CARE HOMES FOR OLDER PEOPLE
Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ Lead Inspector
Alison Ford Unannounced Inspection 4th October 2005 10:30 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.V254730.R01.S.doc Version 5.0 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.V254730.R01.S.doc Version 5.0 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.V254730.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 10 service users in the Dementia - over 65 (DE(E)) category. 15th September 2004 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.V254730.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2005/2006 and was an unannounced visit lasting five hours. During this time, a tour of the premises was undertaken and the majority of the residents, one visiting relative and five members of staff were spoken to. A sample of care plans was seen and also a sample of staff files. The homes manager was not on duty during the inspection and the senior nurse is thanked for her help. Since the inspection the commission has received notice that the manager will not be staying at the home and interviews are being undertaken to replace her. Prior to the inspection, comment cards had been received from fifteen residents and relatives and the GP who visits the home and the majority of comments were very favourable. No complaints have been received by The Commission for Social Care Inspection about the home since the last inspection. What the service does well:
On the day of the inspection the majority 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 feature of this home. Particular comments were received about the food served, which was described, as ” excellent” and “marvellous”. Photographs around the home illustrate various recent activities that have been undertaken and a structured programme is in place for those wishing to participate. Other residents choose to watch television or stay in their rooms, as is their preference. 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 reviewed regularly and a key worker system is in operation in the home, which is designed to provide particular support to residents. Maintenance and safety records were in good order and necessary checks had been carried out. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.V254730.R01.S.doc Version 5.0 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 Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 A comprehensive pre - admission assessment ensures that the home is confident that it can meet the healthcare needs of any potential resident however, residents are not always 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: There was a Statement of Purpose and Service User Guide in the home however there appeared to be several errors in it and it was not at all clear how it would be made available to prospective residents and their families. A newly admitted resident and their relative said that this information had not been given to them until several weeks after admission. Both of these documents must be made available to service users as part of the information that will allow them to decide whether or not the home can meet their needs. These documents had been the subject of previous requirements, which appear not to have been complied with.
Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 9 The care plans that were seen, showed that a comprehensive pre-admission assessment had been carried out prior to residents moving into the home to ensure that it would be suitable for their needs. A care manager’s assessment was in place for residents funded by the local authority. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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): 7,8,10 An individual care plan and access to allied healthcare services, ensures that residents healthcare needs are identified however, they are not always confident that all staff will treat them with respect and dignity. EVIDENCE: Each resident has an individual care plan, five of which were assessed at this visit. All residents have a named nurse that is responsible for the plan and in addition have a key worker amongst the care staff. The care plans were generally in good order, reflecting the care currently being provided and included risk assessments, manual handling assessments and regular identification of factors, which may predispose to the formation of pressure sores. Visits from other healthcare professional were recorded and appropriate equipment was in use where necessary to prevent pressure sores occurring. Photographic evidence was available to show the progress of wound healing however there was no record that permission had been given by the resident for these pictures to be taken. The resident or their relatives must complete a consent form where these photographs are to be used. The most current daily progress sheets were stored in a supplementary file and it was recommended that these should all be consolidated into one so that staff were able to view the plan in its entirety. It was also recommended that there
Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 11 should be a facility for care staff to contribute to these plans as they deliver a substantial amount of the care and support. There was evidence that these care plans are reviewed regularly to ensure that residents healthcare needs can be met however none of the residents that were spoken to recalled that they had been consulted in their compilation. The homes manager must ensure that they are helped to contribute where it is at all possible. Personal care is delivered in resident’s own rooms and staff were observed to be treating them politely and kindly however, some adverse comments were received about the care that is delivered during the night. A requirement is issued, under standard 36, to ensure that there is regular supervision for staff at night so that standards of care are maintained. In addition the manager must ensure that care given at night is monitored. It was noted that not all of the shared rooms have screening to provide privacy for residents when required. This must be put into place. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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 A range of activities, suitable for residents needs, is in place in the home and visitors are encouraged so that family links and friendships can be maintained. 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: An activities programme is in place during the afternoons and there is documentation showing which residents have taken part. Some relatives comment cards indicated that they would like to see the range of activities increased however this view was not supported by those residents that were spoken to. Photographs on the wall illustrated recent events including a holiday for two residents. Visitors are always made welcome into the home and could stay for a meal if they wished. Comments were received that the food was “excellent” “marvellous” and “you couldn’t have a better cook”. Residents 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. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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 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 are not always made aware of the homes complaints policy so do not always feel able to raise concerns. Recruitment policies do not always ensure that staff are suitable to work with elderly people therefore residents cannot be certain that they are protected from abuse. EVIDENCE: A complaints procedure was seen, however it was not clear how this is conveyed to residents. Those spoken to, during the visit, were uncertain of the procedures to be followed, which had meant that concerns had not always been raised. This procedure must be made available to residents prior to admission to the home. It must also explain that there is the right to complain to The Commission at any stage of the complaints process. Staff were aware of issues around the abuse of vulnerable adults however, in order to ensure the protection of the residents in the home, a requirement is issued under standard 29 that all staff must have clearance from the Criminal Records Bureau prior to starting work in the home. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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): 19,23,26 Residents live in a homely environment however more thorough cleaning and some redecoration of the home would make it more pleasant for them. EVIDENCE: The residents spoken to felt that they lived in a comfortable environment however it was noted that some floors were not very clean and some redecoration is required. The Registered Provider must submit an action plan outlining how these issues will be addressed. It was noted that door wedges were in use in the home to hold bedroom doors open. Automatic closers, which operate in the event of a fire, must be fitted if resident wish to keep their doors open. 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. The home was free from odour on the day of inspection and the majority of the laundry is sent out to a commercial company. Only personal items are laundered in the home.
Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 15 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): 29 Residents cannot be certain that the homes recruitment policies will always ensure their protection. EVIDENCE: On the day of inspection there appeared to be sufficient staff on duty, this will be checked against the original staffing notice and assessed at the next visit. Staff files showed that Criminal Records Bureau Clearance is not always received prior to the start of their employment. The Registered Manager must ensure that this is always obtained unless there is a prior arrangement with The Commission. This must include staff that are working supplementary hours in the home with a main job elsewhere. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 16 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): 36,38 Staff supervision is not always sufficient to ensure that good care practices are always maintained. The homes maintenance procedures ensure the safety of the residents in the home. EVIDENCE: A selection of certificates relating to the maintenance of equipment in the home was seen and were in order. The pre-inspection questionnaire stated that all appropriate checks had been carried out and any requirements issued had been complied with. It is recommended that advice be sought from the Fire Safety Officer as no recent visits appear to have been made. Comments were received, during the inspection, regarding the quality of the care provided at night. The homes manager must ensure that supervision of these staff occurs on a regular basis and that the experiences of residents are monitored closely so that they feel appropriately cared for at night.
Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 17 Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 18 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 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 2 17 X 18 2 2 X X X 2 X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 3 Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 30/01/06 1 OP1 4(2) 5(2) 2 OP7 15(1)(c) 3 4 OP10 OP10 12(4)(a) 12(5)(b) 5 OP16 5(1)(e) 6 OP16 5(1)(e) 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. The homes manager must ensure that there is evidence that all residents and their relatives have been able to contribute to their care plans. The Registered Provider must ensure that privacy screens are in place in all shared bedrooms. The homes manager must ensure that there is regular monitoring of the standard of care that is delivered at night and that residents views of this care are monitored closely. The homes manager must ensure that a copy of the complaints procedure is given to all potential residents prior to their admission. The Registered Provider must ensure that the homes complaints procedure reflects the
DS0000026253.V254730.R01.S.doc 30/01/06 30/01/06 30/01/06 30/01/06 30/01/06 Milverton Nursing Home Version 5.0 Page 20 7 OP19 23(2)(d) ability to contact The Commission for Social Care Inspection at any stage of the complaints process. The Registered Provider must 30/01/06 supply The Commission for Social Care Inspection with an action plan detailing future plans for the redecoration of the home. The Registered Provider must supply The Commission for Social Care Inspection with an action plan detailing how cleanliness of the home will be maintained in the future. The Registered Provider must provide evidence that all residents have been offered a lockable space in their bedrooms The Registered Provider must ensure that all staff files contain all of the requirements of Schedule 2 & 4. (Previous timescale 1.12.04 not met) The Registered Provider must ensure that supervision of night staff occurs on a regular basis and that there is evidence that resident’s views, on the quality of care at night, are monitored closely. 30/01/06 8 OP19 23(2)(d) 9 OP23 23(2)(m) 30/01/06 10 OP29 19(1)(b) 30/11/05 11 OP36 18(2) 30/11/05 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 OP7 OP7 Good Practice Recommendations It is recommended that all care plans of residents be kept together in one folder. It is recommended that provision be made for care staff to
DS0000026253.V254730.R01.S.doc Version 5.0 Page 21 Milverton Nursing Home 3 OP38 write in residents care plans in order to evidence all of the care that is given. It is recommended that a visit be requested from the Fire Safety Officer. Milverton Nursing Home DS0000026253.V254730.R01.S.doc Version 5.0 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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