Inspection on 28/06/06 for Milton House

This inspection was carried out on 28th June 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 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 14/10/09

Milton House 15/10/07

Milton House 20/12/06

Milton House 04/10/05

Milton House 10/05/05

Milton House 25/01/05

Milton House 08/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Milton House West Street Bridgwater Somerset TA6 3RH Lead Inspector Caroline Baker Unannounced Inspection 28th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address West Street Bridgwater Somerset TA6 3RH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01278 422235 01278 451511 Somerset Care Limited *** Post Vacant *** Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to three persons of either sex, between the ages of 50-60 years, who require general nursing care. Registered for a total of 51 places in Categories OP and PD When the home reaches provision of care for 40 service users requiring nursing care 2 Registered Nurses must be provided at night to comply with the staffing notice in line with Somerset Health Authority. Staffing levels are monitored on a monthly basis to suit the dependency levels of individual service users. Staffing should not fall below 1 - 10 at night and 1 - 5 during the day. 4th October 2005 5. Date of last inspection Brief Description of the Service: Milton House is a purpose built care home situated in the town of Bridgwater, within walking distance of the town centre. It is owned by Somerset Care Ltd. There is no registered manager at present. The home is registered with the Commission for Social Care Inspection (CSCI) for 51 people over the age of 60 years; it is a care home providing nursing care for older people and those with physical disabilities. Within the registered numbers the home can provide care for up to 3 people ages 50-60 years who require general nursing care. The accommodation is arranged on two floors with two passenger lifts. All the bedrooms are single. The home has a three lounges and a large dining area. A telephone is available for service user use. There is a patio area and a garden, which is being landscaped to ensure safe level access for service users. Car parking space although is minimal. The current fees range from: £295 - £577.50 dependent on whether residential or nursing care is required, and does not include hairdressing, newspapers, magazines or toiletries. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last main inspection was announced and took place on 4th October 2005. Since that inspection the CSCI has made unannounced additional visits on 23 January 2006 and 7 March 2006 to measure compliance with the National Minimum Standards and Care Home Regulations 2001. Five requirements are outstanding and two recommendations were made following the last visit. A meeting with the provider was held on 25 April 2006 when an Improvement Plan was submitted. This inspection was unannounced and took place over one day (17.5 inspector hours) and was conducted by Caroline Baker and Stephen Humphreys. At the time of this inspection four of the requirements had been met fully and one partly and the recommendations had been actioned. Forty-one service users were residing at the home, including five that were in hospital. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least seventeen service users, six members of staff and five visitors were consulted with. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. The CSCI sent comment cards to twelve service users, their relatives/carers and health care professionals for their views on the provision of care at the home. Five surveys were received from service users, none from relatives/carers and one from a GP. What the service does well: Milton House provides a well-maintained, secure and comfortable environment, which meets the needs of the current client group. Service users spoken to stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users praised the food. A good choice of wholesome food was given. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 6 Staffing numbers and the skill mix of staff were sufficient to meet the needs of current service users on the day of inspection. Staff training was well documented and the provision of training for staff is good. Staff looked and acted in a professional manner. Any complaints the home had received had been taken seriously and appropriate action had been taken. What has improved since the last inspection? What they could do better: Twelve requirements and three good practice recommendations have been identified as a result of this inspection. Service users would benefit if their individual specialist needs, for example diabetes and wound care were set out in a detailed way in their care plans, with input from specialist nurses, to enable care staff to deliver the care required. Service users would be at less risk of dehydration if care staff ensured fluid intake and output charts were totalled to allow the monitoring of intake. Service users identified as requiring regular turns to prevent pressure ulcers would benefit if staff could identify when they were last turned from charts being completed correctly. Service users would benefit from all care staff treating them with respect and addressing them appropriately. Service users would benefit more if their social care needs were being met in a more person centred and stimulating way taking into consideration, for example, their life histories, hobbies, occupation and cultural needs. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 7 Service users who spend some of their time in the communal lounges would be at a lesser risk of harm if they could always access a call bell. Service users would benefit more if the routine of the home were planned with them with particular regard to when they would like a bath. Service users would benefit and be at a lesser risk of harm if all staff were aware of the types of abuse and the steps to take should they suspect abuse. Service users would benefit if the homes quality monitoring systems included consultation with them, in regard to how long it takes staff to answer their call bells, and how long they then took to assist them once they had answered the bells. Although many issues were identified and brought to the attention of the acting manger and manager designate the inspectors were satisfied that appropriate action will be taken to improve outcomes for service users. An Improvement plan is in place at the home and the CSCI will expect a further Improvement/Action Plan to be submitted in response to the further findings in response to this report. 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 DS0000003271.V290727.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. NMS 6 does not apply to this service. Quality in this outcome group was good. Prospective service users are provided with information to allow them to make an informed choice. The home takes appropriate steps to ensure the needs of prospective service users can be met prior to a decision being made about admission. EVIDENCE: The home had an up to date Statement of Purpose displayed in the reception area of the home and the contents were in line with legislation. Prospective service users are given a Service User Guide, which assists them to make an informed choice. A copy was given to the inspectors. The guide is informative and easy to read. Service users spoken to told the inspectors that they had not seen a Service User Guide. This was brought to the attention of the acting manager to look into. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 10 Service users are assessed prior to admission and evidence was seen in some of the care plans sampled. At the time of this inspection the acting manager had asked that a service user be re-assessed and a more suitable placement found as the home could no longer meet their individual needs. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7; 8; 9 and 10 Quality in this outcome group was poor. Each service user had a care plan. The processes had improved however omissions could lead to service users with specialist needs being at a potential risk of harm. There was evidence of service user input into their individual care plans. Overall the privacy and dignity of service users was respected. The procedures for the management and administration of medication had improved. EVIDENCE: The inspectors examined seven individual care plans and met with the service users as part of the case tracking process. An improvement was noted in the care plans; care needs sheets were very detailed. All risk assessments were in place for example, moving and handling, nutritional risks, pressure ulcer risks and falls risks. Daily records were maintained. Evidence was seen where service users had signed their care plans and on the day of inspection a nurse Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 12 was seen going through a care plan with the individual service user. This is an improvement since the last inspection and additional visits undertaken. Service users with specialised needs for example diabetes had management plans in their care records however there were no clear guidelines for individuals’ with diabetes to indicate normal blood monitoring ranges and often no record of action to take when blood sugars were found to be high or low. One diabetes management plan seen explained in detail what to look for when a person is hypo or hyperglycaemic, however one diabetes management plan stated: ‘offer regular snacks’ with no explanation, which could potentially put service users with diabetes at risk of harm. Wound care plans sampled did not provide sufficient detail about the wound to inform progress or deterioration of the wound, there was wound mapping but there had been no action taken where a wound had not changed over 4 weeks. One wound care plan was unable to be found and a new one was recorded which could not reflect the wounds progress. At the time of this inspection at least four service users had pressure ulcers, which had developed before admission to the home according to the manager. Where supplementary fluids were prescribed, the individuals care plan did not always reflect which supplement fluids the individual service user should have; one sampled stated ‘give supplement fluids’. Inspectors acknowledged the fact that registered nurses are at the home 24 hours a day, however care staff and agency care workers picking up care plans would not know actions to take in regard to specialist needs unless care records clearly detail all actions. The acting manager told inspectors that as part of the homes Improvement Plan, care plan training for nurses and care staff was scheduled for week commencing 3rd July 2006. The managers acknowledged the urgency of this training to ensure service users are not put at risk by the omissions in care records. This will be followed up at the next inspection. There was evidence that the advice of other professionals was sought and that equipment was available to support staff and service users. Opportunities were available for exercise as part of the activities programme. Chiropody is available however according to the care plans sampled and speaking with service users it was concerning that not many had received chiropody. The acting manager agreed to explore this further. Five service users were in hospital at the time of this inspection with varying problems including suspected heart attack and unstable diabetes. Care plans sampled of one person in hospital evidenced appropriate action taken by the home. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 13 Pressure relieving equipment was available and was being used appropriately. At least three service users seen at inspection had a turn chart, one service user was seen on their left side at 13:00hrs and according to their turn chart they had not been turned since 05:00hrs when they were turned to their left side. This was brought to the attention of the managers. Surveys returned from service users (five) and their representatives indicated that 40 felt they always received the care and support they need, 40 felt that they usually did and 20 felt that they sometimes did. They indicated that 40 felt that staff listened and acted on what they said, 20 thought they usually did and 40 thought that they sometimes did. Comments received from service users during the inspection included: ‘the staff are kind and caring’, ‘ I feel well looked after’, ‘my social worker said I need two baths a week and I only get one’, ‘my bath day has changed as they changed the rota’, ‘I didn’t get a bath this Sunday they changed it to Monday’ and ‘the hairdresser is very nice’. Of the surveys received from service users (five) and their representatives 60 felt that they always received the medical support they needed 20 thought they usually did and 20 thought they sometimes did. Good practice was found on examination of the medication systems at the home. Monitoring systems and audits were in place. The acting manager agreed to investigate a discrepancy found, with an individual service users prescribed ibuprofen, and inform the CSCI of her results. The majority of service users spoken to during the inspection felt that staff treat them with respect and staff were observed to interact in a kind and caring manner. Personal care was carried out in private. One service user commented on how some staff shout a lot as many people are deaf and felt that some were like ‘sergeant majors’ and did not treat you with respect. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12; 13; 14 and 15. Quality in this outcome group was poor. Many service users benefit from the activity provision and social care, however some service users were unable to access activities and received minimal social care. The opportunities for exercising choice and control appeared limited and service users were not always able to summon help in lounges should they have needed to. Service users benefit from a varied menu and nicely presented food. The process of delivering meals to service users rooms was unsatisfactory. EVIDENCE: The home employs one activities co-ordinator and one comment received indicated that she is a credit to the home. There is an activities programme at the home and evidence was seen of regular entertainment being provided, for example, bingo, flexercise and dominos. Each individual service user has a record of activity they have attended. It was evident through consultation with service users, care plans sampled, activity records and surveys received that many service users were missing out on social care. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 15 Surveys received (five) indicated that 20 of service users felt that there were always activities available to suit them, 40 indicated that there usually were, 20 felt that there sometimes were and 20 felt that there were never any activities provided that suited them. Twelve service users were enjoying a game of bingo during the afternoon. Two service users were seen in the downstairs lounge and garden. One service user was seen in the upstairs lounge and the remaining service users spent their afternoon in their rooms either watching TV or sleeping. Staff spoken to felt that some people are bored and they do not have time to spend with them, other than when they are providing personal care. Service users told inspectors that staff ‘never have time to talk’. Activity records evidenced minimal one to one social care. Care plans lacked life histories. The acting manager agreed that social care needed to be more person centred and would be adding this to the care planning training. Visitors seen on the day of inspection were on the whole satisfied with the care provision at the home. They always felt welcomed. The visitor’s book indicated many visitors to the home. All service users seen in their rooms during the inspection could access a call bell. Two out of three service users in the lounge upstairs did not have access to a call bell even though they were available; this was brought to the attention of the acting manager who agreed to explore the reasons for the service users not being given access. As mentioned previously some service users felt that the staff dictated the daily routine, for example through bathing rotas. Many told inspectors that when they used the call bell they often had to wait and were told once it was answered that the staff would come back as they were busy with others. Comments received service users included: ‘I press the buzzer – someone switches it off – then they walk off. You wonder if they are coming back, so you press again and another one turns up, a nurse we are used to’, a service user in the upstairs lounge told inspectors ‘we usually have a buzzer – but we haven’t got one’ and ‘staff come in sometimes but not constant’. The inspectors were able to observe the lunchtime experience for service users and were provided with a pleasant lunch. Through speaking with service users and through surveys it was evident that the food provision at the home was very good. Menus are available and service users are offered a choice. Those service users needing assistance were unhurried and treated with respect and their dignity was maintained. Tables were laid to a good standard with fresh flowers on every table. Specialist cutlery was provided for those assessed as requiring it. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 16 Lunchtime serving began at 13:15 hrs in the dining room and service users completed their meals and were taken to where they wished to go from 14:30 hrs onwards. At least eight service users were sitting in the dining area from 11:30 hrs, including two who liked to sit at the tables from that time. There was no supervision or non-task orientated social interaction from staff as they walked through the dining area either to bring other service users in or walk through to the nurse’s office, kitchen or staff areas. Service users were generally unsupervised for up to one hour and a half. One service user was given charge of a call bell. At least twenty-eight service users were in the dining room for lunch by 12:45 hrs and many had been sat at tables from 12:30 hrs. Drinks were not available at the tables until after 13:00. Six members of staff were serving lunch in the dining area. Service users spoken to did not complain about waiting. The inspectors’ observations were brought to the attention of the managers who agreed to monitor these areas. An audit had been undertaken by the home of those service users who used the dining room, as required at the last inspection survey with the following results: Questions used: 1. Do you mind waiting for your meals? 21 indicated that they did mind waiting. 79 said ‘NO’ 2. How long do you feel is a reasonable time to have to wait? 34 indicated 5-10 mins. 0.3 indicated 3-4 mins. 34.5 indicated 15-20 mins. 0.6 indicated 30mins. 20 did not mind. 3. How long do you have to wait? 31 indicated 30mins – 1 hour. 24 were not sure and 45 indicated between 10 and 30 mins. 4. Any other comments you would like to make around meal times? 0.3 indicated they would like lunch 30 mins earlier. 1.2 indicated that meals were very good. 0.3 indicated that they were not always ready. 98.2 stated ‘NO’. Surveys received from service users (five) indicated that 40 always liked the meals provided and 60 usually liked the meals provided. The inspectors spoke with the catering staff. The cook informed the inspector that menus are being reviewed and service users have had input. Catering hours have not been increased at the home despite the homes expansion and as discussed at past inspections should be considered. Catering staff appeared very busy and told inspectors that they did need more help to continue to Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 17 provide a high standard of meals, and that they often went home ‘exhausted’. Another member of the catering staff told inspectors that sometimes they couldn’t get all the clearing up done as there is ‘so much to do’. These matters were brought to the attention of the managers. The kitchen was well organised and clean. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome group was adequate. The home has a satisfactory complaints system in place with evidence that concerns were acted upon. Systems were in place to protect service users from abuse however domestic staff need updating as to the steps to take should they suspect any abuse. EVIDENCE: Service users, staff and visitors spoken to were aware of the homes complaint procedure and who to talk to with any concerns. One comment received in a survey indicated that they would contact their social worker with any concerns. The procedure named ‘Seeking Your Views’ is found in the service user guide and is displayed in the reception area. The home had received two complaints since the last inspection in October 2005. Evidence was seen that they had been dealt with appropriately. The home has the multi-agency policy on Safeguarding Vulnerable Adults. The home had a Whistleblowing Policy (Confidential Reporting), which is comprehensive and details outside bodies that staff can approach. Care staff spoken to on the day of inspection were aware of the Whistleblowing Policy and lines of communication to be taken if necessary. Domestic staff spoken to were not aware and had not received training in the Protection of Vulnerable Adults (POVA) and this should be provided to all staff to enable them to Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 19 understand the different types of abuse and the steps to take should they suspect abuse. Recruitment file sampled evidenced POVAFirst checks and enhanced CRB disclosures being received prior to employment. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 20 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; 22; 24 and 26. Quality in this outcome group was good. Service users live in a safe, clean and comfortable environment, which is able to meet the assessed needs of service users living there. Service users have access to specialist equipment where there is an assessed need. EVIDENCE: On assessment of the premises it appeared safe and well maintained. Maintenance records had been recorded. The building complied with the local fire service. The environmental health department had visited in May 2006 and issued two legal requirements and made two recommendations, according to the manager designate action had and was being taken to action them. The home was well ventilated on the day of inspection. Windows were restricted and radiators were guarded in line with HSE guidelines. Lighting is domestic in character. Bath temperature records were seen in bathrooms assessed. Hot water outlet temperature records indicated that they were checked monthly. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 21 Communal space is plentiful however on the day of the inspection very few service users accessed the garden or the lounges, many were in their rooms or the sitting area in the dining room and/or sat at tables following activities at 16:30 hours waiting for supper. All service users spoken to were happy with their rooms and felt that they were adequate to meet their needs. Rooms seen were furnished to a high standard and were personalised and homely. Profiling beds and adjustable height nursing type beds were available for all those with assessed nursing needs. Infection control systems were in place at the home. The cleanliness of the home was very good at this inspection, one malodour was identified and brought to the attention of the managers. The laundry area has hand-washing facilities for staff and the room next to it has been adapted and is now a clean laundry area. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 22 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; 28; 29 and 30. Quality in this outcome group was adequate. Service users benefit from staffing levels being maintained at the agreed level, however continue to feel that the home is short of staff especially at weekends. 62 of the staff had gained a National Vocational Qualification (NVQ) in Care. The home’s staff recruitment procedures were robust and protected service users from the risk of abuse. Overall, service users benefit from staff that have received appropriate training, to enable them to deliver the care to meet their individual needs. EVIDENCE: Weekly duty rotas are recorded reflecting staff on duty 24 hours per day. The home is expected to have two registered nurses on duty 24 hours per day with a I: 5 service user ratio of staff during the day and a 1:10 service user ratio at night. The home continues to struggle to meet this and uses agency staff for support. At the time of this inspection there were 41 service users residing at the home including 5 in hospital. Staffing levels were adequate. According to the rotas given to the inspectors minimum staffing levels have been maintained in line with the numbers of service users at the home up until the weekend of 24th and 25th June 2006 when there were six not seven care Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 23 staff during each afternoon. Staff spoken to confirmed the shortage and service users comments also confirmed a shortage. Comments received from service users include: ‘Since expansion the home appears short of staff and everyone is stretched’, ‘the staff do their best under the circumstances of being short staffed’, ‘weekends are always different’, they take a long time to answer the buzzer sometimes and they say its because they are short of staff’, ‘I hope they take me down for lunch soon, sometimes its earlier but it depends when they get to you’ and ‘the staff are very pleasant and there appears to be enough staff’. The managers must review and ensure staffing levels remain at agreed levels to meet the dependency levels of the current service users at all times, if there are any shortfalls the CSCI must be notified under Regulation 37. Staff spoken to told inspectors that they enjoyed working at the home and that staff morale was good. Although busy staff observed appeared happy in their work. They indicated that at times routines were dependant on who was on duty not the dependencies of service users. Staff training records and speaking with staff and service users indicated that staff employed at the home are skilled and competent to do their job. The home has exceeded 50 of care staff with a NVQ in care in line with NMS. Four staff recruitment files were examined at this inspection of recently employed staff all evidenced robust recruitment procedures. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 24 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; 36 and 38. Quality in this outcome group was adequate. Quality monitoring systems are in place. Service users are protected by the systems adopted by the home to look after their personal finances. Service users can be confident that staff are receiving the supervision and support they need to ensure they work effectively and in the best way. The home has systems in place to ensure the health and safety of service users. EVIDENCE: Since the last inspection the registered manager resigned her post and has taken up the post of Clinical Lead at the home. Therefore there is an acting manager in place for three days per week, Diane Allen, who manages another Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 25 SCL home, and has been given the job of mentoring the new manager and moving the home forward in line with Improvement Plan submitted to the CSCI in May 2006. The new manager has submitted an application to be registered with the CSCI under the Care Standards Act 2000. Because of this NMS 31 has not been assessed at this inspection. Staff spoken to felt that at times routines were dependant on who was on duty and that staff morale and the teamwork was generally good. Staff had been supervised on a one to one basis; records were kept, and were seen in the staff files examined at inspection. Action had been progressed within agreed timescales to implement requirements identified in the last CSCI Additional Inspection reports. There had been a recent staff meeting and surveys to service users had last been distributed in July 2005 to gather their views on the running of the home. The area manager had recorded monthly Regulation 26 visits. The home had monitored call bell responses using an electronic machine as recommended at the last inspection and as part of its improvement plan, however given the responses from service users consulted in regard to staff answering call bells, it is required that the management review the monitoring systems in consultation with staff and service users. Finances kept on behalf of residents by the home were sampled and good practise was observed. Records of all transactions are maintained and two staff always sign as witnesses to money being drawn out. All receipts are kept. Staff spoken to were aware of the homes health and safety policies. Food was stored correctly in the kitchen. Fridge and freezer temperature records were available and current. All service histories were found to be up to date. Hot water outlet temperatures had been tested and were up to date at this inspection. All accidents and injuries had been recorded however the five recorded for June 2006 had no reference in the care records or any associated risk assessments recorded. All accidents are audited at head office. The CSCI expressed an interest at the last main inspection in October 2005 in the feedback the home gets from this analysis in regard to identifying traits and action taken and recommended it be sent to the CSCI for assessment, it was not sent and is recommended again. There have been a further two thefts at the home since the last inspection in October 2005 and the police have been investigating. The home has kept the CSCI informed under Regulation 37. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 X 3 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X 2 Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 12(1)[a] [b] Timescale for action The registered person must 20/07/06 ensure that all specialist needs e.g. Diabetes have clear detailed care plans written with advise from a diabetes specialist to ensure service users are not put at risk. The registered person must 20/07/06 ensure that service users identified as requiring fluid intake and output charts and at high risk of malnutrition must have clear totalled records maintained to evidence progress and action taken by staff should they identify a lack of fluid or food intake. Also turn charts in use must be used appropriately. (Previous timescale of 28 February and 30 March 2006 not met) Requirement 2 OP8 15(1) (2 b c) 17(1a) S3 Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 28 3 OP8 12(1)[a] [b] The registered person must 20/07/06 ensure that wound care plans provide sufficient detail about the wound with advise from a tissue viability specialist to inform progress or deterioration of the wound. The registered person must ensure that at all times service users are addressed appropriately. 20/07/06 4 OP10 12(4)[a] 5 OP12 16(2)(m) (n) The registered person must 30/08/06 review the arrangements to meet the social and psychological needs of all service users. Opportunities must be made available for all service users to engage in stimulating activities suited to their needs, preferences and abilities. The registered person must 20/07/06 ensure that all service users have access to a call bell to alert staff to their needs or in the event of an emergency with particular regard to the lounge and sitting areas. The registered person must 20/07/06 ensure that the routine at the home in particular regard to service users receiving a bath is planned in consultation with them. The registered person must 20/07/06 ensure that all staff are aware of the steps to take should they suspect any form of abuse. 6 OP14 12(1)(a) 13(6) 7 OP14 12(1)(a) 13(6) 8 OP18 13(6) Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 29 9 OP27 18(1)[a] 37 The registered person must 20/07/06 ensure that the CSCI is informed of any shortfall in agreed staffing levels and must ensure that at all times staffing levels are in line with the dependency levels of the service users to ensure all their individual needs can be met. The registered person must audit 20/07/06 the call bell responses to support the electronic monitoring system. Also the registered person must consult with service users and staff to ensure the call bell monitoring systems are working. 10 OP33 24(1)[a] [b] 11 OP38 17(1)(a) S3 (1) The registered person must 20/07/06 ensure that all accidents and/or injuries to service users are also recorded in the individuals daily records and an associated risk assessment compiled where necessary. Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that where a service user is identified as needing supplement drinks, the type is reflected in the nutritional risk care plan. The registered person should ensure that all service users have access and are provided with chiropody. The registered person should, in consultation with service users, review the length of time they are sitting either in the sitting areas or at the dining room tables at mealtimes without supervision or any social interaction. Also the registered person should review the catering hours provided at the home in consultation with the catering staff. 2 3 OP8 OP15 Milton House DS0000003271.V290727.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 DS0000003271.V290727.R01.S.doc Version 5.2 Page 32 - 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!