Inspection on 28/08/07 for Milton House

This inspection was carried out on 28th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milton House 16/12/08

Milton House 14/02/08

Milton House 12/04/07

Milton House 30/05/06

Milton House 23/01/06

Milton House 19/09/05

Milton House 06/01/05

Milton House 09/09/04

Milton House 19/02/04

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

CARE HOMES FOR OLDER PEOPLE Milton House 58 Avenue Road Westcliff On Sea Essex SS0 7PJ Lead Inspector Michelle Love Unannounced Inspection 09:00 28 August 2007 th 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.V350637.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address 58 Avenue Road Westcliff On Sea Essex SS0 7PJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01702 437222 01702 436536 Mr Davie Vive-Kananda Vacant Post Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2007 Brief Description of the Service: Milton House is owned and managed as part of the Strathmore Care group of homes. Milton House provides accommodation for 28 older people. The home has 24 single and 2 double bedrooms. Not all bedrooms have an en suite facility. There are 2 spacious lounge areas and a dining room. There is ample car parking area to the front of the building and a small secure garden/patio courtyard style to the rear of the property. Milton House is situated close to central Southend and has good access to local bus and train routes. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken by a regulation inspector, over a period of approximately 10 hours. The inspection was conducted with the home’s newly appointed manager. As part of the process a number of records relating to individual residents and care staff were examined e.g. care plans, risk assessments, healthcare records, staff employment files, staff training records, staff supervision records etc. Additionally the home’s medication systems were observed and records reviewed. A tour of the premises was undertaken throughout the day. An Annual Quality Assurance Assessment was completed by the registered provider and information contained in this document is reflected in this report. During the visit 6 residents and 2 members of staff were spoken with. At the time of and following the inspection, 8 relatives surveys were handed out/forwarded so as to seek people’s views. At the time of writing this report 3 surveys were completed and returned to the Commission for Social Care Inspection. Comments from residents and staff are documented throughout the main text of the report. As a result of the inspector’s findings following the last inspection the registered provider was requested to complete an improvement plan, detailing how he was going to address identified requirements and recommendations. This was received at the Commission on the 15.8.07. Several requirements made as a result of this inspection had been highlighted at the inspection of 12.4.07. Should continued breaches of regulation occur and where individual residents are placed at risk of not having their care needs met, the Commission for Social Care Inspection may instigate enforcement action. What the service does well: Visitors to the home are always made to feel welcome and can visit the care home at any time. The management/staff team have a good relationship with visiting professionals. Some staff have worked at Milton House/Strathmore Care for some considerable time and this ensures that people living at Milton House have a staff team who are familiar to them and who know their care needs. A comprehensive system for assessing the needs of prospective residents is used so as to ensure that the management/staff team are able to meet the person’s needs. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 6 The home is clean, tidy and comfortable. What has improved since the last inspection? What they could do better: There continues to be little evidence to suggest that residents and/or their representatives are enabled to actively participate and communicate their views to the development of their care plans or their review. The management of the home does not fully understand the importance of involving residents in all aspects of their care and there was little evidence to indicate that staff had consulted residents about their care. Additionally care staff do not understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. The registered provider confirmed during the inspector’s feedback that he was aware of some staff member’s struggles to understand the importance of care planning and the impact this has on the quality of care actually delivered. Procedures for the safe management of medication were poor and of concern. This referred specifically to poor record keeping and some residents not receiving their prescribed medication. This potentially places residents at serious and unnecessary risk. The activity programme for residents remains limited and poor for those people with poor communication, poor cognitive development and for those who are immobile. This needs reviewing and the registered provider must ensure that staff, receive appropriate training in this area so as to enable them to confidently work with individual residents and to ensure that they have their social care needs met. Inadequate staffing levels at the home have a major impact on actual care delivery to residents, resulting with some resident’s needs being not attended Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 7 to. Better staff training is required for those conditions primarily associated with the needs of older people. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents have their needs assessed before moving in, they are not given clear information about the service/facilities provided, which enables them to make an informed choice. EVIDENCE: The proprietor’s formal assessment process, for assessing the needs of prospective residents prior to their admission to the care home, was much improved. On inspection of pre admission assessments for the three newest people, documentation was informative and detailed. In addition to the assessments undertaken by the home, information had been sought from placing authorities and/or hospitals. Evidence suggested that wherever possible the placement co-ordinator had undertaken the pre assessment process with the aid of the resident and/or their representative. The manager is not involved with the assessment Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 10 process, however the Statement of Purpose details “A pre admission visit is carried out by the manager when a pre admission questionnaire is completed”. No evidence was available to show that the registered provider had formally written to the resident and/or their representative to confirm it could meet the needs of the prospective person. The improvement plan following the last inspection recorded “All residents will be aware of the home’s ability to care for them and have confirmation of this”. This has been in place since May 2007 and is co-ordinated by the placement team”. This does not concur with the evidence found on the day of the inspection. The Statement of Purpose and Service Users Guide does not contain the most up to date information about the services/facilities provided at Milton House. Both documents must be reviewed to enable prospective residents, their representatives and other interested parties to make an informed choice as to where to live. The home does not provide intermediate care. Milton House DS0000015457.V350637.R02.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 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the provision of care at the home means that some residents receive a basic standard of care that does not always meet their individual needs. The home’s medication procedures and record keeping do not safeguard those people who live at the care home. EVIDENCE: At this inspection a total of seven care plans were examined. It was positive to note that all seven people had a plan of care. It remains disappointing and of concern that issues relating to the care planning processes as highlighted at the inspection of 12.4.07 have not improved. This refers specifically to some areas of documentation remaining generic, not person centred and actual delivery of care not being provided by care staff in line with individuals’ care needs/care plans. Individual’s personal preferences, likes and dislikes were not always detailed. Additionally specific illnesses and conditions e.g. Parkinson’s disease/confusion/poor Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 12 communication etc. did not record how this impacts on the individual and their daily living skills. Care records show that further development of the care planning and risk assessment processes is needed. Staff, need to ensure that individual resident’s needs are fully recorded and detail the interventions required so as to ensure the appropriate delivery of care. Care records must be regularly reviewed to reflect individual resident’s changed needs. From inspection of care records it is also evident that where residents are taking insufficient diet and fluids, these concerns are not proactively raised with healthcare professionals and recording within the care plan/nutritional records is inconsistent and provides insufficient information detailing the actual care provided by staff. This is concerning as following the last inspection, a complaint was forwarded to the Commission and one element of this related to poor nutrition and record keeping. Following that complaint the registered provider’s Care Standards Officer forwarded a memorandum to Milton House stating “ Please can you ensure that a named senior on each shift is allocated the responsibility of checking the nutritional status of individual residents who are of concern in relation to eating and drinking and in need of help/assistance with dietary intake. They will be responsible for recording/reporting and taking appropriate actions. Ensure all nutritional sheets are completed fully with symbols shaded as necessary. Relatives kept informed of any concerns and notified of action being taken”. During the inspection the inspector spoke with one resident’s relative and they confirmed that they were unaware of their family member’s poor nutritional intake. There was no evidence to suggest what action was being undertaken by the registered provider to address the resident’s care needs. This was not an isolated case and for other people who also experienced poor nutritional intake, recording within individual care plans and `Food Intake Charts` bear little evidence to indicate what action was being taken. From other records it was evident that residents’ care needs in relation to personal care were not always being met and where daily care records confirmed that care staff were aware of individuals’ care needs, action to be undertaken by care staff was not recorded. Records showed insufficient monitoring of the frequency of baths for some individual residents and insufficient monitoring of residents who spend the majority of their time in their bedroom. Daily care records were not written after every shift and on some days no information was recorded. The acting manager was advised that daily care records are a good source of evidence to show that care is being provided as detailed in the care plan. Risk assessments are not devised for specific areas of assessed risk. The home has a generic format, which does not contain sufficient detail identifying the Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 13 specific area of risk to be minimised and staff’s interventions. For example the care plan for one person made reference to a consent form having been completed pertaining to bed rails. No risk assessment was devised. Additionally the care plan made reference to them having a small appetite and requiring encouragement. No risk assessment was devised. Comments from relative’s surveys were mixed. One survey commented positively that the food and resident’s appearance were generally seen as satisfactory and that they were always informed of their relative’s wellbeing. In contrast one survey and one telephone call with a relative advised the Commission they were not always informed of the condition of their family member and they had not been asked to contribute to the care planning process. One relative stated they had witnessed residents not being toileted frequently, resulting in some residents becoming distressed. The proprietor’s improvement plan recorded “Care plans are currently being reviewed by the deputy manager. The training officer is conducting care planning workshops. Deputy manager is reviewing care plans”. There was little evidence to indicate this has happened and improvements had been made. The home’s storage facilities for medication were observed to be secure and satisfactory. However a number of concerns relating to medication were highlighted at this inspection. Shortfalls were noted whereby records detailed that some residents had not received their prescribed medication as a result of their medication being out of stock. Staff were also noted to be administering prescribed medication to some residents at their discretion e.g. prescribed medication given as PRN (as and when required) and against the prescriber’s instructions. Additional shortfalls were noted pertaining to gaps in the Medication Administration Records (MAR) whereby staff had not signed to indicate medication had been administered to individual residents. Staff also need to be more proactive in ensuring that those people who receive medication for pain relief have this administered. Areas of good practice included appropriate storage facilities and record keeping for controlled drugs. An audit of controlled drugs was undertaken and records/actual medication was observed to tally. It is of concern that the improvement plan detailed, “The deputy manager administers medication throughout the week. The medication trolley is also tidied and checked for stock on a weekly basis. Regular monitoring will ensure that procedures are being followed regarding the safe handling and administration of medication”. As highlighted above it is evident that shortfalls relating to medication practices and procedures are not being monitored and addressed to ensure resident’s wellbeing/healthcare needs are being met. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 14 The home’s training plan detailed all but one member of staff who administer medication, had received refresher medication training. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The activities programme is limited which means that not all residents have their social care needs met. Meals for residents are satisfactory but some shortfalls in nutritional care could affect outcomes for residents. EVIDENCE: The Statement of Purpose details under the heading of Therapeutic Activities “activities with the staff (on a daily basis)” include chatting to individual residents, going for walks (staff members permitting), manicures, playing games, armchair exercises, reading letters/magazines/newspapers, helping to choose library books, music and sing-a-longs and maintain life long hobbies, crossword puzzles etc. The manager was observed to have implemented an activity book on 21.7.07. This records some residents have participated in shopping, playing ball, participation within a quiz, sing-a-long and bingo, however this is not in line with the above document. Although there is some minor improvement since the last inspection, activities tend to be undertaken by the same people. It remains clear that the management of the home/staff team are not Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 16 considering all the different needs of residents. Two notices were observed within the home’s reception area informing residents of the activity of the day. Residents could not confirm to the inspector that they had seen these or knew what was on offer. No weekly plan as detailed within the home’s improvement plan was evident. The Annual Quality Assurance Assessment makes no reference to social activities for residents. The management continues to operate a 4 week rolling menu. Consideration could be given by the registered provider to provide menus in both a written and pictorial format, so as to enable people to make an informed choice about what they would like to eat. On the day of inspection there was only one choice of main meal available, however some residents were observed to have alternatives e.g. sandwiches or jacket potatoes. Meals provided to residents were plentiful and looked appetising and actual assistance for some people was better than at the previous inspection to the care home. However, unfinished meals were taken away promptly and residents were not asked if they had finished, if they wanted more food or encouraged to eat more. Tables were laid attractively, meals were provided promptly and there was a choice of drinks offered to residents. The teatime meal for residents is prepared by care staff from existing staffing levels. As stated previously this provides insufficient cover for residents elsewhere within the home and potentially places residents at risk of being left unsupported. This was evident on the day of inspection and there were several times during the afternoon when lounge areas/residents were left without sufficient staff support. This has a detrimental affect on resident’s wellbeing and delivery of person centred care e.g. call alarms not answered promptly, residents having to wait for long periods before being taken to the toilet and drinks not being easily accessible for some people. The delivery of specialist diets for residents at the home needs more work. Identified needs, as written in the care plans were not being provided and on discussion with staff there was obvious confusion as to the real needs of the residents. Records showed that people were not receiving specialist diets and staff had not followed up, with healthcare professionals, the continued need for them. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst adult protection systems are in place, training in the area of managing challenging behaviour would improve outcomes for residents and staff awareness of individuals’ assessed needs. EVIDENCE: The complaints procedure has been amended to reflect that the Commission for Social Care Inspection no longer has any statutory responsibility to investigate complaints. A new complaints book has been devised and implemented. Since the last inspection the home has received 7 complaints. The acting manager advised the inspector that the newest complaint received at the care home had not been logged but was being investigated by the registered provider. There was clear evidence to indicate the specific nature of the complaint and details of the investigation undertaken. However in some cases it was unclear as to the specific action taken/outcome, and this must be recorded. At the time of this inspection, further investigation was being undertaken for two of the complaints by Southend Borough Council. The majority of staff working within the care home had received safeguarding training. Some residents are known to exhibit challenging behaviour, however Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 18 no staff within the care home had received training relating to this area. On the day of inspection the manager advised the inspector of difficult to manage behaviour e.g. constantly calling out, displaying extremes of agitation and picking at dressings/bandages. It was disappointing to note that staff appeared unsure and unaware of how to provide appropriate interventions and the manager was too eager to have additional medication prescribed by the resident’s GP rather than exploring other avenues first. Some members of staff were observed to walk past residents and ignore their requests for assistance and the manager confirmed to the inspector that staff, were struggling to meet people’s needs and deal with their behaviours. Staff spoken with advised the inspector that should a safeguarding matter arise they would refer this to the person in charge/manager. Staff, were aware that policies and procedures relating to safeguarding were held in the office. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, tidy and comfortable. EVIDENCE: A tour of the premises was undertaken throughout the day of the inspection and the home was observed to be clean, tidy and comfortable for residents. Further redecoration to some resident’s bedrooms had been undertaken. A random sample of individual bedrooms, were inspected and all were observed to be personalised and individualised. The Annual Quality Assurance Assessment details that the management of the home does well in providing residents with a “safe well-maintained environment”. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 20 The issues as previously highlighted pertaining to the home’s door bell and hot water temperatures (wash hand basins) had been rectified. No health and safety concerns were found at this inspection. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment practices, staffing levels and training do not ensure that the needs of residents living in the home are met. EVIDENCE: The inspector was advised that staffing levels at the care home are 5 staff between 08.00 a.m. and 14.20 p.m., 4 staff between 14.00 a.m. and 20.20 p.m. and 3 members of staff between 20.00 p.m. and 08.20 a.m. each day. The manager’s hours are supernumerary. On inspection of five weeks staff rosters, records showed that staffing levels have not always been regularly maintained in line with the above figures and staffing shortfalls are resulting in the needs of residents not being fully met. At this inspection it was evident that inadequate staffing levels/poor deployment of staff are having a detrimental affect on individual residents wellbeing and the delivery of person centred care. This refers specifically to residents not being toileted frequently, lounge areas left unattended for long periods, little interaction between staff and residents and some residents isolated within their bedroom. On the day of inspection there were insufficient staff on duty on both the a.m. and p.m. shifts resulting in each shift being short by one member of care staff. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 22 The manager advised the inspector that additional staff were requested from head office, either from within the organisation or an external agency. During the day one member of night staff telephoned sick, and all efforts were made by the acting manager to ensure that the home was staffed. The majority of staff working at the care home regularly complete 12 hour shifts. No Regulation 37 Notifications identifying staffing shortfalls have been forwarded to the Commission. Within the home there was no evidence to confirm what measures had been undertaken to deploy staff to the care home on any given shift, which was short of staff. The improvement plan following the last inspection recorded staffing levels as being monitored, “monitor on a regular basis. Ensure all annual leave; sickness is covered with existing staff or with agency staff”. The manager advised the inspector, since the last inspection only one new member of staff had been employed. The majority of records as required by regulation had been sought, however the POVA 1st had not been received prior to commencement of employment and there was no evidence of the completed CRB application or evidence they were being supervised. Written references were received but not from the applicant’s last place of employment. There was no photograph and no evidence of an induction having been undertaken. Three members of staff had recently transferred from another care home within the organisation. No evidence of training or induction was available for two members of staff. An additional staff recruitment file was requested at random. No file was available for this person and when questioned the manager advised this had been forwarded to another care home where they were being transferred to. The member of staff was on duty at Milton House on the day of inspection. A copy of the manager’s training plan was provided for the inspector. Records detailed that further training/refresher training for staff is required in relation to safeguarding, manual handling, fire awareness, food hygiene, care planning, infection control and those conditions associated with the care needs of older people. The Annual Quality Assurance Assessment confirms that further improvement is required to ensure staff are familiar with infection control procedures. Records indicate 3 members of staff had attained NVQ Level 2 and 3 people are to undertake NVQ Level 3. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Inconsistent and on occasions ineffective management of some aspects of the home are adversely affecting positive outcomes for residents. EVIDENCE: The manager has been in post at Milton House since 2.7.07 and has previous experience of working with older people. The manager has attained NVQ Level 3 and a variety of other training courses, which are appropriate to her role. The manager confirmed that she did not receive an induction upon commencement of employment at Milton House. The Commission recognises the manager has only been in post for a short period of time and has had little time to make a significant impact within the Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 24 care home. However, this was the home’s second key inspection since 1.4.07 and it is of concern and disappointing that little progress has been made by the registered provider to address previous identified requirements and recommendations. As highlighted throughout the main text of the report, there is limited evidence to indicate good resident led care practices and positive outcomes for people who live at the care home. Since the manager’s appointment, all staff had received, at least one, formal supervision. Records continue to evidence that not all staff had received formal supervision in line with regulatory requirements, however improvements were noted. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 2 X X Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement Ensure that the homes Statement of Purpose and Service Users Guide is reviewed and updated to accurately reflect information and services provided at Milton House. The registered person must ensure that appropriate consultation has been undertaken between the home, the resident and their representative as to whether or not the care home can meet the individual residents needs. This must be confirmed in writing. Previous timescale of 14.6.07 not met. Ensure that all residents have a plan of care which is detailed, comprehensive and depicts individuals care needs, how they are to be met, who by and how often. Ensure that the care plan is regularly reviewed and updated. Previous timescale of 14.6.07 not met. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 27 Timescale for action 01/12/07 2. OP3 14(1)(c) 01/10/07 3. OP7 15 28/08/07 4. OP7 13(4) Ensure that risk assessments are devised for all areas of assessed risk so that risks to residents’ health and wellbeing are minimised. Previous timescale of 14.6.07 not met. Ensure that residents’ health and wellbeing are maintained at all times. This refers specifically to actual care delivery being in line with individual care needs as highlighted on the care plan. Ensure that the records of food provided for residents is in sufficient detail to enable any person to determine whether or not the dietary needs of the resident are being met/satisfactory. The registered person must ensure that prescribed medication is recorded and administered safely and appropriately. Previous timescale of 14.6.07 not met. Residents must be given medication in accordance with the prescriber’s instructions. Ensure that appropriate arrangements are made for all residents to participate within a programme of activities both `in house` and within the local community. 28/08/07 5. OP8 12(1)(a) 28/08/07 6. OP8 17(2), Sch 4 (13) 28/08/07 7. OP9 13(2) 28/08/07 8. 9. OP9 OP12 13(2) 16(2)(m) and (n) 28/08/07 01/11/07 10. OP16 22 Previous timescale of 30.4.07 and 1.7.07 not met. Ensure that where complaints 28/08/07 are received, there is evidence to indicate action taken and outcomes. Previous timescale of 14.6.07 not fully met. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 28 11. OP18 13(6) 12. OP27 18(1)(a) Ensure all senior/care staff receive training relating to challenging behaviour so as to ensure that resident’s needs can be best met and understood. Ensure there are sufficient staff on duty at all times to meet the needs of residents so as to ensure their wellbeing. Previous timescale of 30.4.07 and 14.6.07 not met. Ensure that robust recruitment procedures are adopted and maintained at all times so that residents are safeguarded and kept safe. Ensure that all records as required by regulation are sought and available for inspection. Previous timescale of 14.6.07 not met. Ensure that all staff working at the home receive appropriate training which meets the needs of residents. Ensure the manager and the registered provider manage the care home with sufficient care and competence. 01/01/08 28/08/07 13. OP29 19 28/08/07 14. OP30 18(1)© 01/01/08 15. OP31 10(1) 28/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Enable the manager and/or senior staff to undertake an active role within the pre admission assessment process of prospective residents. Daily care records should record how residents spend their DS0000015457.V350637.R02.S.doc Version 5.2 Page 29 2. OP7 Milton House 3. 4. 5. 6. 7. 8. 9. 10. OP9 OP12 OP14 OP15 OP27 OP30 OP31 OP36 day, staff’s interventions and outcomes for residents. PRN (as and when required) medication protocols should be devised for individual residents. Consider reviewing the activity programme format e.g. larger print and pictorial. Ensure that residents are empowered and enabled to make everyday decisions and choices. Consider reviewing the way menu’s are displayed/choice of meals is displayed e.g. larger print and/or pictorial. Ensure that appropriate measures are undertaken to deploy staff within the home so that residents are better supported. 50 of staff attain an NVQ qualification. Enable the manager to have more autonomy in the day to day running of the home and to be part of and contribute to the decision making process. All staff to receive regular supervision. Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton House DS0000015457.V350637.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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