Care Home: Mildred Stone House

What the care home does well Those living in the home continue to benefit from a generally hard working staff team who care about their jobs and about the care that they deliver. Staff are well trained and the provider has a robust recruitment process which helps to protect residents. Residents are offered choices of food and great care is taken to ensure that help is available to supervise and assist those who need it. The home is kept clean, pleasant and hygienic. What has improved since the last inspection? Since last inspected the service has had a change of manager and although the current manager is currently in a temporary position it was apparent to the inspector that she has influenced significant improvement. Whilst there are still some staffing difficulties , staff morale has improved and recruitment is on going which it is hoped will address over reliance on agency staff. A significant amount of staff training has taken place and more is planned. Welcome improvements to the environment including re decoration of the ground floor using colour schemes and visual prompts which are beneficial to people with dementia. The homes care planning and medication systems have received attention and in the case of the latter robust action has resulted in a safe approach being re-established. What the care home could do better: Whilst there have been improvements in relation to staffing it was apparent to the inspector that there are still issues regarding staff morale. As such there are obvious splits within the staff team and producing a harmonious team who consistently work together in the best interests of those cared for remains an important challenge for the management of the home. Likewise the provider must keep under review the staffing levels at the home to ensure that the measures being taken in this area produce outcomes where residents receive safe and effective care at all times. More effort needs to be made in respect of the provision of activity and stimulation, as although action has been taken this maybe affected by current staffing levels. Given the significant efforts being made to improve the environment for caring for people with dementia, it would be desirable for the work on the ground floor to be extended to the first floor of the home. The provider needs to ensure that a quality survey is undertaken in line with its quality process. Staff supervision has improved, however there are still deficits and the manager needs to establish a system which allows for consistent supervision for all staff. The provider must ensure that where monies and valuables are held for residents, then clear and accurate records are held. CARE HOMES FOR OLDER PEOPLE Mildred Stone House Lawn Avenue Great Yarmouth Norfolk NR30 1QS Lead Inspector Mr Pearson Clarke Unannounced Inspection 26th February 2008 09:50 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 Mildred Stone House DS0000034268.V360792.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. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mildred Stone House Address Lawn Avenue Great Yarmouth Norfolk NR30 1QS 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) 01493 855797 01493 332128 mildredstone@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care Mrs Patricia Ann Dove Care Home 32 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (32) of places Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2007 Brief Description of the Service: Mildred Stone House is a two-storey residential care home for older people and is managed by Norfolk County Council. The home is situated beside the river Yare within easy reach of the local amenities of Great Yarmouth. The home offers long and short-term care for older people. The accommodation comprises 32 single rooms with one having en-suite facilities. The home is divided into four living areas and can accommodate up to 32 people with dementia, all who may be older people but 5 of whom may be people who are not yet 65 years old. Attached to the building is a day centre that is separate from the main house and independently managed by NCC. The home is surrounded by landscaped gardens with an enclosed area at the rear. There is ample parking at the front entrance. The current fee levels for the home are individually assessed with a maximum weekly charge of £368.72. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers ,the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and current judgements for each outcome. The inspector was accompanied by an expert by experience for the site visit and her findings have been taken in to account when forming judgements about the service. What the service does well: What has improved since the last inspection? Since last inspected the service has had a change of manager and although the current manager is currently in a temporary position it was apparent to the inspector that she has influenced significant improvement. Whilst there are still some staffing difficulties , staff morale has improved and recruitment is on Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 6 going which it is hoped will address over reliance on agency staff. A significant amount of staff training has taken place and more is planned. Welcome improvements to the environment including re decoration of the ground floor using colour schemes and visual prompts which are beneficial to people with dementia. The homes care planning and medication systems have received attention and in the case of the latter robust action has resulted in a safe approach being re-established. 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. The summary of this inspection report can Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Mildred Stone House DS0000034268.V360792.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 Mildred Stone House DS0000034268.V360792.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 Quality in this outcome area is ( good). Prospective users of the home and their families can be confident that their needs and wishes will have been assessed prior to admission so as to ensure that the home is appropriate for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector tracked the admission process for two people admitted for respite care and also in respect of permanent admissions. In all cases seen appropriate pre admission assessment was in place and this had been used to underpin a plan of care. Discussion with the homes manager indicated that care is taken to ensure that appropriate admissions are made and that there was an awareness of the needs that could and could not be met. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 10 Mildred Stone House DS0000034268.V360792.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). People using Mildred Stone House benefit from good care plans, a sound approach to medication and health, with staff who respect their dignity and privacy, which helps to ensure that they receive the care that they need in a manner that they want. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six care plans were looked at during the site visit and these generally showed better recording than found at the last inspection. Those plans seen had improved social histories which would allow staff to have a better understanding of the person that they were caring for. Nutritional screening was in place allowing for the identification of those most at risk from malnutrition and introducing specific plans to counteract this. Plans seen recorded medical intervention indicating that peoples medical needs were Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 12 being met. Moving and handling and other risk assessments were in place. From discussion on the day it was clear that much work has taken place, however there is still more to do to improve plans for all of those cared for. The arrangements for the management of medication were inspected and found to be much improved from that found at the last inspection. As such medicines were securely stored with clear and accurate records were maintained. The manager has established a thorough internal medication audit system with both daily and monthly audits. This system allows for the identification of any error and helps ensure that people get the medication they need in a safe way. The inspector was accompanied for part of this inspection by an expert by experience and based on both peoples observation of care delivery could see that staff respected the need to protect peoples privacy and dignity. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 13 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 ( adequate). That residents benefit from a relaxed and open home with a good choice of nutritious food available. Whilst the provision of activity for residents has improved, staffing shortage is still a factor in maintaining consistent improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This site visit found some improvement in relation to the provision of activity and stimulation and with recruitment of designated staff to co-ordinate this there should be further improvement. Staffing shortages are however still having a negative impact on occasions and reducing the positive impact. The atmosphere within the home was more relaxed than that found when last inspected and a visitor to the home commented positively about the good standard of care and how staff and management kept him up to date regarding his relative. The home operates a restaurant style of dining and this offers good choice to residents. Observation of lunchtime found the meal to be relaxed with help given in a patient way. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 14 Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 15 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): 16 and 18 Quality in this outcome area is ( good). That people benefit from a service where there is a robust approach to complaints and to safeguarding, which helps ensure their overall protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints process and the record of complaints seen at the site visit showed there to have been two complaints since last inspected. In both cases the complaint was upheld and appropriate action was taken. Survey responses were received for three relatives and two said they knew how to complain with one saying that they had forgotten. The provider has robust adult protection process’s and staffing records seen showed that safeguarding training is part of the expected training for staff. Staff spoken to were confident that any issues in this area would be reported and dealt with. Mildred Stone House DS0000034268.V360792.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is (good). That residents enjoy a clean and safe home , which will be much improved and more suitable for the needs of those cared for when planned work is completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As a result of a tour of the home and discussion with the manager the inspector is satisfied that significant improvements to the environment are planned or underway. At the time of the site visit refurbishment and redecoration of the ground floor areas of the home was underway. The provider is introducing colour schemes and new signage shown to be beneficial to people with dementia and the use of colour coding will help guide people to Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 17 bedrooms, toilets etc and away from cleaning stores and areas of potential danger. Lighting is being improved in bathrooms and planning is underway for the creation of a secure sensory garden. A new call bell system incorporating assistive technology such as continence sensors and sensors to alert to people moving around at night has been introduced. The inspector was also shown a reminiscence room which staff are putting together. All of the above will produce an environment which will be much better suited to the needs of people with dementia when completed , however it would produce better outcomes if the redecoration also incorporated first floor accommodation. All areas seen were clean and the inspector found no unwanted odour. Mildred Stone House DS0000034268.V360792.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is ( adequate ). That residents have benefited from improved staffing and generally higher morale, however staffing needs to be kept under review to ensure that effective levels are consistently in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector looked at staff records relating to recruitment and training. Both of which confirmed that there is a good approach maintained by the provider. Since last inspected a substantial package of training has been undertaken or was planned for the near future. This included training relating to the care of people with dementia and managing aggressive behaviour. The inspector was also shown evidence of efforts made to recruit more staff including relief staff although some of these were yet to commence employment. The views of staff were expressed in written surveys, discussion with the inspector and accompanying expert by experience. In many respects these views were contradictory with many staff feeling that the home has improved and that if fully staffed the job is hard work, but achievable. In contrast others expressed doubts over staffing levels and the inspector had some difficulty in reconciling such differing views, Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 19 especially as recruitment processes were still underway. It is clear that the service has still had to rely too much on agency staff which has contributed to some of the staffing problems, however new staff soon to commence should ensure that this becomes less of an issue. As to the overall adequacy of staffing levels this is difficult to judge. The resident group is very dependant and the home cannot afford to run effectively when short on a shift without the potential for a poorer standard of care. When current recruitment is in place it will be easier to judge staffing levels and whilst no requirements are made at this time the provider must review the recent changes to staffing at the home to ensure that levels are adequate to meet the needs of those cared for. Survey views received by the commission indicated that staff are valued and felt to be good at their jobs. Mildred Stone House DS0000034268.V360792.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is ( good). The home is currently effectively managed and operates in the best interests of those living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since last inspected the manager of the service has left and a temporary manager has been in place. It was clear from the views of staff and a visitor to the home that the temporary manager has had a significant positive impact on the conduct of the home. Staff spoken to felt that there was a general improvement and that staff morale and pride in the home had significantly improved. It is understood that a permanent management appointment is soon Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 21 to be made and it was noted that staff have raised a petition hoping to persuade the temporary manager to apply. It was noted that the providers annual quality survey has not taken place, however after discussion the inspector accepts that this is a result of the managerial uncertainty and will be addressed in the near future. The provider has robust procedures for the management of peoples monies, however it was of some concern that when the inspector looked at sample records they were not as well maintained as would be expected. Inspection was complicated by the holding of historic records in with the records of those currently accommodated and it was of concern that money was still being held for a resident who had had a period of respite care the previous year. Where other peoples monies are managed or stored then it is essential that the system is clear, robust and auditable and as such a requirement is made. Records of supervision were seen and whilst these showed a generally more consistent process more effort needs to be made to ensure that all staff receive their planned supervision. Health and safety records and procedures were seen and confirmed that a satisfactory approach is adopted by the provider. Mildred Stone House DS0000034268.V360792.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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 3 Mildred Stone House DS0000034268.V360792.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 OP35 Regulation 17 (2) Requirement That the arrangements for the management of residents finances are reviewed, so as to ensure that accurate records of monies and valuable’s held are maintained at all times. Timescale for action 30/04/08 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 Refer to Standard OP19 Good Practice Recommendations That the Provider extend the programme of redecoration to the first floor of the home. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 24 2 OP27 That the provider keep under review staffing levels at the home to ensure that they allow for the delivery of safe and adequate care at all times. Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Mildred Stone House DS0000034268.V360792.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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