Inspection on 23/01/06 for Milton House

This inspection was carried out on 23rd January 2006.

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

The inspector 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 16/12/08

Milton House 14/02/08

Milton House 28/08/07

Milton House 12/04/07

Milton House 30/05/06

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 Ann Davey & Christine Bennett Unannounced Inspection 23rd January 2006 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.V271600.R01.S.doc Version 5.0 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.V271600.R01.S.doc Version 5.0 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 Ms Nicola Findlater Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2005 Brief Description of the Service: Milton House is owned and managed as part of the Strathmore Care group of homes. Milton House provides accommodation for 28 older people. The home has 24 single and 2 double bedrooms. Not all bedrooms have an ensuite facility. There are 2 lounges and a dining room. There is a car parking area to the front of the building and a small secure garden/patio courtyard style area. Milton House is situated close to central Southend and has good access to local bus and train routes. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of 8.15 hours. As there were two inspectors, this equated to 16.30 hours input. The inspection focused mainly on the progress the home had made since the last inspection, although other standards were also assessed. A partial tour of the home took place. Staff and residents were spoken with. Records were selected at random and various elements viewed. A notice was displayed in the main entrance advising all visitors to the home that an inspection was taking place with an open invitation to speak with an inspector. A full and detailed ‘feedback’ was provided during and at the end of the inspection with opportunity for further discussion and/or clarification. A photocopy of the inspector’s ‘premises audit’ was given to the home. The deputy manager and the training officer were present throughout the inspection. The registered provider (Mr Davie Vive-Kananda) was present at the beginning and end of the inspection. A copy of the inspector’s initial summary of the inspection was left with the home. The current registration certificate on display states that there is a registered manager in post. The home does not currently have a registered manager and the Commission is issuing a new certificate to reflect the current situation. Following the last inspection that took place on 19th September 2005, the registered provided assured in writing that many of the identified shortfalls had been addressed and were ‘completed’. It is therefore disappointing that a number of the same shortfalls were identified again at this inspection. In the previous inspection report it was stated that if no or inadequate progress was evident at the next (this) inspection, the Commission would be minded to take further action. The Commission is to arrange to meet with the registered provider to discuss the current situation. The registered provider was anxious about the content of this report as he felt it would have a demoralising effect on the staff. Readers of this report should note that the responsibly for compliance remains with the registered person and is not a reflection of individual members of staff. Although the Commission gives careful consideration to the manner in which details and information are presented, the outcome of the inspection i.e. this report has to be fair reflection of what was seen, observed, heard and read on the day. At the conclusion of the inspection the registered person stated that the inspectors’ assessment of the inspection had been fair. What the service does well: Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 6 The home is in a good position for central Southend. The deputy manager is a stabilising factor within the home and has a good base knowledge and understanding of residents care needs. The turnover of staff within the home has been low. Staff were helpful and cooperative with the inspectors. The home accommodated the inspection well and the inspectors’ were well looked after. Resident’s clothing was nicely put away in drawers and wardrobes. Residents spoke well of the food. The system whereby residents’ monies are looked after was in good order. Staff work well together as a team. Visitors are welcomed. What has improved since the last inspection? 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. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Pre admission and admission documentation was incomplete and lacked detail. EVIDENCE: Pre admission and admission documentation was incomplete and lack essential detail on which to base a care plan. The current format mainly consists of a ‘tick box’ style. (Also see standard 12). This matter was raised at the previous inspection and there has been insignificant improvement. Pre admission assessments in the main are carried out by a representative from the head office. This is not good practice, as the home should take a more proactive role. The inspector’s findings did not meet with the requirement of legislation and the national minimum standards. Examples were discussed with those present. The home does not provide intermediate care. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The current care planning and associated documentation system remains inadequate. There was insufficient and/or inadequate information in the presented documentation for staff to follow in order to provide the required care. EVIDENCE: The current care planning and associated documentation system remains inadequate. Specific examples were discussed with those present. The deputy manager and the training officer experienced difficulty in identifying specific care needs, how they were to be met, who by and how often. Care plans did not always contain identified medical/health care needs. Risk assessments were in place but generally there was no indication or direction about how the identified risks were to be managed. There was no evidence of a multi disciplinary approach decision to the use of bed rails. This lack of continuity and consistency throughout the recording system continues to place residents at potential risk because known care needs are not systematically and/or routinely recorded and there was a lack of clear instructions for staff on how to deliver care. There is no organised approach to monitoring residents weight loss or gain. The deputy manager said that staff tend to rely on ‘verbal Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 10 handover’ rather than read through the complex, lengthy and often disjointed care plan documentation. This continuing situation is of concern because the training officer said that there has been training in the home regarding care planning. Residents spoken with said that they were happy with their care and spoke positively about staff. The inspectors observed relatively long periods of time in the morning when residents were left unsupervised in one of the main lounges. In the afternoon, there were 3 separate occasions when the inspector had to alert a senior member of staff to various situations where no staff were present and residents clearly required attention. (Also see standard 12) Although direct interaction with residents was observed to be carried out in a sensitive and dignified manner, the fact the staff were not available when need by residents or had no means of summoning help is not acceptable. The call bell system in at least two bedrooms was not functional and some identified call bells in bedrooms were not accessible to residents. Examples were given to the home. Those calls bells tested at random were responded to well by staff. As at the pervious inspection, there were identified shortfalls regarding various elements within the medication recording/storage system. These include homely liquid medication not labelled with the resident’s name, prescribed eye drop medication with no opening date (4 week shelf life), the manual transcribing of medication not being signed by 2 members of staff, the use of oxygen not being recorded in care planning documentation or within the medication recording system, PRN (as/when required) documentation not in place and inconsistent referencing to medication issues within individual care documentation. The audit was carried out with the deputy manager and all findings were discussed. The storage of medication was however orderly and secure. It was brought to the attention that some staff have/are carrying out ‘blood sugar testing’. Although the home assured that staff have received adequate/accredited training to do this, the home was not following CSCI guidance, as there was no protocol on place. This matter was discussed with the home’s training officer who was not aware of the requirement. Documentation made reference to the intervention and assistance of health /clinical related services. Community nurses were in the home during the course of the inspection and had opportunity to speak with the inspectors should they choose to do so, although this was not taken up. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Residents stated that current social activities do not meet their expectations. Residents are encouraged to maintain contact with their family and friends. The manner in which nutrition records are maintained, needs to be reviewed. EVIDENCE: Clearly the home has some good ideas about appropriate social activities, events and occupational activities. However, there was a clear difference of opinion and expectation about this matter between the registered person and the experiences of the residents. Residents spoken with said they were bored and wanted ‘something to do’. The registered provider said that he felt that the current provision was adequate and spoke about staffing and financial limitations. It was suggested to the home that as part of the pre admission process, residents’ expectations should be sought and if the home cannot meet the expectations, they perhaps should not be admitted. There was no evidence that this process in currently in place. The home does not have an ‘in house’ activities budget. In addition, residents were observed to be left for long period of time unsupervised with no means of stimulation expect for the television, which in the main, was not being watched by residents. A number of visitors were in and out of the home during the day. Staff were overhead to be very welcoming and attentive. At previous inspections it has Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 12 been recorded that the home does not have a designated visitors room. Currently, residents have to see their visitors (personal and professional representatives) in the respective bedrooms (some are double rooms) or one of the main communal areas. The registered provider has stated that he is unable to provide a designated visitors room but ‘all efforts are made to provide privacy when required’. The registered provider must be in a position to demonstrate what efforts have been made and what provision is made for privacy. The registered provider must ensure that the current situation is made very clear and recorded within the home’s Statement of Purpose and the Service User’s Guide. Should there be any construction changes to the home, any proposed changes to room designations, or registration numbers, there will be a clear expectation that a designated visitors room will be incorporated/provided for. Residents were positive about the provision of food and said that they enjoyed their meals. Staff were observed to be sensitively assisting residents at mealtimes. Food seen was presented well and looked appetising. However, nutrition records do not indicate the quantity or amount of food eaten (this has a direct impact on the term ‘adequate’ diet), individual preferences (one resident said she keeps being given mashed potato when the home knows she doesn’t like it and then told to leave it) need to be established and recorded and the menu board in the dining area was 2 days out of date. Residents said that they did not know in advance what choices they had. Standard 14 was not assessed in any detail, but residents were seen to be consulted during the day about different issues pertinent to them as individuals. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home’s complaints procedure was displayed, but associated records were not current. Staff spoken with had an adequate base awareness of POVA related issues. EVIDENCE: An appropriate complaints procedure was displayed in the main entrance hallway. As on the previous inspection, the complaints recording book was not current. Two complaints received/being dealt with by the home had not been recorded. This was discussed with the deputy manager. Staff spoken with had an adequate base knowledge and understanding of POVA reporting procedures. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 & 26 As on the previous inspection the standard of décor, furnishings, fitments, hygiene and safety within the home varied from acceptable to not acceptable. Some aspects of the environment as before are potential dangerous to residents. EVIDENCE: A ‘premises audit’ was given to the home. This contained details of the inspectors’ findings. In general residents bedrooms were clean, warm and homely. A number were rather stark and gloomy. Many contained items of personal processions. Some residents choose to spend considerable periods of time in their respective rooms and these rooms were adequately equipped. Two residents have their own private telephone line. It was evident that some interior redecoration had taken place and it was positive to see that the front of the building had been redecorated. The rear of the building was in the process of being completed. Improvements had been made in the laundry area. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 15 However, a relatively large number of issues identified at the previous inspection have not been addressed and could place residents at potential risk. These include items of furniture remain worn, old and not in good condition, a number of hospital style beds are still in use with two metal post sections sticking out the bottom, metal frames on identified beds and lifting apparatus were stained and unclean, some divans were not in good condition, some bed clothing was stained, areas of paintwork and wall coverings were in poor condition, wardrobes were not securely attached to walls and the footplate on one bathroom lifting hoist and the housing on a bath seat was not in good condition. Odour control was not being effectively managed. Residents are unable to control the temperature within the respective bedrooms. The registered provider said that this could not be rectified because of the ‘single line’ pipe work system, however a number of rooms are not connected to this system because they are powered by electric. Within the laundry area, soiled washing was left exposed to the elements and all washing is washed using either a ‘45 degree’ or a ‘warm wash’. Although a sluice facility was available on the machine this was not being used by the home. Soiled laundry is rinsed in the sink and then put in with the other laundry one of the above temperatures. This practice is unacceptable. The cupboard containing COSHH substances and the sluice area that also contained cleaning chemicals was found open and assessable to residents. The sluice was found to have faeces around the pan that had not been cleaned by staff. There was a lack of soap and towels in some bedrooms/ensuites. Other matters and issues found were recorded and the findings were made available to the registered provider. The registered provider said that regular premises audits are now carried out as a result of the last inspection, however there was little evidence of any impact this activity has had, because the vast majority of the above matters were recorded at the previous inspection. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 The staff rota requires attention to reflect current practice, staffing levels/deployment of staff requires attention and the effectiveness current staff training requires review. EVIDENCE: At the previous inspection, significant shortfalls were identified within staff recruitment files. The registered provider assured that these shortfalls have been addressed and all records were now fully complaint with regulatory requirements. The inspectors were advised that no staff have been recruitment to the home since the last inspection (apart from one transfer from another home within the group) and therefore no recruitment records were viewed in this occasion. The home is required to review the information recorded on the current staff rota. The training manager works 27.5 hours in the home complimenting the hours worked by the deputy manager. Her activity within the home has a clear impact on the local management of home, staffing and care and also in providing direct care to residents, therefore her hours must be recorded on the rota. In addition, it was evident that the role/responsibility as detailed on the rota regarding identified staff is not consistent with the role undertaken on a day-to-day basis. Furthermore, information and detail on the rota must identify the person ‘in charge’ at any given time. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 17 As noted earlier in this report there were a number of incidents during the day when inspectors observed relatively long periods when residents were left unsupervised and/or could not summon help in communal areas when assistance was required. Either the home does not have sufficient numbers of staff on duty, or there are enough staff, but there are serious issues of inadequate staff deployment. The home must carry out a full review of the situation as residents are at potential risk. It was positive to note that staff have been attending external and internal training sessions and records were in good order. However, the registered provider must assess the effectiveness of this training as the outcome of this inspection did not always evidence a sound understanding and awareness of acceptable practice i.e. care planning, medication, health & safety, universal infection control measures. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,37 & 38 The absence of effective overall local management remains evident. EVIDENCE: It was positive to note that the home has begun to address some quality assurance control issues. The home has already had a relatives meeting and others are planned. Residents meetings are also planned. This will be further assessed at the next inspection. The system whereby residents personal monies are kept and transaction recorded was sampled. Documentation was in good order and the monies in safe keeping equated with the stated amounts. The deputy manager said that residents could access their monies at any time. The registered provider stated that recent attempts to recruit a suitable manager have been unsuccessful, but further attempts are to be made. In the Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 19 meantime, the registered provider has a legal obligation to ensure that the home complies with regulation and the national minimum standards. Although some progress has been made since the last inspection, a significant number of shortfalls remain. Therefore current local management provision at the home is inadequate/not effective at this time. If there were a registered manager in place, the environmental standards within the home would still remain the responsibility of the registered provider. The registered provider was reminded that over the past 12 months, only one Regulation 26 report (visits by the registered person) has been received by the Commission. Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 20 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 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 2 17 X 18 3 1 2 X X 3 2 2 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X 2 2 Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered person must ensure that adequate documentation is in place to demonstrate that an appropriate assessment process has taken place to ensure that the home can meet all assessed needs prior to any admission taking place. The previous timescale of ‘immediate’ to meet this requirement has not been achieved. The registered person must ensure that all residents have a current comprehensive plan of care in place. Care needs must be identified, how they are to be met, who by and how often. In addition, there must be evidence of regular reviews and appropriate changes made (if any) to documentation. Documentation must be able to demonstrate adequate management of identified risk and all other associated care documentation must be maintained in a appropriate DS0000015457.V271600.R01.S.doc Timescale for action 28/02/06 2 OP7 15 28/02/06 Milton House Version 5.0 Page 22 manner and be compliant with regulatory and NMS requirements. The previous timescale of 31/10/05 to meet this requirement has not been achieved. The registered person must 28/02/06 ensure that adequate training is provided for staff that deal with medication within the home. This must include adequate supervision and monitoring of practice to ensure compliance with current guidance. Details of non-compliance issues are recorded within the report. The previous timescale of 31/10/05 to meet this requirement has not been achieved. The registered person must 28/02/06 ensure that appropriate interaction and stimulation is in place and provided for all residents. In addition, resident’s individual expectations concerning social, recreational, occupational and social activities must be considered prior to admission and recorded. Residents must be consulted about the current level of activity and the findings recorded on appropriate documentation. The registered person must 28/02/06 maintain a current record to demonstrate that residents have been provided with an adequate diet. (This has a direct implication on the need to maintain and manage any changes residents body weight records. See standard 7) The registered person must 28/02/06 maintain appropriate records DS0000015457.V271600.R01.S.doc Version 5.0 Page 23 3 OP9 13 4 OP12 16 5 OP15 16 6 OP16 22 Milton House concerning known complaint issues. Details are within the report. The previous timescale of 31/10/05 to meet this requirement has not been achieved. The registered person must ensure that the environment and equipment within the home is in a good state of repair, be safe, suitable, adequate and maintained in accordance with regulatory requirements and the NMS. Full details are within report but include: Systems must be in place to address identified physical hazards for the comfort, safety and wellbeing of residents. All residents must have access to a fully functional call bell system. Old and worn furniture, fitments and fittings must be replaced with suitable and adequate replacements. Suitable beds for a residential setting must be provided. Adequate odour control management. Adequate universal infection control management systems must be in place concerning the laundry and sluice areas. Wardrobes must be fitted in a secure manner. Adequate arrangements must be in place concerning the storage of COSHH and other cleaning Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 24 7 OP38OP26 OP25OP24 OP23OP20 OP19 13,16 & 23 28/02/06 fluids. A cleaning schedule be put in place for lifting & moving apparatus frames and equipment. The registered provider has stated he is unable to provide a designated visitors room. Therefore he must demonstrate how he is going to ensure that residents may receive their visitors in a private setting. Details of this arrangement must be recorded in the Home’s Statement of Purpose & Service Users Guide and amended copies sent to the Commission. A full audit of the environment must be carried out and sent to and sent to the Commission by 28/2/06. The audit must include a description of items assessed, what will be implemented to bring items up to registration standard and the timescale. A numbers of these shortfalls have been brought to the registered providers attention on previous inspections. Continuing non-compliance of regulatory requirements is not an option. 8 OP27 18 The registered person must ensure and demonstrate that there are sufficient competent and skilled staff on duty at all times to meet the needs of residents. The registered person must maintain and accurate rota within the home in accordance with regulatory and NMS requirements. Full details are DS0000015457.V271600.R01.S.doc 28/02/06 9 OP27 17 28/02/06 Milton House Version 5.0 Page 25 10 OP30 19 11 OP38OP37 OP33 13,16,17, 18,19,22, 23 within the report. The registered provider must 28/02/06 review the adequacy of current staff training within the home and/or the competence of staff. Current practice does not reflect effective training. Full details are within the report. The registered provider must 28/02/06 conduct a detailed review of corporate and local management systems to ensure and/or put in place adequate and appropriate measures concerning the day-today management of practice within the home. These measures are vital for the safety, comfort and wellbeing of residents. This requirement was made at the previous inspection and it is of concern that a number of shortfalls have been repeated. 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 OP14 Good Practice Recommendations The registered person should review daily routines within the home to ensure that all residents have the opportunity to exercise maximum choice and control over their lives as is possible. The registered person should ensure that the information on the home’s menu board is current. The registered person should demonstrate that the deployment of staff on duty is adequate to meet the needs of residents. 2 3 OP15 OP27 Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton House DS0000015457.V271600.R01.S.doc Version 5.0 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!