Inspection on 11/07/07 for Mitchell House

This inspection was carried out on 11th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mitchell House 19/08/08

Mitchell House 22/06/06

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

CARE HOMES FOR OLDER PEOPLE Mitchell House 2 Mitchell Road Canford Heath Poole Dorset BH17 8US Lead Inspector Debra Jones Unannounced Inspection 11th July 2007 9:45 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 Mitchell House DS0000067219.V345848.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. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mitchell House Address 2 Mitchell Road Canford Heath Poole Dorset BH17 8US 01202 681446 01202 852248 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) Care UK Community Partnerships Ltd Mrs Sylvia Ann Williams Care Home 49 Category(ies) of Dementia (49) registration, with number of places Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia- Code DE The maximum number of service users who can be accommodated is 49. 22 June 2006 Date of last inspection Brief Description of the Service: Mitchell House is a care home accommodating a maximum of 49 older people. All new permanent admissions have a diagnosis of dementia. The home is operated by Care UK who lease the home from the local authority. Mrs Sylvia Williams is the registered manager of the home. The premises are split into 5 bungalows with 10 bedrooms except bungalow 4 with 9 bedrooms. Each room is offered for single occupancy. Bungalow 4 is designated for up to 6 respite beds; the others are for permanent residence. The bungalows have communal lounge/dining space, bathroom and kitchen facilities. None of the rooms have en suite facilities other than hand washbasins. The home is located at Canford Heath and is within easy reach of Poole town centre. Public transport operates close to the home. At the time of the visit, the weekly fees were set at £477.69. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 11 July 2007. Debra Jones was the inspector who carried out the visit. Sylvia Williams, the registered manager and staff at the home helped the inspector in her work. The inspector was made to feel welcome in the home throughout her time there. A tour of the premises took place and a variety of records and related documentation was examined, including care records. Time was spent amongst residents. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting requirements and recommendations made as a result of previous inspections in 2006. Progress had been made. Three requirements and three recommendations were made as a result of this visit. Some good practice guidance was discussed and is referred to in the report, intended to encourage further improvement. The management of the home has demonstrated through developing their own systems of regular audits of aspects of the service and their recent success in moving towards compliance with requirements and recommendations, made at previous visits, that there is a good capacity for the service to continue to improve for the residents in their care. What the service does well: The home has a warm and relaxed atmosphere. Throughout the visit staff were seen providing support and encouragement to residents. This was clearly appreciated. Pre-admission assessments are carried out to ensure that only people whose needs can be met are offered places at the home. Residents also receive good support from community health professionals, such as GPs and district nurses. Staff were observed throughout the inspection to be treating residents with courtesy, patience, kindness and respect. Residents are encouraged to make choices about how they live their lives and the home provides them with access to social and recreational activities. They are able to have visitors whenever they like. Meals are based on the known preferences of residents and a nutritious diet is provided. They may choose where to eat their meals. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 6 The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of people living at the home is important to Mitchell House and that any concerns raised will be properly investigated and resolved. Mitchell House is kept clean and smells pleasant. The number of well-trained care staff employed at the home is sufficient to meet the needs of residents. The home is well managed and organised with the care, contentment and safety of residents being at the heart of the way Mitchell House is run. What has improved since the last inspection? What they could do better: The outcome of pre admission assessments need to be confirmed in writing, so prospective residents are fully assured that their care needs will be met. Care plans need to be more detailed and individual. Assessment and care documentation needs to cross reference and be up to date to ensure that staff have the information they need to meet the health and personal care needs of residents. Some further improvements are needed in the medication system. The home should be countersigning all handwritten entries on medication administration records and the audit trail of all medicines should be clear. Where staff are left to make decisions about whether to administer medicines and their dose rather than the resident, the circumstances and decision making process should be clearly documented on the care plan. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 7 It would be good if Care UK Community Partnership Ltd developed a programme for the upkeep of Mitchell House for the coming year while the new home is being progressed. Certain information and documentation is required to be gathered prior to any person starting work at the home. Some gaps were noted at this inspection, namely full employment histories and references. These must be addressed to ensure that only suitable people work at Mitchell House. The following good practice suggestions are made that the home are urged to consider and act upon. • Noting the origin of information gathered at pre admission assessments. • Carrying out fuller pre admission assessments in respect of dementia and increasing care planning for this significant need. • Including a section on medication in care plans, detailing what medicines are being taken and what they are for; in the longer term this provides a history of medication use. • Looking at daily choices offered to residents to ensure that they are meaningful e.g. considering the effectiveness of offering choices of meals the day before. • Looking into specialist training in dementia and nutrition for the chefs. 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. Mitchell House DS0000067219.V345848.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 Mitchell House DS0000067219.V345848.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission assessments are undertaken to establish that the home can meet the needs of the prospective resident, however the resident is not reassured in writing that following the assessment the home is able to meet these needs. EVIDENCE: The files of three residents who had been newly admitted to the home were reviewed. All residents living at the home on a long-term basis or for respite are referred by the Borough of Poole, who ‘block book’ the beds there. Before staff at the home assess any prospective residents they obtain the local authority assessment. All prospective residents are assessed in person by staff at the home and a standard form is used to do this. Assessments were comprehensive in respect of the physical health of the person and information Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 10 about the persons likes, dislikes and previous interests were recorded. The assessment was weaker when it came to the primary need of the person i.e. their dementia, how this manifested and particular needs the home would have to meet. This is significant as Mitchell House offers a specialist service for people with dementia. Assessments could be clearer as to the origin of the information contained on them, e.g. if it was supplied by the resident or a family member present at the assessment. The home is not sending letters confirming, that following the pre admission assessment, the home can meet the health and welfare needs of the prospective resident. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The home strives to have care plans of a high standard and Care UK Community Partnerships Ltd have invested in an electronic care planning system to support this aim. Paper files are kept to back up the system. In addition to the regular reviews of care plans and assessments, a representative of Care UK audits care plan documentation relating to each resident as part of the monthly visit made to the home. Records are kept of the reviews and findings and the manager ensures follow up at the home. At this visit plans were reviewed for esidents of varying need. A broad range of information is collected on the assessment forms and there was evidence to show these were reviewed monthly and updated, however information did not always cross reference leaving the resident at risk of not receiving the care Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 12 they needed or of updates not being followed through. For example one plan referred to the need for a resident to be turned through the night. Turning charts were not being kept and it was established that the resident did not need turning anymore and the plan was out of date. On another plan the resident had been assessed as needing a pressure mat at night, this did not feature on the night care plan. The manager recognises that plans generally need to be more specific about the details of care staff are to provide for residents. For example the plan would say to offer mouth care to a resident but it would not be clear whether the resident had their own teeth or dentures. Although residents are referred to Mitchell House because of their need for dementia care the original assessments are not strong in this area and this weakness continues through the care plans. The home are still considering the best way to demonstrate the involvement of residents / their representatives in care planning. Despite the flaws identified in the care planning system there was nothing to demonstrate that residents at the home were not receiving good care. The use of bed rails was discussed and the need for the reasons for their use (the assessment) to be well documented, along with a risk assessment for their actual use. The home immediately obtained information to progress this. Records are kept of the interventions of health professionals e.g. GPs, district nurses, chiropodists etc. Where directions for care have been made by visiting professionals these were seen to have been noted on the care records and the follow through evidenced on the daily notes. District Nurses come to the home twice a week and the home can arrange for any residents to see them. Residents can also access the Doctor at the community surgery, which is located very near to the home. Chiropodists, dentists and opticians come to the home. Where there is concern over how some residents are eating nutrition monitoring charts are put in place to inform any action needing to be taken. The medication and records for two of the bungalows were reviewed at this visit. Medication is subject to regular audits by home staff. Records are kept of these audits. The home assesses whether any residents are able to administer their own medication. This is clear in the care plans. Care plans could be improved by including by listing what medication residents take and what it is for. Medication administration records showed that there were some medicines administered ‘when required.’ Most residents are not able to say when they require medicines of this nature. Where this is the case when medication is administered becomes the decision of the staff, rather than the resident. The circumstances as to when these medicines are administered or what doses are to be given where the instructions are variable, were not clear in the care plans. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 13 A local pharmacist supplies the medicines using a monitored dosage system (MDS) and provides computer generated Medication Administration Record (MAR) sheets. Not all sheets made it clear if the resident had any allergies. All medication received into the home is signed for and dated. A set of sample signatures (initials) were seen as per good practice, so it is clear who has signed the records. No gaps were seen in the medication records, it was clear where residents had taken their medication or where they had not, why. Where medicines are not in the monitored dosage system the home marks on the bottles, boxes when they are brought into use. Medication records sampled tallied with the medicines on the premises in all cases with the exception of paracetamol. An audit trail was not clear as some ‘home stock’ had been used. Where handwritten entries / changes had been made to the printed MAR sheets these were mostly countersigned by another competent person to confirm that the changes made were correct but not in all cases. The home has a separate fridge for medication and this fridge temperature is regularly checked to ensure that the medicines do not get too cold or too warm. Staff were seen to treat residents in a respectful and dignified way during the course of the inspection. Residents responded well to their kindness. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is available for residents to participate in. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets the preferences of residents. EVIDENCE: The home now has 2 part time activities organisers, Current activities include bingo, exercise sessions, painting, crochet, dressing up and sing a longs. Entertainers come to the home and a garden party took place recently. The manager talked positively of how the home were looking at expanding the opportunities for stimulation for residents through engaging them in enjoyable day-to-day activities to better occupy their time e.g. folding washing, laying tables. Photo boards have been placed around the home depicting daily life e.g. residents enjoying celebrations and entertainment. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 15 The visitors books confirmed the number and range of visitors to the home. Visitors are welcome at any time. People are encouraged to make choices about how they live their lives at the home. Residents can do as they wish, choose to eat what they like and join in with activities as it suits them. Staff offered and encouraged residents to make choices during the course of the visit. The main meals are cooked centrally and distributed to the bungalows in heated trolleys. The meals are then served to residents by the care staff and portions are varied according to the preferences of the individual residents. Residents usually go to the dining areas for meals but can have meals in their own rooms if they wish. Menus seen show that residents get variety and choice at all meals. There are summer and winter menus; menus are on a four week cycle. On the day of the visit lunch was lamb stew with creamed and roast potatoes and fresh vegetables – carrots, swede, broccoli, cauliflower and peas. Pear and chocolate sponge with chocolate sauce or fresh fruit salad was for dessert. Supper was to be cheese and bacon on toast or sandwiches, and cake. Diabetic diets are catered for. All residents are offered choices of meals the afternoon before. Some residents find this choice more difficult / meaningful than others. Staff know from experience what residents like to eat, this is explored when the residents first move into the home. The home was agreeable to looking at this system of offering choice to the residents particularly to any residents who were confused, to see if the way they are currently offering choice about food is empowering or adding to confusion. In respect of the outcome for residents at mealtimes the kitchen is very accommodating and residents get meals they like from the menu or can have alternatives. It was suggested that the home looks into training in nutrition and dementia for the chef to broaden their knowledge and stimulate thought on meeting the needs of the resident group. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a responsive complaints procedure. The abuse policies and procedures reassure anyone raising concerns that these would be listened to and acted upon. EVIDENCE: Mitchell House has a complaints procedure and keeps a record of any complaints made, the investigation of the complaint and the outcome to the complainant. All complaints investigations in the last year have been completed in 28 days as per the home’s procedure. The home has an adult protection policy and there is staff training in this subject at the home from induction onwards. Since the last key inspection an adult protection issues have been raised and investigated at the home. These were handled in accordance with the home’s procedures and involved the local authority and the Commission. Appropriate action was taken. Prior to any members of staff commencing employment at the home the Protection of Vulnerable Adults list is checked to ensure their suitability. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 17 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, adequately maintained and homely environment, which encourages independence. EVIDENCE: Care UK Community Partnerships Ltd intend moving Mitchell House to new purpose built premises in the near future. It is anticipated that this will not be for at least another year. Since taking over the property in 2006, a number of improvements had been carried out and a maintenance man had been employed to carry out minor repairs. Staff and residents are currently unclear about what improvements will be made to the home over the next year given the longer-term plan for Mitchell House. Continuing, proportionate investment needs to be made to ensure the comfort of residents currently living at the home. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 18 Mitchell House is arranged in 5 bungalows, which are joined together. Four of the bungalows have 10 bedrooms and bungalow 4 has 9. All bedrooms are single occupancy. Bungalow 4 can have up to 6 respite beds; All others are for permanent residence. The bungalows have communal lounge/dining space, bathroom and kitchen facilities. None of the rooms have en suite facilities other than hand washbasins. The various communal areas are available and accessible to all residents, regardless of which bungalow their bedrooms are in. Residents are not restricted in their movements and can wander safely throughout the home and the garden. A choice of assisted baths are available in the communal bathrooms. There are sufficient communal WCs, including some situated close to the lounges and dining areas. All rooms are centrally heated and have natural light and opening windows. Bedrooms are adequately furnished and personalised to varying degrees. Mitchell House has suitable laundry facilities to meet the needs of the residents. The home was clean and there were no unpleasant smells. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 19 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well qualified are employed in sufficient numbers to support the people who live at Mitchell House, and ensure the smooth running of the home. EVIDENCE: Clear staffing rosters are in place that show who is on duty, where, when and what jobs they do. Staffing levels have increased since the last key inspection. There are now 2 carers in each bungalow from 7am to 10pm. In addition a senior member of staff is always on duty, 24 hours a day, 7 days a week. The manager said that they try to ensure that the same care staff are rostered to work in the same areas of the home so that residents benefit from continuity; seeing and being assisted by the same staff. The manager and deputy are on duty between 9am and 5pm on weekdays and both have a ‘hands on’ approach to their work and are readily available to assist in the bungalows when needed. At night there are 4 care workers on duty along with a team leader. Domestic, laundry, kitchen and maintenance staff are also employed at the home enabling care staff to concentrate on providing care and support to the residents. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 20 Well ordered staff records/ personnel files demonstrate the homes’ recruitment procedure in action. The files of three of the latest members of staff to join the home were reviewed. Most documents that should be on file were. Prospective staff complete an application form and are interviewed. All files showed that CRB disclosures and POVA 1st checks are applied for and received prior to the commencement of duties. There was evidence on all files that references had been requested, but two of the three files only contained one written reference. An additional reference was on one file that was addressed ‘to whom it may concern.’ Two of the three files did not contain a full employment history, and there was nothing on file to show that these gaps had been explored and explained. The percentage of care staff with the NVQ level 2 in care qualification is now around 75 , which is in excess of the 50 target set by the Department of Health. An overview of training is kept that shows when staff have had training and in what areas. Staff receive induction and foundation training to the industry standard ‘Skills for Care.’ Ongoing training is discussed at supervision sessions and where needs are identified these are addressed in the home’s ongoing training programme. The home has also organised training for staff in a range of areas and has a core of training that they see as essential for all staff, including dementia, moving and handling, health and safety, first aid, abuse, fire and drugs administration. Training is delivered in a range of ways including via a laptop which can be used anywhere in the home or taken home by staff who prefer to study away from work. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of people in the home. EVIDENCE: The home is managed by Sylvia Williams. Ms Williams has a background in care and training. She has successfully completed her National Vocational Qualification (NVQ) at level 3 in care and is working towards her NVQ level 4. Once obtained, she is intending to enrol on the Registered Managers Award (equivalent to NVQ level 4 in management). Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 22 Representatives regularly visit the home from Care UK Community Partnerships Ltd. Reports are made of these visits and copied to the Commission for Social Care Inspection. Prior to this inspection the home completed an annual quality assurance assessment (AQAA), which they submitted to CSCI. This identifies how the home have taken into account the views of residents and their supporters in the running of the home and sets out their plans for improvement over the next twelve months. The home also conducts regular surveys of residents and relatives. Recent feedback included comments such as ‘I love it here and I never want to move away’ and ‘very satisfied! ’ Other feedback resulted in the redecoration of some parts of the home and some new chairs being purchased. Residents expressed a desire that there were more things to do and this also is being looked into. The home does not manage the finances of any residents. There is a system for residents or their families to deposit personal allowances with the administrative staff. Clear records are kept of expenditure and balances along with receipts. Records show that residents have access to personal money, are receiving services e.g. chiropody and hairdressing and are able to purchase any extras they want. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. A supervision system has been set up and records are kept. The home is aiming to have at least 6 supervision sessions with each member of staff every year. These sessions look at practice in the home and assist both the supervisor and supervisee to identify training needs. Staff meetings have taken place giving the staff the opportunity to give their views on the home. Accident and incident records are kept and regularly audited and analysed. As a result of the audits changes have been made to practice at the home e.g. in response to the identification of a high number of falls at night a member of staff is now stationed in each bungalow thereby able to react more quickly to alarms raised. Appropriate notifications about incidents and accidents are made to other bodies. Examination of the fire records showed that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals. Staff fire Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 23 training and fire drills are also carried out to ensure staff are fully aware of what to do in the event of fire. The manager confirmed that a fire risk assessment had been carried out and the home was awaiting the report of this. A fire plan is in place and is due for review in November 2007. Dorset Fire and Rescue Services will be visiting the home in September 2007. They have been previously satisfied with the standard of fire safety. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 24 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 25 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 OP4 Regulation 14 Requirement The registered person must confirm in writing to prospective residents that having regard to the pre admission assessment the care home can meet their health and welfare needs. Assessments and different areas of the care plans must cross reference to ensure that all current needs are being taken into account in the provision of care. Care plans must also be more detailed in their content and stronger in respect of the specialist need of the residents e.g. their dementia. An assessment as to the need of the use of bed rails must be made as well as a risk assessment for their use. 3. OP29 19 People must only be allowed to work at the home after the information / documents required by law have been obtained e.g. full employment DS0000067219.V345848.R01.S.doc Timescale for action 31/08/07 2. OP7 12 & 13 31/08/07 31/08/07 Mitchell House Version 5.2 Page 26 histories, 2 written references. 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 OP9 Good Practice Recommendations The care plans and reviews should confirm the involvement of the residents or their representatives. The home should follow guidance from the Royal Pharmaceutical Society including: When medicines are handwritten on the MAR chart a second competent person should always check the details are accurate and countersign. Where medicines are PRN and the decision to administrate is that of the staff rather than the resident, circumstances for administration and dosage should be clearly documented on the care plan. The audit trail of medicines in use should be clear for all stock, including ‘home stock’ / paracetamol. 3. OP19 It is recommended that Care UK Community Partnerships Ltd draw up a programme for maintenance, renewal and decoration for the home for the next 12 months. Mitchell House DS0000067219.V345848.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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