Inspection on 27/03/07 for Milton House Nursing Home

This inspection was carried out on 27th March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milton House Nursing Home 06/03/06

Milton House Nursing Home 25/07/05

Milton House Nursing Home 25/01/05

Milton House Nursing Home 25/05/04

Milton House Nursing Home 16/01/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Milton House Nursing Home Marton Road Gargrave Skipton North Yorkshire BD23 3NN Lead Inspector John McGarva Key Unannounced Inspection 27th March 2007 10:00 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 Nursing Home DS0000027942.V334468.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 Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Nursing Home Address Marton Road Gargrave Skipton North Yorkshire BD23 3NN 01756 748141 F/P 01756 748141 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) Mr Winston Shutt Mrs Carol Shutt Mrs Hilary Ormrod Mrs Patricia Sykes Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 65 years upwards Date of last inspection 6th March 2006 Brief Description of the Service: Milton House is registered to provide personal and nursing care for twenty-two residents aged 65 years and above. The main part Milton House is over 200 years old and this provides the lounges and a small number of bedrooms. There is additional purpose built accommodation providing further bedrooms, dining room and a new conservatory lounge. It is located a short drive of the village centre and there is ample parking space for visitors and staff. The fees charged at 26/09/06 are £450 - £550 per week. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to the unannounced inspection, which took place on Tuesday 27th March 2007 and the managers Mrs Hillary Ormrod and Mrs Patricia Sykes together with Mrs Shut, the provider were available to assist throughout with the process. The inspection commenced at 10.00hrs until 13:30 hrs, 3.5hrs in total. There were 20 residents present of which 11 were in receipt of nursing care and 9 social care only. The inspections focused on the key standards as well as addressing issues raised at the previous inspection. An inspection of some of the residents’ rooms, lounges, bathrooms and kitchen also took place. Discussions took place with the manager, nurses, carers, and residents. What the service does well: What has improved since the last inspection? There have been some environmental improvements including: New windows to the rear of the building. New carpeting and general decorating. Additional en-suite facilities for one bedroom. Improved access to an assisted toilet. Three new adjustable ‘profiling beds’. Two new ‘pressure relieving’ mattresses. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the foundation on which the care plans can be developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. The managers or undertake these prior to admission. Intermediate care (Standard 6) is not provided in this home. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive a good standard of health and personal care. The storage of medication however could be improved on. EVIDENCE: Individual ring folders are available for each of the home’s residents into which all information relating to their care plan and needs are kept. The records inspected included admission details, medical history, medications, general assessment, nutrition & risk assessments, moving & handling, weight charts, cares plans and daily statements. The care plans are specific to the individual resident and identify all pertinent issues, which helps ensure that all health and social needs are met. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 10 The timings of the daily statements are recorded utilising the 24hr clock in accordance with good practice. Only the trained nurses are involved in the documentation of the residents care on a daily basis and this was discussed with the managers. All the care staff who provide the care interventions should make the appropriate records thereby providing contemporaneous rather than hearsay accounts. This will also assist with the training of the NVQ Level 2 & 3 carers. Medication is administered using the seven-day ‘Nomad’ blister pack system and it appears to be working satisfactorily. The controlled drug of one resident was checked against the records and found to be correct. The storage of the medication however falls short of the current guidelines of the Royal Pharmaceutical Society. There is no clinical room as such, just an area off the main dining area that is adjacent to the sluice room, which is not ideal. There is no sink in the area and the main storage cupboard for the scheduled drugs is not a proprietary drug cabinet. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is meeting residents’ social and dietary needs in a satisfactory manner. EVIDENCE: The residents’ routines of daily living are tailored to their needs and choice and the provider arranges activities when time permits. Care staff said there used to be trips out on the ‘Skipton and Craven Action for Disability’ (SCAD) buses but that there have been none recently. The residents can rise and retire at a time suitable to them and felt that they were in control of their daily routines of life. The residents made favourable comments about the quality of the meals. There is no choice of menu, but should anyone not like a particular dish then alternatives are offered. The cook confirmed that, as it is a small home, she is Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 12 aware of all residents’ particular likes and dislikes and is able to accommodate these. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can feel confidant that they are well protected and that any complaints will be dealt with. EVIDENCE: The complaints procedure of the home meets the required standard and care staff are aware of how to respond to any complaints made by either the residents or their representatives. There have been no complaints made about the service either to the home or the CSCI in recent times. Staff confirmed that they had received recent training in abuse issues. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environmental standards are good providing residents with a homely place in which to live although the location of the sluice room and medication storage area are less than ideal. EVIDENCE: The accommodation provided is of a good standard and there is a range of communal areas including sitting rooms and a dining room. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 15 There are eighteen single rooms and two shared rooms and all, except one single room, have en-suite toilet facilities. Six rooms also have baths, although without hoisting equipment they are of little benefit in practice. There is a passenger lift and a stair lift giving access to the upper floor and there is level access inside the home and to the garden. There is evidence that residents can bring in their own furniture and belongings should they so wish. Some improvements have been made to the home since the last inspection, and these include: New windows to the rear of the building. New carpeting and general decorating. Additional en-suite facilities for one bedroom. Improved access to an assisted toilet. Three new adjustable ‘profiling beds’. Two new ‘pressure relieving’ mattresses. The home has secure well-maintained gardens for the residents to enjoy. Although eight of the residents have hearing deficits there are no loop systems available to help them, and this was discussed with the provider. There is a sluice room with a sluice disinfector located off the dining room and next to the medicine storage area. The location is not ideal with the access to it being through the dining area. There are mixer valves in the bathrooms to ensure that the water delivered to the bath is no hotter than 43° C. A bath thermometer should be made readily available in each of the two communal bathrooms to help ensure total safety. The provider agreed to do this. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents receive a good standard of personal and nursing care from a skilled and motivated staff team. EVIDENCE: The staff spoken to felt that they were able to provide a good level of personal care with the staff provided and that the residents would confirm this when asked. Five of the nine care staff have NVQ qualifications, representing 55 of the team. Additionally, one carer has commenced NVQ Level 2 training and another has embarked upon level 3. Two of the care staff may go on to undertake nurse training. All staff have full induction training in the home’s policies and practices and attend training in first aid, health and safety, moving and handling and food hygiene. Staff files looked at confirmed that appropriate checks, including Criminal Record Bureau (CRB) checks are undertaken prior to appointment. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 17 Some training records are in composite form, i.e. in books relating to all staff and the need to have individual training records for each member of staff was discussed. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is well managed by its managers who enjoy the support and confidence of the staff. EVIDENCE: The registered managers are qualified first level nurses and undertake the dayto-day management of the home jointly. They have not undertaken training for the Registered Manager’s Award or equivalent management qualification. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 19 The registered providers and the manager work closely together to ensure that the residents receive good quality care and that their views are listened to. Staff spoken to said there have been no recent staff meetings where they might affect the way the service is delivered and have future plans and policies for the home explained to them by the provider. Formal bi-monthly supervision of the care staff has not yet been introduced. Mandatory training in Fire safety, Abuse issues and Moving & Handling, has taken place. ‘Liverpool Pathway’ training in the care of the terminally ill has also been undertaken by some of the nursing and care staff. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 22 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 2 Refer to Standard OP8 OP9 Good Practice Recommendations All care staff should make a record of their interventions and observations, not just the nurses. A clinical room conforming to the Royal Pharmaceutical Societies Guidelines for the storage of medicines should be provided. A propriety medication cabinet and a hand wash sink should be provided in the medication storage area. 3 4 5 6 7 8 9 OP21 OP22 OP26 OP30 OP31 OP32 OP36 Water temperature thermometers should be provided in each bathroom. Loop systems to assist the residents with hearing deficits should be provided. A more satisfactory location for the sluice room should be provided. Individual training records should be kept for each member of staff and all records kept there. It is recommended that the registered managers undertake management training. Regular meetings with the staff should take place so they can affect the way the service is delivered. Bi-monthly formal supervision for all care staff should be undertaken. Milton House Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Nursing Home DS0000027942.V334468.R02.S.doc Version 5.2 Page 24 - 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. 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