CARE HOMES FOR OLDER PEOPLE
Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ Lead Inspector
Alison Ford Unannounced Inspection 11:30 4 January 2006
th 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.V274640.R01.S.doc Version 5.1 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.V274640.R01.S.doc Version 5.1 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.V274640.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 10 service users in the Dementia - over 65 (DE(E)) category. 4th October 2005 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. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/2006 and was an unannounced visit lasting three hours. During this time, a partial tour of the premises was undertaken; several of the residents, and four members of staff were spoken to. Since the last inspection a new manager has been appointed to the home and an application is awaited for her registration. The homes previous manager has now been appointed as the deputy and will have responsibility for clinical issues. All of the current policies and procedures and the residents care plans are in the process of being updated and reviewed and will therefore be assessed at the next visit. The timescales of any requirements relating to these issues has not yet been met however it has been extended to reflect the work that is being undertaken. Over the course of the year all of those standards considered by The Commission to be key to the inspection process have been assessed and this report should be read in conjunction with the one produced following the inspection on 4th October 2005. Since the last inspection, one complaint had been made to the home, which resulted in a strategy meeting being held under the Protection of Vulnerable Adults Procedure. The investigation has now been completed by the home and The Commision has received their action plan. What the service does well:
On the day of the inspection all of the residents spoken to said that “they felt happy” and “well cared for” living in the home. Several of them were sitting by the French windows, overlooking the well-maintained garden, which is a particular feature of this home. Lunch was served during the visit and some residents also had a table positioned so that they could see the garden. They explained how much they enjoyed watching the birds and squirrels. 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
Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 6 and choices are always available to them. In the past, residents from ethnic groups have been catered for although; no one currently requires this service. Photographs around the home illustrate various recent activities that have been undertaken and a structured activities programme is in place for those wishing to participate. There had recently been a Christmas party held in the home and residents commented on how much they had enjoyed it. What has improved since the last inspection?
All residents have an individual plan of care, evolving from a pre-admission assessment, which details the support that is currently required and provides evidence of involvement from other members of the multidisciplinary healthcare team. These are currently being reviewed and a new format is being introduced. This will provide a comprehensive and complete working document to which all members of staff, who provide care to residents, will contribute. In addition, a monitoring tool has been introduced which provides evidence of the care that is given to residents throughout the night. A new Statement of Purpose and Service User Guide is being produced which will meet all of the required standards and be made available to all current and potential residents. This will enable them to make an informed choice as to the suitability of the home. A new format is being introduced for Registered Provider to record the outcomes of his visits to the home and includes a provision for residents to comment on the staff members and the quality of care that is being provided by the home. A formal quality assurance programme will also be undertaken at least once a year. A training needs analysis is being devised for staff to identify additional training that is required. This will be informed by the identified needs of the residents and staff supervision is also being introduced. Recruitment procedures have now been amended to ensure that new staff are not employed prior to the appropriate checks being carried out. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 7 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. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 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.V274640.R01.S.doc Version 5.1 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 A comprehensive pre - admission assessment ensures that the home is confident that it can meet the healthcare needs of any potential resident although, historically residents have not been given sufficient information to allow them to determine whether this home is suitable for them. This home does not offer intermediate care therefore this standard does not apply. EVIDENCE: Pre-admission assessments had previously been seen that showed that the home was confident that it would be able to meet the needs of potential residents. However insufficient information had been available to residents to enable them to make an informed choice. The Statement of Purpose and Service User Guides are in the process of being updated. These will provide all of the information required by potential residents. The draft format was seen, and when they are complete, copies will need to be sent to the Commission for Social Care Inspection office. Although the previous timescale for completion has not yet been met it has been extended in appreciation of the amount of work involved.
Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 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): 10 Residents can be confident that they will always be treated with respect and dignity and that their privacy will be maintained. EVIDENCE: All personal care is delivered in residents own rooms and residents confirmed that “staff were very kind” “ everyone is lovely “and “ nothing is too much trouble “. The previous inspection had raised concerns about some of the night staff however, these were not repeated at this visit and a monitoring tool has been introduced identify the care that is given during the night. In addition, in future the regular visits made by the Registered Provider will also monitor resident’s satisfaction with the staff and enable him to address any issues. Care plans were not assessed at this visit, as they are currently being reviewed and a new format is being introduced. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,15 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: 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 participate in. Some of those spoken with preferred to remain in their rooms and watch television or read. All of them agreed how good the food was that is served in the home, some residents complaining that they were putting on weight since coming to live there, as it was so good. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 12 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 Residents and their relatives have not always been made aware of the homes complaints policy and did not always feel able to raise concerns. Residents cannot be certain that they will be protected by staff following the agreed procedures for reporting abuse. EVIDENCE: The last inspection had revealed that residents and their relatives were not always made aware of the homes complaints procedure and this is now being addressed. A new welcome pack is being devised for residents, which was seen, and this contains a copy of the homes complaints policy and the procedures to be followed. One complaint had been made to the home, which was investigated under the Vulnerable Adults Procedure. The correct reporting processes had not been used at the time although the homes present manager displayed a thorough understanding of the procedure. A requirement is therefore issued that all staff must be made aware of the current procedure for reporting suspected abuse. This issue has since been dealt with and The Commission has received an action plan from the home. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 13 Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in a homely environment however some redecoration and refurbishment of the home would make it more pleasant for them and there are still some concerns about their safety in the event of a fire. EVIDENCE: The residents spoken to, felt that they lived in a comfortable environment however some redecoration is still required. The Registered Provider will be submitting an action plan outlining how these issues will be addressed. It was noted that door wedges were still in use in the home to hold bedroom doors open. Automatic closers, which operate in the event of a fire, must be fitted if residents wish to keep their doors open in order to protect them in the event of a fire. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 15 Residents have all personalised their bedroom however it was noted that not all of them have been provided with a lockable storage space. This must be provided, unless the reason for not doing so is documented in the care plan. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 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. Since the last inspection all of the required checks on staff have been complied with and the current manager displayed an understanding of the processes involved. No new members of staff had been employed since the last inspection although there will be some recruitment as result of the intended training needs analysis. This will also inform the teaching programme that is being introduced. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 17 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 Residents can be confident that an experienced person manages the home and systems will be put in place to ensure that their views are monitored and listened to and their finances protected. EVIDENCE: The home has recently appointed a new manager, who is very experienced in working with this client group. An application must now be made to The Commission for Social Care Inspection, for her registration. The previous manager will be undertaking the deputy’s role and taking responsibility for clinical issues within the home. Evidence was available to show that all of the processes, policies and procedures in use in the home are being reviewed and these will be assessed at the next inspection. Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 18 Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 19 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(2) 5(2) Requirement The Registered Provider must ensure that an up to date Statement of Purpose and Service User Guide is made available to all residents prior to their admission. (Previous timescale 30/01/06 extended) The homes manager must ensure that a copy of the complaints procedure is mad available to all residents. (Previous timescale 30/01/06 extended) The homes manager must ensure that all members of staff are made aware of the procedures to be followed when adult abuse is suspected. Timescale for action 30/03/06 2 OP16 22(5) 30/03/06 3 OP18 13(6) 30/03/06 4 OP19 23(2)(d) The Registered Provider must 30/03/06 supply The Commission for Social Care Inspection with an action plan detailing future plans for the redecoration of the home. (Previous timescale 30/01/06 extended) Milverton Nursing Home DS0000026253.V274640.R01.S.doc Version 5.1 Page 21 5 OP19 13(4)(c) 6 OP23 23(2)(m) The Registered Provider must ensure that automatic closers, which operate in the event of a fire, are fitted to the bedroom doors of residents who wish them to remain open. The Registered Provider must provide evidence that all residents have been offered a lockable space in their bedrooms and it has been provided for those who wish to have it. (Previous timescale 30/01/06 extended 30/03/06 30/03/06 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.V274640.R01.S.doc Version 5.1 Page 22 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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