CARE HOMES FOR OLDER PEOPLE
Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ Lead Inspector
Alison Ford Key Unannounced Inspection 22nd May 2006 09:30 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 Milverton Nursing Home DS0000026253.V295517.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. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Milverton Nursing Home Address 99 Ditton Road Surbiton Surrey KT6 6RJ 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) 020 8399 4663 020 8399 4663 Surbiton Care Home Limited Care Home 23 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability over 65 years of age (0), Terminally ill over 65 years of age (0) Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 10 service users in the Dementia - over 65 (DE(E)) category. 4th January 2006 Date of last inspection Brief Description of the Service: Milverton is a care home situated in a residential area of Surbiton and registered with the Commission for Social Care Inspection to provide nursing care for up to twenty three elderly people, of which ten may have dementia. The home is near to shops and public transport links and there is off-street parking available. Accommodation is provided within a mixture of single and shared rooms on the ground and first floor. There is a communal lounge and dining room and a beautiful garden to the rear of the property, which is greatly enjoyed by the residents. There is both a passenger and stair lift in use within the home and various adaptations have been made to make it suitable for the residents that live there. At the time of this latest inspection weekly fees range from £600 - £750 per week, exclusive of extra charges for personal items, and would be discussed at the time of admission. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first key inspection for the year 2005/2006 and was an unannounced visit. During this time, a tour of the premises including the kitchen was undertaken; the majority of the residents, and six members of staff were spoken to. The care plans of six residents, and two staff files were seen. Medication records and storage were assessed and the complaints and accident book were also seen. There is an ongoing refurbishment and redecoration plan and there are plans to extend the home this year and provide accommodation for another eight residents in addition to increased communal and staff space. Since the last inspection, two complaints have been resolved appropriately by the home and considered to be unsubstantiated. Prior to the inspection a pre-inspection questionnaire was completed by the manager of the home and during the course of the year the views of the people who use this service and their representatives will continue to be monitored. What the service does well:
On the day of the inspection all of the residents spoken to said, “they felt happy” and were “looked after very well “. One commented, “staff were very kind and very friendly” and one lady explained how she especially liked the fact that bed linen was changed frequently and that the home was “very clean”. Residents have been encouraged to bring in personal possessions in order to individualise their bedrooms and the home is clean and free from malodour. Several residents were sitting in the lounge by the French windows, overlooking the well-maintained garden, which is a particular feature of this home. An activities organiser arrived during the visit and residents joined in with chair based exercises enthusiastically. Particular comments were received about the food served, which was described, as ” excellent” and “marvellous”. The cook has been at the home for some time and all of the food served is completely home made. She talks with the residents frequently to make sure that they are enjoying the meals and choices are always available to them. In the past, dietary preferences of
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 6 residents from ethnic groups have been catered for although no one currently requires these choices Photographs around the home illustrate various recent activities that have been undertaken and a comprehensive structured activities programme is in place for those wishing to participate. A party is being planned for the summer. The home aims to maximise independence and choice for residents and a “residents charter” is displayed in the hall, which outlines the homes philosophy and the rights of the residents while they remain in the home. What has improved since the last inspection? What they could do better:
Despite having been in post since before the last inspection The Commission has still not received an application for registration of the homes manager. This situation must be rectified without delay. Although it is acknowledge that residents care plans have improved significantly since the last inspection, more attention still needs to be paid to their social and personal healthcare needs. Training is planned for staff with regard to life history work and this should lead to a greater insight of resident’s needs and behaviour patterns. There must also be more evidence that residents and their representatives have contributed to their care plans and been given the opportunity to influence the support that they receive.
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 7 The redecoration and refurbishment of the home is ongoing and the Registered Provider must ensure that this continues according to the action plan that was previously submitted. Following an incident in the home some concerns were raised about the security of the front door and the fire exit. The Registered Provider must inform the Commission how he intends to ensure that residents cannot leave the home unnoticed in the future. 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. Milverton Nursing Home DS0000026253.V295517.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 Milverton Nursing Home DS0000026253.V295517.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): 3,6 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. A comprehensive pre - admission assessment ensures that the home is confident that it can meet the healthcare needs of any potential resident This home does not offer intermediate care therefore this standard does not apply. EVIDENCE: The care plans of seven residents were seen and all contained evidence of a comprehensive pre-admission assessment, which would ensure that the home would meet their healthcare needs. Since the last inspection the Service User Guide is now put in resident’s rooms so that they are aware of the homes responsibilities towards them. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. All residents have an individual plan of care, which ensures that staff are familiar with the support that they require and that their healthcare needs remain met. There are medication procedures in place to protect residents and they can be confident that they will be treated in a way, which maintains their privacy and dignity. EVIDENCE: On the day of the inspection all of the residents looked clean and well cared for. All residents have an individual plan of care, which details the support that they currently require. The format of these has been improved since the last inspection however although they are much better they would still benefit from a greater emphasis on residents personal and social needs especially for those residents suffering from dementia. Consideration also needs to be given to resident’s wishes in the event of them becoming very unwell or dying. There must be evidence that these issues have been discussed with them or their
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 11 representatives and also that they have been given an opportunity to influence and contribute to their care plans. There is a key worker system in operation in the home to ensure continuity of care for residents and there was evidence of input from other healthcare professionals as required. Regular monitoring of those thought to be at risk from developing pressure sores is undertaken and appropriate interventions are in place. Photographic evidence is used to monitor the healing process f wounds. The nurse responsible for the residents care reviews care plans regularly. All personal care is delivered in residents own rooms and they confirmed, “staff are very kind” “ everyone is lovely “and “ nothing is too much trouble “. During the visit care staff were observed interacting with residents in a very gentle and caring way. Medication administration records and storage were seen to be in order; trained nurses administer all the medication in the home. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. A range of activities is available which suit resident’s preferences and abilities and provide interest and stimulation and their relatives and friends are always welcomed into the home. Residents are encouraged to exercise as much choice in their lives as they are able, in order to retain their individuality and independence and the meals that are served provide a wholesome and nutritious diet, which helps to maintain their health and wellbeing. EVIDENCE: A range of activities is available in the home for those who wish to join in and a timetable in the hall shows that there is something available for residents to do on most days. Special events and festivals are always celebrated and there are photographs of some of them displayed in the home. On the day of inspection several residents were undertaking chair-based exercises enthusiastically in the lounge. Residents confirmed that they are always able to exercise choices over what they would like to eat, what they wear and the activities that they wish to
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 13 participate in. Some of those spoken with preferred to remain in their rooms and watch television or read. The home aims to maximise choice and independence to enable residents to live a fulfilling life. All the residents agreed how good the food was that is served in the home. All the food is homemade and the cook, who has been in post for some time, visits residents daily to offer choices to the main menu if they wish. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and their relatives are made aware of the homes complaints policy and are confident that any concerns would be acted upon and that they will be protected by staff following the agreed procedures for reporting abuse. EVIDENCE: Since the last inspection work has been undertaken to ensure that residents and their relatives are aware of the homes complaints procedure. A copy of the process is displayed in resident’s bedrooms and is in the Service User Guide, which has been distributed. The home has a “Charter of Rights” displayed in the hall outlining how residents can expect to be treated while they live in the home In response to recent issues all staff have received training in the recognition and reporting of adult abuse and this is ongoing with support from a local authority care manager Two complaints since the last inspection have been dealt with appropriately. To help ensure the protection and safety of resident all staff have received clearance from the Criminal Records Bureau
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 15 Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service Residents live in a homely and clean environment however some redecoration and refurbishment of the home is still required make it more pleasant for them and security measures need to be improved to ensure their safety. EVIDENCE: The residents spoken to, felt that they lived in a comfortable environment however some redecoration is still required. There are also plans to extend the home and upgrade several areas. The Registered Provider previously submitted an action plan outlining how these issues will be addressed and his timescales have not been reached as yet. The situation will continue to be monitored. Automatic closers, which operate in the event of a fire, have now been fitted where residents wish to keep their doors open in order to protect them in the event of a fire.
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 17 A recent incident had occurred where a resident had been able to leave the home. The Registered Manager must notify The Commission how he will increase security in the home. The fire exit door is opened with a push bar and a requirement is issued that this must be linked to an alarm system to ensure that residents do not leave the home unnoticed. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service Residents can be confident that the management team in the home is endeavouring to ensure that sufficient suitably trained staff will meet their needs and recruitment policies are in place, which are designed to protect them. EVIDENCE: On the day of inspection there were sufficient numbers of staff on duty to ensure that the healthcare needs of the residents would be met and off duty rotas were seen which showed that this was always so. The majority of care staff have achieved NVQ qualifications to at least level 2 and the deputy matron is completing a level 4. A planned programme of staff training, including statutory updates has begun which will be monitored at future visits and there is comprehensive induction training package in place for new staff members, which was seen. Given that the home has several residents with dementia there must be particular emphasis on training for care staff in the problems experienced by this group of people Some training has been planned in these issues and all staff must have the opportunity to participate in this. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 19 The home has been audited by City University to enable adaptation nurses, already qualified in their home country and awaiting validation from the NMC, to be employed and there are currently two working in the home. All of the required checks on staff have been complied with to ensure the protection and safety of residents and there was evidence of robust preemployment procedures being in place in the two files that were seen. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service A lack of registration means that residents cannot be certain that a suitably qualified person manages the home. Systems have been put in place to ensure that residents views are monitored and used to influence the running of the home and that the health safety of both them and the staff is promoted. EVIDENCE: The manager of the home is appropriately qualified and has several years experience in working with this client group, displaying an in depth understanding of the issues. However an application has still not been received for her registration. This situation must be addressed without delay.
Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 21 A meeting was planned for relatives during the week following the inspection: the first held by the present manager. At this, satisfaction questionnaires will be distributed to monitor their views of the service. The results will be collated and published. There will also be a notice displayed informing everyone that an inspection has taken place and how they could obtain a copy of the report if they wished. The administrator, who was away on the day of the visit, keeps some personal money on behalf of residents. However records had previously been examined and found to be in order. She also keeps records of all checks made on equipment and services in use in the home. These too, had previously been in good order and the pre-inspection questionnaire showed that they were all up to date. Records were available to show that regular fire drills were being undertaken and a senior staff member has undertaken training in order to hold these and to produce a fire risk assessment for the home. All care staff receive regular supervision and appraisal in order to monitor their performance and identify their training needs. Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 22 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 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 3 X 3 Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 23 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. 1 Standard OP7 Regulation 15(1) Requirement The Registered Provider must ensure that care plans provide more information relating to the personal and social needs of residents. The Registered Provider must ensure that care plans provide evidence that residents and their representatives have been encouraged to contribute and influence the care that is being given. The Registered Provider must ensure that care plans provide evidence that residents and their representatives have been asked about their wishes in the event of serious illness or dying. The Registered Provider must ensure that the redecoration and refurbishment of the home continues according to the previously supplied action plan. The Registered Provider must improve security measures to prevent residents leaving the home unnoticed. The Registered Provider must ensure that an alarm is fitted to
DS0000026253.V295517.R01.S.doc Timescale for action 30/08/06 2 OP7 12(2) 30/08/06 3 OP7 12(2) 30/08/06 4 OP19 23(2)(d) 30/09/06 5 OP19 13(4)(c) 30/08/06 6 OP19 13(4)(c) 30/08/06 Milverton Nursing Home Version 5.2 Page 24 7 OP30 18(1)(a) 8 OP31 8(1) the fire door to indicate when it has been opened. The Registered Provider must 30/08/06 provide an action plan showing how all staff will be given the opportunity to undertake training in dementia care. The Registered Provider must 30/08/06 apply to The Commission for registration of a suitable person to manage the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milverton Nursing Home DS0000026253.V295517.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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