up to date contact information for local safeguarding teams was not readily available. From care planning information it was evident that some people living at the home have the potential to exhibit challenging behaviour. This had been risk assessed and good care planning strategies put in place. However it was confirmed that no staff have as yet undertaken training in managing challenging behaviour that would help inform their practice and encourage a consistent approach. The manager felt that this had been addressed to a degree through the dementia training that had been undertaken by some staff. The training matrix however showed that only the manager and three staff have undertaken recent training in dementia. Seven staff have not undertaken any training and five staffs’ training in dementia care dates from 2004/5. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 19 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, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable and well maintained home. EVIDENCE: Milton House provides a generally comfortable and homely environment for people to live in. The premises appeared well maintained and no particular health and safety issues were noted during a partial tour of the building. Since the previous inspection some areas have been redecorated. During the site visit redecoration continued in the main lounge. The minutes of a meeting showed that people had been asked if they wanted their individual bedrooms decorated. While this was positive it was not so positive to learn that people cannot then choose what colour they would like to have their rooms decorated in. All rooms and areas of the home are decorated in a uniform plain colour. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 20 It was noted that a number of bedrooms had un-homely looking hospital style beds. The manager said that these will be replaced in a phased approach, with eight new beds being currently on order. Although the home is not registered to admit people who have a diagnosis of dementia, clearly some people living at the home do now have cognitive impairments. It was therefore advised that staff consider if any specific aids or signage might assist in meeting these people’s individual needs. On the day of the site visit the home appeared clean and there were no unpleasant odours. On surveys people felt that the home was ‘always’ or ‘usually’ fresh and clean. The laundry area is accessed through the home’s garden. It provides an adequate facility to meet the needs of people. Training records identified that most staff had undertaken training in infection control. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by safely recruited and generally well trained staff, who are available in sufficient numbers to meet their care needs. EVIDENCE: People spoken with were positive about staff at the home, and felt that they were caring and pleasant. On surveys three people felt that staff were ‘usually’ available when needed, and two said that they ‘always’ were. The staff rota examined on the site visit reflected that the home is providing a suitable level of staffing based on the their assessment of people’s needs. The home had an appropriate number of day care and night care staff and additional numbers were on duty during busy periods. The home does not use agency staff to cover absence, as it will use a member of the permanent staff team, or a member of the bank staff team to cover the shortfall. This results in people being cared for by a consistent team of carers. The home is not full at the moment and has ten vacancies. As numbers increase the staffing levels will need to be kept under review so that they continue to meet people’s needs. Three members of staff spoken with said they are supported to do National Vocational Qualifications (NVQ). Two have completed the award and one has just finished. The training matrix shows that out of a total of 16 care staff, 10 have completed NVQ at level two, and a further three are planning to Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 22 undertake the award. This shows that the home have exceeded the National Minimum Standards which say that at least 50 of care staff in a home should be trained to NVQ level two or above. The recruitment process used in Milton House is rigorous. The personnel files of two recently employed staff were inspected. Both had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and copies of birth certificates, passports, and photographs obtained before the individual’s commenced employment at the home. All had received a statement of terms and conditions of employment. Staff spoken with said …’I could not start work until all my checks had been done,’ and ‘all staff have to have checks carried out.’ The personnel records examined confirm that the recruitment process is thorough enough to make sure that people living in the home benefit from appropriately recruited staff. The files are well organised, all contain a photograph of the staff member, two written references, job description, employment history and relevant proofs of identity. When staff start work at the home an induction process is undertaken to ensure that they have a good understanding of procedures and practice expectations. The home has a training programme that aims to ensure that people are cared for by competent and knowledgeable staff. Staff training certificates are kept in the individual personnel files. Staff spoken with said ‘the training I have had is good,’ and ‘I find any training very helpful to me.’ A further three members of staff spoken with all made positive comments about training; one said ‘the training is useful.’ One said they have had training including Manual Handling, and First Aid but felt that they needed training in dementia care. Although the home is not registered to admit people who have dementia, observations during the site visit clearly showed that a number of people living at there have significant cognitive impairments. An up to date training matrix shows that only three staff and the manager have completed recent training in dementia care. The matrix shows that although on paper the home provides a range of training that includes: Fire Safety, First Aid, Food & Hygiene, Heath & Safety, Infection Control, Moving & Handling, NVQ2, NVQ3 and Protection of Vulnerable Adults not all staff have received refresher training this can leave people living in the home at a disadvantage as staff do not have up to date knowledge to inform their practice. As highlighted earlier staff would also benefit from being trained in managing challenging behaviour. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 23 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, 35, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be sure that management at the home is working towards providing them with a well managed and safe service, where their views are listened to. EVIDENCE: A new manager started work at Milton House last November. With ongoing support from other managers in the organisation, they have made excellent progress in a short space of time in addressing many of the issues previously identified at the home. The manager has a good level of previous experience. Documentaion and discussion during this inspection showed that the manager is organised and efficient in their role. They demonstrated that they have a clear vision for the home, and the ways in which it can improve. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 24 Regular meetings are now taking place for people living at the home and staff. The minutes of a ‘residents meeting’ showed that people felt able to express their views. On the completed AQAA it was felt that the home provided an ‘Open and friendly environment to all residents and visitors alike, open door policy.’ This was confirmed by visitors and people spoken with during the site visit. During the day of the site visit different surveys and elements that contribute towards quality assurance were seen. These included a ‘listening form,’ and a ‘post admission service user appraisal survey,’ (completed last November for a person who had lived at the home since 2005.) The provider has strategies in place to monitor the service. Quality monitoring audits take place on a monthly basis. Visits as required by regulation are also carried out on a monthly basis. These visits include talking to people about the service provided. These elements show that people’s views on the service are sought, but that there is not a co-ordinated approach to gathering and analysing information that could be used to provide an ongoing plan for developing the service. The AQAA completed by the manager was briefly but fully completed. It identified that some of the home’s policies and procedures have not been reviewed since 2002. This includes in some areas where legislation changes may mean that a review is required such as ‘Confidentiality and Disclosure of Information,’ or areas important to the service such as ‘Individual Planning and Review,’ and ‘Health and Safety (Health and Safety at Work Act 1974)’ Records viewed showed that when people’s personal monies are held for safe keeping, this is done in a safe way that protects their interests. The AQAA completed showed that systems and services are regularly maintained. A fire risk assessment was in place, and records showed that regular fire drills take place so that staff are aware of the correct procedures to follow. Training records showed that staff had received recent fire and health and safety training. The AQAA stated that 100 of staff are trained in food safety. This is correct but training records showed that seven staff are now overdue or nearly due for update training to keep their skills and knowledge current and people safe. The organisations procedures stipulate that routine checks and testing of fire equipment take place on a weekly basis. Records showed that this has not been happening. Only one test had been recorded for January and one for December. In November checks had been carried out on three occasions. Records prior to that dated from August 2007. People cannot therefore be confident that when needed equipment such as emergency lighting will fully provide for their safety. Milton House DS0000015457.V359850.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 2 Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 26 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 OP12 Regulation 16(2)(m) and (n) Requirement Ensure that appropriate arrangements are made for all people living at the home to participate in a programme of activities that is suitable to meet their assessed needs, both `in house` and within the local community. Previous timescales of 30.4.07 and 1.7.07 and 01/11/07 not yet fully met. 2. OP18 13(6) So that people are protected and 01/04/08 staff take appropriate actions, up to date policies, procedures and information must be available and understood by staff in relation to safeguarding. So that people receive care from skilled and well trained staff at all times, Staff working at the home must receive appropriate training. This includes training in dementia care and in managing challenging behaviour. 01/07/08 Timescale for action 01/04/08 3. OP30 18(1) Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 27 4. OP38 12(1)(a) Regular safety checks of fire and 10/04/08 other equipment must be maintained and should be carried out in line with the Company’s own procedures. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations An accurate and up to date Statement of Purpose and Service Users Guide should be available, and given to people where appropriate to provide them with information about the home. Information should be provided in suitable formats. When the current review of the Statement of Purpose and Service Users Guide is completed, copies to be sent to CSCI. To ensure people are cared for safely risk assessments in relation to the use of bedrails should be undertaken using a multidisciplinary approach. The menus and provision of food at the home should be reviewed to ensure that people are offered fresh foods and a wholesome diet in line with their individual choices. People living at the home should be able to have a choice about how their personal accommodation is decorated. Policies and procedures used to ensure the correct running of the home should be kept under regular review. 2. OP1 3. OP7 4. OP15 5. 6. OP19 OP37 Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Milton House DS0000015457.V359850.R01.S.doc Version 5.2 Page 29 - 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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