Inspection on 04/10/05 for Milton House

This inspection was carried out on 4th October 2005.

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 28/06/06

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 Announced 04 October 2005 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 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 D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Milton House Address West Street, Bridgwater, Somerset, TA6 3RH Telephone number Fax number Email 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 Ltd Mrs Audrey Pursey Care home with nursing 51 Category(ies) of Old age (51) registration, with number Physical Disability (51) of places Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 10th May 2005 Brief Description of the Service: Milton House is a purpose built care home situated in the town of Bridgwater, within walking distance of the town centre. It is owned by Somerset Care Ltd, the registered manager is Mrs Audrey Pursey. 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 home is arranged on two floors with two passenger lifts. All the bedrooms are single. The home has a selection of small lounges and a large dining area. A telephone is available for service user use. There is a patio area and a garden which has been landscaped to ensure safe level access for service users. The home has been enlarged and refurbished recently to a high standard to provide the 51 beds. Car parking space although increased is minimal. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 10th May 2005. At that inspection fifteen requirements were identified and three recommendations were made. This inspection was announced and took place over one day (18 inspector hours) and was conducted by Caroline Baker and Kathy McCluskey. At the time of this inspection ten of the requirements had been complied with and two of the recommendations had been actioned. The home had not complied with a requirement made at the last two inspections. Forty-six service users were residing at the home. Admissions to the home had temporarily been stopped due to a recent staffing crisis. Staffing levels were adequate on the day of inspection. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least fifteen service users, four members of staff and five visitors were consulted with. The registered manager was available throughout the inspection. The area manager was available during the afternoon. 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 service users, their relatives/carers and health care professionals for their views on the provision of care at the home. 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 were observed using all communal areas and appeared comfortable and relaxed in their environment. 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. Staffing numbers and the skill mix of staff were sufficient to meet the needs of current service users on the day of inspection. Staff spoken with stated that Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 6 they felt well supported by the manager. Staff training was well documented and the provision of training for staff is good. Staff looked and acted in a professional manner. Staff and service users praised the support of the manager. Any complaints the home had received had been taken seriously and appropriate action had been taken. Staffing issues and shortage of staff has been taken seriously and action taken to ensure service users are not at risk. Comment cards received from service users included comments such as: ‘its like my home’. Other comments received at inspection included ‘they are all lovely here’, ‘the night staff are superb’ and ‘the food is excellent’. Comments received from relatives included: ‘thanks for making my mothers life so comforting’ and ‘On the whole the care is good and the staff are kind and helpful’. Health Care Professionals comments received were positive. What has improved since the last inspection? What they could do better: Issues were identified at this inspection which compromised the safety and welfare of the service users these included: • • • • • • • Care planning Activity provision Recruitment and volunteer workers Risk assessments and the rationale for the use of bedrails Storage of oxygen and creams and use of out of date creams The length of time service users are sat at the tables awaiting their meals – several comments have been made in regard to this from relatives. Informing the CSCI of any incidents in the home which affect the welfare of the service users. The inspectors were satisfied that the management would take action to ensure these matters were acted upon however were concerned that Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 7 recruitment continues not to be robust putting service users at risk. The CSCI will continue to monitor the home as necessary. 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 D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, and 5. NMS 6 is not applicable to the home. 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. Staff at the home have the skills to deliver the services the home offers. EVIDENCE: The statement of purpose for the home is displayed in the reception area of the home allowing access to all visitors and prospective service users who may visit. The manager informed the inspectors that there had been no changes made to it since the last inspection. As part of a case tracking process seven individual service user’s care plans were examined. Evidence was seen that pre-admission assessments although brief had been carried out to ensure the home could meet the needs of the prospective service users. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 10 At the time of this inspection the home had ceased admissions due to the current shortage of staff, and would not be admitting service users until it was confident that appropriate staffing levels were in place to meet the dependency levels of all service users. The CSCI will continue to monitor the homes progress. The inspectors saw evidence that service users are provided with a contract, which meets NMS at the point of moving into the home. Social Services have a block contract with the home for 39 beds. Staff at the home consists of Registered General Nurses (RGN), Registered Mental Nurses (RMN), care staff trained to NVQ in care level 2 and 3, and staff with little or no experience in care. Staff training is provided at the home and the company provides its own training through Acacia Training. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10 and 11. Each service user had a care plan. As at the last two inspections the processes needed improvement, current care needs were not reflected and there continued to be no evidence of service user input. The privacy and dignity of service users was respected. The home, on the whole, had improved their procedures for the management and administration of medication. EVIDENCE: Seven individual service user care plans were examined in detail and the six of the individuals met during the inspection (one was in hospital). The following was identified: • current care needs and interventions were not recorded. • there was no evidence of service user input. • nutritional assessments had not always been completed or reassessed to reflect loss of weight and action to be taken • bed rail assessments were not always completed no risk assessment or rationale for use. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 12 • • • • where wounds had been identified in the daily records there was no care need plan or for service users assessed as high risk of developing pressure ulcers where care needs stated, for example, offer hourly fluids and record, there was no evidence of this happening the reviewing of care plans was inconsistent and not monthly and service users had not been weighed or their observations recorded on admission in some instances and again were inconsistent. This was discussed with the management team who acknowledged there was a problem with care planning and informed the inspectors that the company nurse advisor would be asked to review and provide training. This will be followed up at the next inspection. On examination of medication administration, storage, recording and disposal it was evident that there had been an improvement since the last inspection. However, prescribed creams seen in two rooms were stored inappropriately and were out of date and oxygen was still stored unsafely and not secure. The CD cupboard was secured as required and the pharmacist inspector has been asked to ensure it conforms to current guidelines. The large amount of controlled drugs stored was discussed and whether the new medicine fridge thermometer is functioning correctly. In regard to maintaining privacy and dignity service users spoken to praised the staff stating that they were always kind and caring and treated them with respect. Comment cards received from serviced users indicated that 100 thought staff treated them well. The Inspectors noted that the interaction between staff and service users was kind and friendly throughout the inspection. The inspectors were able to assess the care and provision for service users when they are very ill through case tracking and meeting with other service users. It was evident that a high standard of care was delivered and comfort was assured. Visitors consulted with agreed that a high standard of care was given to their ill relatives, even when there is a shortage of regular staff. However as discussed care plans should reflect the funeral arrangement, as recommended at the last inspection, for individual service users. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. The home’s arrangement for meeting service users social needs needed reviewing. Service users were able to have a choice in regard to their daily living. Service users benefited from a varied diet. EVIDENCE: Many service users were spoken to during the course of the inspection including six who were case tracked as part of the inspection process. All of the service users stated that they were happy at the home and felt it met their individual needs. It was evident that a choice had been given to service users for the time they got up in the morning. The routine of the home appeared to be dictated by service users choice and staff spoken to confirmed this. Individual social needs were not seen recorded in the seven care plans examined. Although regular in-house activities are provided for the service users it was evident from the records kept that the same nine or ten attend. A review of the activities provision was discussed with the co-ordinator and the management who agreed to explore this. Service users on the whole indicated Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 14 that the home provided adequate activities although some expressed a wish for flexercise on a regular basis. This will be followed up at the next inspection. Many visitors were seen on the day of inspection and relatives spoken to were on the whole satisfied with the care provision at the home. The visitor’s book indicated many visitors to the home. The lunchtime and suppertime meal was assessed. They were unhurried and relaxed. Evidence was seen that choice was given and that staff saw each service user individually to ask what vegetable they would like to accompany their dinner. Those needing assistance with food were treated respectfully. Records of service user choice were seen in the kitchen. Although some service users were seated at the tables up to ¾ hour before it was served they were offered drinks and those consulted told the inspectors they did not mind waiting. All service users consulted stated that they enjoyed the food. Two relatives, through surveys, raised concerns over the length of time some service users have to wait at the tables in the dining room before meals. This was brought to the attention of the management. The last inspection highlighted the same concerns and the home was asked to undertake a survey with all service users as to the seating and length of time they wait for meals. The survey was sent out which included size of tables but not the length of time service users have to wait. In light of comments received from relatives the CSCI would expect the home to undertake a survey asking specifically if service users mind waiting at tables for up to an hour at times before meals are served. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, and 18. The home has a satisfactory complaints system in place with evidence that concerns were acted upon. As at the last two inspections the home’s recruitment procedures for staff did not protect service users from the risk of abuse. EVIDENCE: Service users, staff and relatives spoken to were aware of the homes complaint procedure and who to talk to 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 four complaints in the past twelve months one from a service user, one from a nurse agency and two from relatives, the most recent being on Monday 3rd October 2005. Evidence was seen that three been dealt with appropriately. The CSCI had received one anonymous complaint and one written complaint from a relative in the past twelve months with regard to staffing levels and care provision. The home had 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. Staff spoken to on the day of inspection were aware of the Whistleblowing Policy and lines of communication to be taken if necessary. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 16 Service users spoken to stated that they felt safe at the home and comment cards received indicated that 100 of service users felt safe. Somerset Care Ltd is a registered umbrella body and signatory for the Criminal Records Bureau (CRB). Four staff recruitment files were examined as part of the inspection and issues were raised as at the last two inspections that compromised the protection of vulnerable adults as detailed later in the report. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 17 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 standard(s) 19, 22, 23, 24, and 26. Service users live in a safe 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. The standards of cleanliness were good. 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 and environmental health department according to records seen. 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 D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 18 Communal space has increased with the new build giving service users more choice of where to sit and meet others. Adaptations were made to include grab rails in all areas to maximise service users independence. All service users spoken to were happy with their rooms and felt that they were adequate to meet their needs. Room sizes are reflected in the homes Statement of Purpose and meet NMS. Rooms seen were furnished to a high standard. All rooms at the home are single. Infection control systems were in place at the home. The cleanliness of the home was good at this inspection and there were no malodours. The laundry area now has hand-washing facilities for staff and the room next to it was being adapted to a clean laundry area. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. As at the last two inspections the home’s recruitment procedures for staff were not robust and did not protect service users from the risk of abuse. The skill mix of staff was appropriate to meet the needs of current service users. There had been a shortage of staff leading to a staffing crisis since the last inspection. Relatives and service users were concerned over the shortage of staff. 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 has struggled to meet this and has used agency staff for support. The home reached a staffing crisis in September 2005 and stopped all admissions to the home. There is a recruitment drive in hand and action had been taken to reassure staff, service users and relatives that the home is striving to ensure a full compliment of staff. Several staff have left in the past year putting pressure on the remaining staff to undertake extra hours and assist agency staff who may or may not know the home. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 20 Many relatives through surveys have indicated that staffing levels are inadequate at the home and many service users spoken to felt the same. The majority of service users relatives and staff indicated that it was worst at weekends. The CSCI have been assured that the company are taking this crisis seriously and have already employed a member of staff for 2 hours each afternoon to undertake refreshment duties for service users which takes off a duty that care staff used to undertake. Kitchen staff indicated that they felt rushed and have not had an increase in hours since the home increased in size. The management were informed. Staff informed the inspectors that morale had been very poor but was now improving due to the knowledge that the company are assessing the situation and are pro-active. The area manager has been in close contact with the home on a daily basis. The manager felt supported. It was evident at this inspection that the majority of service users have high dependency needs, however this was not always reflected in the care plans seen as previously mentioned. The management showed a clear understanding of the need to staff the home according to the needs of the service users. The CSCI will continue to monitor the home as necessary. During lunchtime at the home the inspector spoke to a volunteer at the home who told the inspector that they had been helping out at the home with feeding and serving at mealtimes. The inspector discovered that the manager had not known this and the volunteer had not been screened to ensure that were fit to work within the care home. The manager took action to ensure service users were not at risk. This concerned the inspectors given the recent thefts of service users monies at the home. Recruitment systems must be more robust. Four staff recruitment files were examined at this inspection of recently employed staff. The Registered Nurse had an up to date Pin No. Evidence was seen of induction and mandatory training. Two overseas staff who had commenced employment did not have Criminal Records Bureau (CRB) disclosure or POVAfirst checks. This has been identified at the last two inspections. A further Immediate Requirement was issued which stated that the CSCI legal action might be considered as this puts service users at risk of abuse. 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. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37 and 38. There has been no change in the management of the home since the last inspection. The management style of the home is pleasing to service users and staff. Views of service users are sought on the conduct of the home. The systems in place for ensuring the health and safety of service users and staff were good. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 22 EVIDENCE: Mrs Audrey Pursey has been the registered manager at Milton House since November 2000. Mrs Pursey has completed the Registered Managers Award at NVQ level 4 and I.O.S.H training in health and safety. It was evident having spoken to staff, relatives and service users on the day of inspection, that the manager communicates a clear sense of direction, and leads the staff in a way that they understand. Staff morale appeared good at this inspection. A recent staff meeting with the management team covered many issues in regard to staffing levels, morale, and excessive use of agency staff. Action was being taken to resolve many of these issues. Staff spoken to felt that at times routines were depending 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. There had been a recent service user meeting and surveys distributed in July 2005 to gather views on the running of the home. The area manager had recorded monthly Regulation 26 visits and as discussed should be unannounced at times. Action had not been progressed within agreed timescales to implement all requirements identified in the last two CSCI inspection reports. On the whole records required for inspection were well maintained and in line with current legislation. Care plans were not maintained however in line with Schedule 3 of the Care Home Regulations 2001 as at the last two inspections. Staff spoken to were aware of the homes health and safety policies. health and safety. 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. The home has had one incident reported to RIDDOR in the past twelve months. CSCI. All accidents and injuries had been recorded. Four had involved bed rails. There were 51 recorded since the last inspection on 10/05/05. All are audited at head office. The CSCI is interested to know the feedback the home gets from this analysis in regard to identifying traits and action taken it is recommended this is sent to the CSCI for assessment. The inspectors reminded the management to always inform the CSCI under Regulation 37 of any serious incidents at the care home including theft. It was Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 23 evident that the CSCI had not been informed of two thefts from service users in August. The police officer involved in the investigation was seen at the home during the inspection. The manager recorded a REG 37 notice and gave it to the inspectors. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 3 3 3 x 3 2 2 Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 25 YES 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 OP7 and 37 Regulation 15(1) and 17(1)[a] Schedule 3(k) Requirement All individual service user care plans must reflect current care needs, including social needs, reflect input from service users, and be person centered. (previous timescale of 27 May 2005 not met) Risks assessments and the rationale for the use of bed rails must be reflected within the individual service users records. (previous timescale of 27 May 2005 not met). All medications including O2 and creams must be stored securely within individual service users rooms, a risk assessment put in place and out of date creams discarded. (previous timescale of 10 May 2005 not met) Funeral arrangements must be reflected within individual the care plans. (recommended at last inspection) Activity provision at the home must be reveiwed and individual social care needs taken into consideration. Service users must be asked for Timescale for action 23 October 2005. 2. OP8 17(1)[a] Schedule 3(q) 23 October 2005 3. OP9 13(2) 23 October 2005 4. OP11 15(1) and 17(1)[a] Schedule 3(k) 16(2)[m] and [n] 16(2)[i] 23 October 2005 5. OP12 30 December 2005 30 Page 26 6. OP15 Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 7. OP18 and 29 12(1)[a] 17(2) Schedule 4(6) 19 Schedule 2 8. OP31 12(1)[a] and [b] 9. OP 31 and 38 37 their views on the length of time they wait at the table for lunch and supper and the results sent to the CSCI. The home must safeguard and protect service users at all times by ensuring the fitness of persons before their commencement of employment in line with company recruitment policies. (Previous timescales of 25 January and 10 May 2005 not met) A further Immediate Requirement Notice was issued. There must be systems in place to ensure that the registered manager is aware of who is working in the care home at all times. The registered manager must ensure that the CSCI is kept informed without delay of all incidents that happen in the care home which affect the safety and welfare of service users. December 2005 04 October 2005 23 October 2005 23 October 2005 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 OP7 Good Practice Recommendations All staff involved in care planning should receive training from the companies nurse advisor as discussed. Milton House D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection 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 D53 - D02 S3271 Milton House V245209 041005 Stage 4.doc Version 1.40 Page 28 - 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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