Inspection on 16/12/08 for Milton House

This inspection was carried out on 16th December 2008.

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

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 14/02/08

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Milton House 58 Avenue Road Westcliff On Sea Essex SS0 7PJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Milton House 58 Avenue Road Westcliff On Sea Essex SS0 7PJ 01702437222 01702436536 info@strathmorecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Davie Vive-Kananda Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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 is not registered to provide care for people who have dementia. The home has twenty four single and two shared bedrooms. Most 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, overlooked by the homes two lounge areas. 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. The Service Users Guide (updated in April this year) advised that the current fees at the home range between £55.43 to £72.50 per day. There are additional charges for chiropody, hairdressing, and other personal requirements. Care Homes for Older People Page 4 of 31 Over 65 28 0 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that people who use this service receive adequate quality outcomes. This was an unannounced key site visit. The previous inspection of the home took place on 14th February 2008. At this visit we (CSCI) 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 helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. Care Homes for Older People Page 6 of 31 The site visit took place over a period of eight hours. A partial tour of the premises was undertaken. Care records, staff records, medication records and other documentation was selected, and various elements of these looked at to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. We also spoke to four visitors and one visiting professional during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was received by the due date. It was very briefly completed but outlined how management feel they are performing against the National Minumum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. Eight residents and four relatives surveys were returned. No staff or visiting professionals returned surveys. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The manager has worked to improve the level and consistency of activities available for people. Unfortunately staffing issues have meant that good intentions have not always Care Homes for Older People Page 8 of 31 been achieved, and a number of people remain dissatisfied with this aspect of the home. At the moment people cannot feel confident that their care plans are properly completed and maintained, so that their needs are fully identified, and they receive care in the ways that they wish. Although things should now be improving as the home has recruited more staff, people told us that staffing shortages and a heavy reliance on agency staff has also had a major impact on the quality and consistency of care provided. When new staff start work at the home they have not always had the support and training that they need to work well and safely with people. At the last inspection we made a requirement for management to ensure that safeguarding policies and procedures are up to date, understood and acted on by staff. This has not fully happened, so people still cannot be confident that if an incident occurs staff will manage this openly, and refer it to the local safeguarding team. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Milton House can be assured that their needs will be assessed to ensure that the home will be able to care for them. Evidence: We saw that the home had an up to date Statement of Purpose and Service Users Guide in place. The Service Users Guide had been reviewed in April 2008, and contained good information for people, including up to date details of fees charged. Copies of the Service Users Guide were noted to be available in peoples bedrooms for them to refer to once they had moved in. Out of eight resident surveys returned to us five people said that they had received sufficient information about the home. Others indicated that the placement had been at short notice, or that their family had made the arrangements. One person said that they had visited the home before moving in. One relative said. The care home has succeeded in making my [relative] very welcome and although they have not been there very long, they already call it home. Care Homes for Older People Page 11 of 31 Evidence: So that people interested in moving in, and management, know that the home will be suitable to meet peoples needs, the Company employs a placement co-coordinator. They carry out pre-admission assessments with people interested in moving into any one of the homes owned by the provider. The Annual Quality Assurance Assessment completed by the manager said that, More assessments are now carried out by the home manager when able. This will enable the manager to ensure that the needs of prospective residents will be able to be met by the home, taking into consideration the needs of people already accommodated. We looked at the files of two people who had most recently moved into the home. We saw that good pre-admission assessments had been completed so that the home were aware of peoples needs when they moved in. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service cannot be confident that the care and support they need will be delivered in a well planned or consistent way. Evidence: Since the previous inspection the manager has been working to improve care arrangements at the home to ensure that people receive good and consistent care. In discussion with people and on surveys, views about the quality of the care provided were very varied. For example people said, My [relative] looks lovely, they have their hair done and their nails and always looks nice, and I am happy with all aspects of care. Whereas others said, My finger nails are often dirty and I often still have sleep in my eyes after I have been washed in the mornings, and, Staff dont have time to give proper care, they are in and out quick. A visiting district nurse felt that care provided at the home was satisfactory and, Better than a lot of places. At the site visit people looked generally well cared for, though two people spoken with did have dirty nails, and some ladies had on nail varnish that was old and peeling. We saw that peoples ongoing care is not always well recorded. For example it appeared that people Care Homes for Older People Page 13 of 31 Evidence: rarely had baths. The manager said that staff often neglected to record this. On surveys five people felt that they always received the care and support that they needed, two that they usually did and one that they sometimes did. Some of the comments about care related to the, up to now, heavy reliance on agency staff. One person said, With the changes of staff and huge changes of agency staff you can never feel confident that likes, dislikes, needs or wants stay in place. This will be explored further under the Staffing section of this report. To see how well peoples care is planned for and arranged so that staff are aware of their needs, and meet them in an individual way, we looked at four care files in detail. The AQAA had indicated that the home performed well in this outcome area and under what we could do better stated Nothing noted at present. It is recognised that the manager and staff have worked to improve care planning to provide a more comprehensive approach. In general care plans provided a level of information that would enable staff to provide adequate care. However the review of four care files highlighted a number of issues. Care plans did not always contain detailed, accurate or up to date information. For example one person was noted going off to a hospital appointment in an unshaved state. The manager said that a relative, or occasionally herself, assisted them with this aspect of care as they did not like anyone else doing this. Their care plan said Is able to shave self, but had no other detail. The care plan relating to Eating and drinking, Nutritional needs made no mention of some specific and important medical and dietary needs. For another person their eating and drinking care plan stated that they were diabetic. A member of staff confirmed that this was the case. The manager said they were not diabetic, and that this was just about to be investigated. One persons night care plan said that they used bed rails and preferred only one pillow. There were two pillows in place, and no bed rails. The manager said that they had removed the bed rails as these were no longer needed. Information gathered from assessments and other sources was not well brought together in the actual care plans. For example the implications or impact of certain medications, such as warfarin, on care needs were not highlighted. One person was on a medication that required the avoidance of a certain food. There was no mention of this in the care plan. For one person using an inhaler, there was no mention anywhere in the care file relating to the specific medical need that this was prescribed for, or of other relevant information in relation to their care that the manager brought up in discussion. Risks associated with individuals care were not always adequately or consistently assessed. For example one persons care plan referred to the use of bed rails. There was a risk assessment in place that indicated that the bed rails were always to be used in conjunction with bumpers for safety. When viewed no bumpers were in place. The manager said that the resident refused to have these in place, but no further risk assessment had been undertaken. All these issues may mean that peoples assessed or expressed needs are not met, staff may not be clear about what peoples needs are or how to meet them, and some issues may compromise peoples safety. Care Homes for Older People Page 14 of 31 Evidence: On surveys five people said that they always received the medical support they needed. Three people felt that they usually did. One person said that they had, Noticed an improvement on this front. On the AQAA the manager felt that there had been improvement and said, More referrals are requested to outside agencies to ensure all residents health and mental needs are maintained and monitored. A new form is in use so that on assessment any referral needed to other professionals is identified and carried out. Records viewed showed that management react to peoples changing needs and seek assistance from appropriate services such as falls prevention and continence assessors. Records showed that people access appropriate health care services including chiropody, opticians, district nursing and community psychiatric services. During the day people attended hospital appointments in accordance with their needs. We saw that peoples weight is monitored, and their nutritional needs assessed. The medication systems and records that we viewed during this inspection showed us that this area of care is well managed. Staff spoken with and a training matrix showed that staff who administer medication have received training to ensure that they are competent. Appropriate procedures and guidelines were available to staff to guide their practice. During the site visit staff were observed to be respectful to people and generally responsive to their needs. Privacy was maintained when carrying out care tasks. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may find that the daily routines and opportunities for activity are not sufficient for them to enjoy a fulfilling lifestyle. Evidence: For some people living at Milton House the perceived lack of activities and exercise is an issue. Out of eight surveys three people felt that there always activities arranged that they could take part in. Some comments were, A list of activities is always listed on the board but rarely carried out, Activities are prone to be cancelled with very little notice, I dont know whats happened with activities at the moment, you go down for bingo and nothing happens. I think they are short of staff, and Never enough activities. More often than not cancelled, or are all over in a few minutes. For less able people care planning does not show a consistent approach to assessing their needs and offering them appropriate occupation or stimulation. The manager recognised that improvements could be made in this area, although on the AQAA under what we could do better it said, Nothing noted at present. The home have been trying to improve this aspect of care and provide more entertainment, activities and interests. For example a hamster has been acquired which is enjoyed by people. More activities equipment has been purchased. Trips have been arranged, for example Care Homes for Older People Page 16 of 31 Evidence: to a local pub. Activities Questionnaires have been undertaken with people to try and identify what activities they would like to take part in. An activities person attends the home each Friday from 14.00 to 17.00. A regular church service now takes place. The manager said that sometimes things are arranged, extra staff brought in and then people choose not to participate. The home do however lay themselves open to criticism. One person said, On the notice board it states morning activities every day. There are none. At the site visit we saw that in the lounge a notice was displayed saying Regular daily Activities, Mornings 11 to 11.45, afternoons 2.30 to 3.30. During the morning in the new lounge people spent time dozing in chairs. A member of agency staff when present did not interact or engage with people. During the afternoon a resident had prepared a sing along session. When we looked at activity records it was hard to match these with the advertised Lists of events for set periods. Visitors are always made welcome at the home, and encouraged to be involved. During the day we saw that management and staff interacted well with visitors, who were always offered refreshments. One person said, I have been in several homes and always felt happy to leave them. I almost feel at home here. A much loved friend is allowed to visit me, and they are also pleased with the home and staff. Although a pay phone was available in the home, this was not working and therefore available for people to use to help them maintain contact with friends and family. One relative said, When the new pay phone is installed [relative] will be able to call us again which they did love when they were at home. The home do not have a cordless phone that people could use instead. The manager said that people can always use the office to make or receive calls, and that it might be some time before the pay phone was available again. Staff were respectful of peoples wishes and people were able to go where they wished, spending time in their rooms or communal areas as desired. Daily living preferences such as rising and retiring times, early morning tea, and so on were recorded in care plans. Details of advocacy services were on display so that people know where they can go for independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. In general people seemed happy with the food provided by the home. People made some positive comments such as I always enjoy the food, and The food is tasty were made. The manager reported that there was now a much greater use of fresh fruit and vegetables which people enjoyed. On surveys three people said that they always enjoyed the food, three that they usually did, and one that they sometimes did. Lunch during the site visit looked plentiful. Menus showed a good range of foods are offered. People spoken with said that they were offered choices. The manager Care Homes for Older People Page 17 of 31 Evidence: advised that they were soon to get a hot plate so that meals can be individually served in the dining room according to peoples choices rather than presented ready plated from the kitchen. They also said that the cooks hours had been changed so that a hot choice was now always offered at tea time. Meal times were advised to be: Breakfast between 08.00 and 09.00, lunch 12.30 to 13.00, tea 17.00 to 17.30. One person said, Breakfast I feel should be earlier as I am washed and dressed and have to wait a long time before breakfast which is a problem as I should eat before I have my medication. At the site visit the manager confirmed that a number of people were up early each day. Some people were observed not to get their breakfast served until 09.15. This could be potentially be up to three hours after they have got up. The manager said that people do have tea and biscuits and that one person has cereal. People then had lunch at 12.30, a very short gap after breakfast. People were then being toileted and taken to the dining room soon after 16.00 ready for tea. This means that all meals are quite close together and there could be a long gap between tea and breakfast, particularly if people choose to go to bed early and miss supper. One person said, I have been promised a hot meal in the evenings, but it is still hit and miss. Just a sandwich at 4.30 and then breakfast at 08.30. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people can feel confident in making a complaint, they cannot feel sure that they will be fully protected by staffs approach to safeguarding. Evidence: Since the previous inspection the home have revised their complaints procedure and large copies of this are available in the homes lounges. (Although an older copy is still on display in the entrance area.) On surveys and in discussion everyone said that they knew how to make a complaint. Since the previous inspection one complaint relating to staffing and activities was made to us (CSCI). The concerns were looked into by the provider who completed an investigation and provided us with a detailed response. When we looked at the homes complaints records we found that two issues that should have been referred to Social Services under safeguarding procedures had or were being dealt with as complaints, with the home conducting their own investigation without referral to the local safeguarding team. This was very concerning, as although the home was taking action, they were not following the correct process, or being open about the concerns raised. The manager had a copy of the recently distributed local safeguarding procedures, and a flow chart with contact details was on display. However the manager said that they knew that it was an area where they lacked some knowledge, and had therefore been guided by more senior people in the organisation. They had launched their own investigation. As one incident had only recently occurred the manager was advised to refer it to social services straight away. An alert form was Care Homes for Older People Page 19 of 31 Evidence: downloaded to be completed during the inspection. A senior member of staff spoken with also thought that if an incident occurred that this would be investigated internally. When we looked at staff training records we saw that the Companys policy is for staff to undertake safeguarding training every two years. Four staff have not completed safeguarding training for over two years. Although the homes policies and procedures were said to be recently reviewed, the Guidelines for The Prevention of Abuse did not appear to give staff the correct information. They said, for example, If it is a manager who is the perpetrator you must report this to the owner of the home or in the extreme to the Registration and Inspection Unit. This is out of date as Registration and Inspection units have not existed for many years. Although not currently a major issue, care files viewed showed that some people living at the home can be challenging in their behaviours. Care plans were not always robust in identifying this, or of what staff actions should be. A requirement made at the previous inspection was for staff to receive training in managing challenging behaviour and dementia care. This has not yet happened. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is suitable to meet their needs. Evidence: People spoken with were happy with the accommodation provided. Of the rooms viewed many had been personalised to individual tastes. Communal areas were warm and homely and the home was nicely decorated ready for Christmas. Since the previous inspection some redecoration and replacement of items such as bedroom furniture, bedspreads, and tablecloths has occurred. Some rooms viewed still had unhomely looking hospital style beds, which we were told at the last inspection were being gradually replaced. The manager said that people are now able to choose a colour that they would like their room to be decorated in. This was confirmed by someone who said that their room had recently been redecorated. During the site visit the home was odour free and appeared to be adequately clean and well maintained. On Surveys six people said that the home was always fresh and clean and two said that it usually was. One person said they do a lovely job [relatives] home is always spotless, their room is lovely, and another that The staff responsible seem to take a pride in a job well done. Staff training records showed that staff have received training in infection control. This was confirmed in discussion with the person working in the laundry who was knowledgeable about infection control Care Homes for Older People Page 21 of 31 Evidence: issues. The laundry at Milton House is external to the home and would benefit from the floor being redone in order to maintain a readily cleanable surface. The member of staff thought that this was soon to happen. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from staff who are safely recruited, and who have mostly had satisfactory training. People may not always receive support from people who are familiar to them. Evidence: Comments about staff were varied. Some positive, The care staff are good at the jobs they do and I have every confidence in their abilities, The staff are all friendly and helpful, and, The friendliness with which help is offered makes it easy to say yes please. Other comments were not so positive, Staff listen to you but dont always act, and, Staff never seem to have time for you. Another issue for people is the frequent use of agency staff. There is often a shortage of staff and there is a real problem with the continual use of agency staff. I get very confused and sometimes very worried with so many different faces in and out. I do not like strangers doing my personal stuff but I dont get a choice, and, I did not expect the constant changes of staff and the constant use of agency staff, sometimes you can have two agency staff on at once. The manager said that the home is nearly fully recruited to and that the use of agency staff had dropped considerably over the last couple of weeks. Rotas viewed supported this, but the AQAA still identified that 77 shifts had been covered by agency staff in the previous three months. It was stated that where possible the same agency staff are used provide greater continuity. Although the home is said to be Care Homes for Older People Page 23 of 31 Evidence: nearly fully recruited to rotas viewed showed that a number of staff continue to regularly work long days from 08.00 to 20.20 which is not best practice as staff may become tired. Also, still five shifts had been covered by agency staff in the previous week. When we visited the home nineteen people were being accommodated. To meet peoples needs rotas showed that a basic staffing level of one senior and three care staff are available during the day and three awake staff at night. Ancillary staff are employed for cooking and domestic duties. The manager is occasionally supernumerary, but is mostly counted as part of the shift. No on site administrative support is provided, so the manager must also complete these tasks. The manager felt that staffing levels were adequate to meet peoples needs. Rotas showed that there was some flexibility with staffing levels, for example extra staff being rostered to cover a hospital escort. Within the day time numbers a new carer who is under 18 is being included in the care figures. When we looked at their file we saw that they had not yet undertaken a proper induction, so it could not be shown that they were receiving the proper support, supervision and guidance. The manager said that the Residential Forum Guidance had been used to calculate the staffing levels required for the home. This tool is dependent on the home accurately assessing peoples level of dependency. As we saw from information provided when the home investigated a complaint, and from care files viewed as part of this inspection, the tool currently being used to do this may not provide an accurate picture of peoples dependency. For example one person who is quite large, a wheelchair user, requires two people to assist them with all tasks, and has some behavioural issues is only just out of the low category into the medium dependency category. The information used to assess staffing levels may therefore misleading, and the management team risk people not being supported in the way that they need by having the correct number of staff always on duty. We have been previously told that the assessment tool being used was going to be reviewed but the manager confirmed that this has not happened. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. At Milton a good level of NVQ has been achieved. Out of 13 staff seven have already achieved an NVQ or have an alternative Qualification. A further four staff are working towards this. The manager said that only two new members of staff had started work at the home since the previous inspection, and that both of these had been previously recruited and worked at another home within the Company. We looked at the file of the staff member who had been most recently recruited to ensure that recruitment procedures protect people living in the home. Good records were in place to show that appropriate checks such as taking up references, checking identification and carrying out Criminal Records Bureau (CRB) checks had taken place. It was noted however that although a Care Homes for Older People Page 24 of 31 Evidence: POVA first check had been undertaken, CRB check was dated a month after the start of their employment. This is not best practice. The newest member of staff had been employed by the Company and had worked in another home since September. They had only been working at Milton House for a few days. The only evidence of any induction having taken place since their employment was a basic introduction and fire procedures at Milton House. A blank Skills for Care induction format was in their file but had not been started. A probationary period form was also blank. According to rotas the person was included in the care staff numbers from their first day in the home. Given the persons age and lack of experience this is poor practice. A training matrix provided showed that staff receive a basic level of core training to support their role. Some additional training is undertaken for example, since the previous inspection two further staff have received training in dementia care, some staff have completed training in care planning, and others in bereavement care. Although Milton House is not registered to provide care for people who have dementia, it was evident that a number of people may have developed dementia or mental health issues since moving into the home. It would therefore be relevant for all staff to be trained in dementia care. This was raised at the previous inspection but still a number of staff have yet to undertake this training. This shortfall was recognised on the AQAA which said what they could do better was, Increase number of staff who are dementia trained. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe home where their views are sought and considered. Evidence: The manager at Milton House has now been in post for over a year, but they are not yet registered with us (CSCI). The manager said that they had commenced their registered managers award, and NVQ at level four. This will provide them with appropriate qualifications for the role. Visitors and people spoken with during the site visit were very positive about local management and said, Feel she is doing and good job, and, She is making a lot of improvements. Staff were positive about the manager and felt that they provided, Good leadership and support. Records viewed showed that people have opportunities to express their views about the service through residents meetings and reviews. Listening Forms, which are surveys about the service, have been completed and an evaluation of these has just taken place. Activities questionnaires have also been completed. The provider has Care Homes for Older People Page 26 of 31 Evidence: strategies in place to monitor the quality of the service. An annual quality audit is normally undertaken by an external company. This has not however taken place at Milton House over the last year. Visits as required by regulation are carried out on a monthly basis. We saw that these visits include talking to people about the service provided. The provider has produced a detailed document, Self Assessment to Maintain Quality of Care. This is an audit tool which the manager has to complete on a monthly basis. The manager has also produced a Progression Chart. This shows the requirements needed to achieve a better service, and when these are to be achieved by. The AQAA was completed by the manager. This was very brief in its completion. It was concerning that in many sections under what we could do better comments such as nothing noted at present, and, nothing apparent at this time were made, whereas the findings of this inspection have highlighted that this is not the case. People know that if they or their families ask the home to help them look after their personal monies that this will be done in a way that safeguards their interests. Good records are maintained, and monies checked during the inspection were correct. The premises were not viewed in detail at this inspection, but a partial tour did not reveal any particular health and safety issues. 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. The fire service visited the home very recently and found things to be satisfactory. Since the previous inspection training in core areas has been ongoing. The training matrix showed that according to the organisations own criteria of frequency many staff have not always been kept up to date in moving and handling and fire awareness. The manager was however able to confirm that training in these two areas is due to take place for all staff during December. For other core areas such as food hygiene and first aid the picture was generally satisfactory with staff being up to date. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People must be confident that assessments and plans for meeting their care, health and social needs are accurate, up to date and comprehensive. So that staff are aware of peoples individual needs and meet them in a thorough and consistent manner. 01/02/2009 2 18 13 The Homes safeguarding 01/01/2009 policies and procedures must be up to date and robust. Management must ensure that staff have a proper understanding of safeguarding procedures and follow the correct protocols. People must be protected by procedures to safeguard them being open and following established practice. 3 30 18 Staff must receive training relevant to meeting the 01/04/2009 Care Homes for Older People Page 29 of 31 needs of people living in the home. This refers to the need for people to receive good training in dementia care. People should expect the staff caring for them to be skilled in meeting their mental health care needs. 4 30 18 Staff must be suitably 01/02/2009 trained to undertake their roles. This refers to the need for a robust induction process to be in place. So that people are cared for by staff with appropriate knowledge and skills, and new staff receive the proper level of support. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 People should have opportunities for occupation and stimulation as part of their daily living arrangements. The home should continue to develop activities and educate staff to see this as integral to peoples ongoing care. People should be able to be able to contact friends and relatives without reference to staff, as in having to use the office. A pay phone should be available for their use. The spacing of mealtimes should be reviewed to make sure that currnet arrangments are meeting peoples needs. So that people receive care from skilled staff, training in managing challanging behavious should be offered to care staff. So that people living in the home have access to sufficient levels of staff to meet their needs, the tool used to assess peoples dependency levels should be reviewed. 2 13 3 4 15 18 5 27 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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