Random inspection report
Care homes for older people
Name: Address: Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jon Fry Date: 1 7 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ 02083994663 02083994663 milvertonhome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Surbiton Care Home Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 31 0 dementia old age, not falling within any other category physical disability Conditions of registration: 10 0 31 The maximum number of service users who can be accommodated is 31 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD Dementia Code DE (maximum number of places: 10) Date of last inspection Care Homes for Older People Page 2 of 9 Brief description of the care home Milverton provides nursing care for up to thirty-one older people, ten of whom may have dementia. The home is in a residential area of Surbiton near to shops and public transport links. Accommodation is provided within a mixture of single and shared rooms on the ground and first floor. There are lifts to both upper floors within the home. Care Homes for Older People Page 3 of 9 What we found:
We spent just under five hours in the home during which time we spoke with five people who live there, two staff members, one visitor and the manager. We sent out surveys in October 2009 and received replies from eleven people living at Milverton and sixteen relatives, friends or advocates. General comments from people living there included very kind and helpful, very good, there is a very homely atmosphere, it provides me with a nice room and staff and cheerful attention and attitude. Feedback from relatives, friends and advocates in surveys was very positive. Their comments included a good quality home, excellent care, we are very happy that our relative lives at Milverton and provides outstanding quality and care. One person commented that they have given my relative a new lease of life. We asked if the care service meets the needs of the person they knew and nine people replied always, six people said usually and one person replied sometimes. We spent time in the main lounge of the home and saw some good interaction between staff members and the people who live there. The homes activities organiser was playing some games with people and a visiting Age Concern home buddy was also spending time chatting with individuals. The manager told us that he is continuing to underline the importance of person centred care to his staff and encouraging them to spend time with people. We were shown a training presentation that has been designed by the manager to help staff understand what person centred care means. We looked at two peoples care files. Each one contained an assessment that had been fully completed and gave good information about the person. Care plans were in place and these contained satisfactory information about individual support needs but were still very clinical in approach. The manager told us that he was still working with staff on making the care plans more individual and person centred. The wound care records we looked at were well completed and contained evidence of referrals to the tissue viability nurse when required. We saw that the home had also made referrals to the physio and speech therapist to meet another persons needs. Fluid records were being kept for this person. These were up to date but needed totalling for each day to make sure that staff were meeting the target intake set for this individual. What the care home does well:
Feedback about the staff who work at Milverton was generally very positive. The staff are very kind and caring, always pleasant and polite and I like the staff were all comments we received. Relatives, friends or advocates said they know their patients well, the quality of staff is exemplary and the staff are always welcoming and show great consideration (tenderness) to the residents. The home has been renovated throughout and the people living there are provided with a comfortable and well maintained place to live. A new lift has been fitted to enable access to the top floor. Feedback we received included a good quality environment, very
Care Homes for Older People Page 4 of 9 homely atmosphere, clean and smelling fresh and the house and garden are bright and lovely. We saw that the manager is making good progress in developing and improving the service on offer to the people living there. There is more training available for staff and records showed that people have attended sessions around areas such as person centred care, Safeguarding and manual handling. A new chef is in post and new menus have been introduced. We saw a picture menu was displayed on the tables and special Christmas menus were also available for people to view. Comments about the food included food very good, food excellent and tea and cakes are always offered to visitors. What they could do better:
The service needs to improve its practice around the administration of medication. We found instances where people had not received their medication as prescribed and the auditing procedures introduced after our last inspection visit were not working well. This is of concern given that shortfalls were found around medication at the April 2009 inspection. We made an Immediate Requirement around this issue and the home wrote to us following this inspection visit to say how they had improved their practice around the administration of medication. The Care Quality Commission will look at this area again to make sure that these improvements have been sustained. Comments from some people who live there highlighted staffing levels as an issue and included they can be short staffed - its not their fault, they try, its ok but not enough staff, there could be more staff on duty and when there is staff leave or sickness, care can be affected. Relatives , friends and advocates were asked in surveys if the service could do anything better. A number of comments were about staffing levels and these included I feel the level of alertness is far lower at weekends, more staff at weekends would be an improvement, I feel Milverton is understaffed and I notice that some people have to wait rather a long time when they need assistance. We have strongly recommended that the home looks at the staffing levels in place as this is clearly an issue for some people and their friends or family. Having enough staff will impact on the person centred approach that the manager is trying to establish in the service. Reviewing the deployment of staff on each shift may also help to make staff more visible to people living there. The training provision has clearly improved and we have recommended that the home continues to build on this. Further training around initiatives such as the Eden Alternative should be considered in order to support person centred care. Care plans could be made more person centred as they are still too clinical in approach. Staff need to focus on increasing individual wellbeing and reflect this within each plan. The emphasis on activities also needs to continue to support this approach and consideration should be given to providing even more things for people to interact with
Care Homes for Older People Page 5 of 9 during the day. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 7 27 Care plans should continue to be developed to focus on the person, their wellbeing and quality of life. We strongly recommend that staffing levels are reviewed. The numbers of staff available and their deployment needs to effectively support a person centred approach within the service. The home should look at accessing initiatives such as the Eden Alternative in order to develop the service provided. 3 30 Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - 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!
