Inspection on 15/10/07 for Milton House

This inspection was carried out on 15th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milton House 14/10/09

Milton House 20/12/06

Milton House 28/06/06

Milton House 04/10/05

Milton House 10/05/05

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 Shelagh Laver. Unannounced Inspection 15th October 2007 09:30 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 DS0000003271.V350897.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 DS0000003271.V350897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address West Street Bridgwater Somerset TA6 3RH 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) 01278 422235 01278 431511 julie.gohot@somersetcare.co.uk Somerset Care Limited Mrs Julie Bohot Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (51) of places Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. 20th December 2006 5. Date of last inspection 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 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 accommodation is arranged on two floors with two passenger lifts. All the bedrooms are single. The home has three lounges and a large dining area. A telephone is available for service user use. There is a patio area and a garden, which has been landscaped to ensure safe level access for service users. Car parking space is minimal. The current fees range from: £487 - £577.50 dependent on whether personal or nursing care is required, and does not include hairdressing, newspapers, magazines or toiletries. Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited the home for one day. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The inspectors spent time talking with people living in the home and staff. There were opportunities to observe lunch being served and care practices. The manager, Julie Bohot was available throughout the day and all records requested were made available. At the time of this inspection there were 46 people living at Milton House. Prior to the visit the manager completed a comprehensive and informative Annual Quality Assurance Assessment (AQAA) detailing work undertaken in the past year. Comment cards were sent to people who lived in the home, their relatives and staff. Cards from people who lived in the home confirmed that they received the care and support needed always or usually. People felt that staff listened to them and that they received medical support. “Staff do their best to help people adjust to a new way of life.” “There is great kindness and the staff are very welcoming to visitors.” “The attempts to provide activity and interest can be good…” The home has been awarded a £30,000 grant to make a sensory garden which will include safe pathways and accesability for the residents. This will also include a gardening area with raised borders so that the residents can tend the garden. There will be a summer house to provide shade and privacy. The work had begun on the construction of the garden. What the service does well: Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 6 People said they were well looked after and that staff were kind. Relatives who responded in comment cards felt the home tried to keep in touch with them and that “on the whole Milton House is a good nursing home.” The manager is well qualified and experienced in clinical care. she is pro-active in bringing about improvements in the home that will benefit the people who live there. There is a clear idea of the standards of care that should be achieved in the home. The home is supported by a raft of policies and procedures that are implemented as a basis of good practice. Lunch-time is leisurely and provides good food in a friendly atmosphere. People were able to talk about some outings and events they had enjoyed. The home is fresh and clean. What has improved since the last inspection? What they could do better: Consideration should be given to the way in which people spend their day. The inspectors saw that several people spent a large part of the morning sitting in the dining room in wheelchairs. There was no staff allocation to this area and no entertainment. People spoken to said they were “waiting for lunch” In a small upstairs lounge it was also seen that people were sitting in this area in standard wheelchairs for most of the day. Again it was not clear how people would summon assistance and no staff were allocated to this area. Not all people had access to drinks and call bells in this area. There is an activities provision in the afternoon but the home should make discuss with people how they would prefer to spend their mornings. There Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 7 should be opportunities for all service users to engage in stimulating activities suited to their needs, preferences and abilities. The home continues to recruit staff and is planning to hold an open day. More staff should be encouraged to undertake NVQ 2. There were comments in the cards received from several residents and their relatives about the length of time taken for staff to respond to bells on occasions. This caused people distress especially if people were needing the toilet. The manager has been able to access additional staffing and is also aware of this issue and is actively addressing it. 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 DS0000003271.V350897.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 DS0000003271.V350897.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): 2 3 4 5 6 Quality in this outcome area is good. 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 This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an up-to-date Statement of Purpose in the front hall and prospective service users/ representatives are provided with a Service User Guide. This is available in large print, braille and audio versions. Pre- admission assessments are carried out by appropriate staff and records of these are kept in peoples care plan folders. There was evidence both of home documentation and information received from hospital discharges or social service assessments in files examined. People in the home said their needs Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 10 were met and some people spoke of the improvement in their health since being at the home. Service users have reviews initially to help the transition period and then to assess whether their needs are being met. Most people who returned a comment card confirmed that they had received sufficient information about the home prior to moving into the home. Milton House DS0000003271.V350897.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 good. The health needs of people are met. Medication administration is safe. People are treated with respect at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comment cards confirm that people in the home receive the medical support needed “always” or occasionally “usually”. It could be seen in care plans that regular reviews with GPs were held. Emergency visits were made to address urgent health needs. The community psychiatric nurse makes regular visits and will provide telephone advice at all times. Plans showed access to other health professionals is organised by the home. Audiologists, opticians and chiropodists will also visit the home. . There was plenty of pressure relieving equipment and specialised nursing beds. Four care plans were observed in detail. The home has implemented a computerised care planning system. The plans seen were comprehensive and detailed. There has been a good deal of work in setting up and using the care Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 12 plans. Paper copies are available but there is increasing emphasis on relying on the computerised version. Plans seen contained some very detailed information about people and there are regular audits by one of the Registered Nurses. This is good practice. They included moving and handling assessments and directions, nutritional care plans and records of weights, falls risk assessment and mental and psychological care plans. Staff keep daily records very brief and task centred. It would be useful to see some holistic comments. How was the person overall on that day? Comments from relatives indicated that people were well cared for at the end of their lives. There were thank you letters and cards from relatives of people who had been in the home. Medication administration was safe and well organised. Medication audits are carried out daily. The management and administration of medication is carried out adhering to SCL and legislative policies. Accurate records are maintained. Staff talked to people appropriately and it was clear that their privacy was respected. Somerset Care have produced a document on how to support dignity in care, this was discussed at a team meeting and is on the staff notice board to raise their awareness. Milton House DS0000003271.V350897.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 15 Quality in this outcome area is adequate. People are encouraged to make choices about how they spend their day. There is a programme of activities available. Food is plentiful and wholesome. Some routine practices in the home need reviewing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were records in peoples’ files that indicated that some had participated in social events. Staff take residents shopping or out for coffee. There are regular musical afternoons. On the day of the inspection people were playing bingo. The AQAA demonstrated acknowledged the homes approach to outdoor activities. “Raised borders have been built which allow residents to take part in gardening sessions,look at, touch and smell. We grew salads which they were able to pick and enjoy eating.” The importance of trips out for people is also recorded in the AQAA. “Although it would be difficult for us to go out on day trips using a coach due to the Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 14 dependency levels of our residents we take every opportunity to get out and about. We attend the fair, carnival concerts, carnival, go into town for any events taking place locally, (as we can take residents out in the wheelchairs).” Key workers work with residents and their families and friends to provide a social history People living in the home who completed questionnaires stated that there were usually or always some activity they could take part in. Other people spoken to during the inspection were not so sure and felt “stuck in their room.” People spoken to enjoyed the food. Lunch is clearly the main meal of the day. On the day of the inspection people enjoyed soup, a choice of main course and a selection of puddings brought to their tables on a trolley. Staff took time to assist people if they needed it and also to talk with people. One lady particularly enjoyed the “fish on Friday.” People commented on the fact that relatives are always welcome. One person said “It is as if it becomes their home too.” There are established practices in the home that the manager must review. People are brought to communal areas when care is completed and can then be waiting for some time for lunch in unadapted wheelchairs. The inspectors were concerned to see that some people spent many hours in wheelchairs. Attention must also be paid to the ways in which people summon assistance and access drinks once in the communal rooms. One person said “Once you are “done” you have to be good while others are “done”.” Milton House DS0000003271.V350897.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 17 18 Quality in this outcome area is good. People in the home feel confident that their complaints will be addressed and dealt with. Effective recruitment practice and training protects people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints policy and procedures. The complaints received since the last inspection had been investigated and recorded according to the policy. People who returned comment cards said that they knew who to talk to if they were unhappy and knew about the complaints policy. Recruitment practices are sound. Staff are receiving training up-dates in the protection of vulnerable adults. Milton House DS0000003271.V350897.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 26 Quality in this outcome area is good. People live in an attractive comfortable environment that is safe and adapted to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home confirmed it to be clean, attractive and adapted to peoples’ needs. Comment cards confirm that the home is fresh and clean. It is presented well and furnished to a good standard. Radiators are covered and windows secured. There are plenty of comfortable chairs and a choice of communal areas. Bedrooms contained personal belongings and peoples preferences for surroundings had been respected. There are appropriate mechanisms in place to prevent infections Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 17 Milton House DS0000003271.V350897.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 30 Quality in this outcome area is good. The skill mix and numbers of staff on duty meet peoples’ needs. The recruitment policy and practices protect people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing numbers and skill mix are appropriate to the assessed needs of the people in the home. The staff rota was accurate and showed evidence of review to ensure balanced shifts. The skill mix has been reviewed and amendments made to the rota including a recent increase in care assistant numbers. The manager acknowledged in the AQAA that staffing the home presents challenges. “Recruitment and retention of good staff is an ongoing problem. The dependency levels of the residents is high and this means staff have to work hard. The recruitment of new staff takes time and investment.” There are times when agency staff are used to maintain numbers although an on-going recruitment programme seeks to reduce agency use. There is an organised staff development programme. Senior staff have received care plan training to ensure a person centred approach which encompasses equality and diversity. Four team leaders have been appointed Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 19 to assist with the induction of new staff and providing a mentoring programme. The team leaders are given time to do this on a supernumery basis. An in house training co-ordinator provides induction as well as the mandatory training. The home is providing a preceptorship programme for the development of a newly qualified nurse. Milton House DS0000003271.V350897.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 35 38 Quality in this outcome area is good. The home is well-run and maintained putting service users in the centre of all systems. There is a system of planned maintenance that promotes the safety of staff and service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The appointment of a new nurse manager has resulted in many changes within the home. Routines have been reviewed and changed and there is constant emphasis on how peoples’ lives can be improved Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 21 The home has the Somerset Social Services quality rating. A residents meeting held in April had discussed menus. There had been a “residents and family “ meeting in July when people had discussed ideas for the new sensory garden. The annual quality survey showed that 85 of people felt that they were treated very well. There were some comments about the waiting time for assistance. The manager is taking action to address this by increasing the staffing levels. There are regular visits by the Somerset Care Quality Assurance Manager. Staff receive regular reviews to highlight areas of concern and monitor progress. Regular staff meetings are held so that staff can have their say, express concerns and for information to be cascaded down as well as sharing ideas. There is planned and methodical maintenance although on the day of inspection there were some omissions in record keeping. Milton House DS0000003271.V350897.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 2 3 3 Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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 OP15 Regulation 12(1) Requirement The registered person should, in consultation with service users, review the length of time they are sitting either in the sitting areas or at the dining room tables at mealtimes without supervision or any social interaction. Staff must be aware of the implications for peoples health of this practice. There must be a clear system in place to ensure that people in communal rooms have continued access to assistance and support. The registered person must ensure that people who cannot leave their rooms due to illness are consulted about possible activities and social interaction. Whenever possible people must be offered the opportunity to be included in the life of the home. (Subject to individual choice.) Timescale for action 01/12/07 3. OP38 13(4) 01/12/07 4. OP14 12(1) 01/12/07 Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 24 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 OP8 Good Practice Recommendations The registered person should ensure that where a service user is identified as needing supplement drinks, the type is reflected in the nutritional risk care plan. All records of transactions relating to peoples’ finances should have two signatures. If a member of staff is being supervised pending the arrival of the CRB check this should be indicated on the duty rota. The person supervising should also be indicated. 2. 3. OP35 OP29 Milton House DS0000003271.V350897.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 DS0000003271.V350897.R01.S.doc Version 5.2 Page 26 - 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. 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