Care Home: Milford House

Similar services:

• Carlton Care Home
• Byars Care Home
• St Marys Nursing Home
• Bramble Lodge
• Parkmanor Residential Home
• Thornham Grove
• Hunter`s Lodge
• London Road Neurological and Specialist Care Unit

What the care home does well People are well informed and supported in choosing the home and their needs are suitably assessed and accounted for. Peoples health care needs are met from an inclusive and person centred approach to their care and they are treated with dignity and respect. Peoples chosen lifestyles and routines are respected and promoted in the home and they receive a nutritious and well presented diet. Peoples rights to raise concerns and to complain are taken seriously, listened to and acted on and they are suitably protected from harm and abuse. People benefit from a clean and comfortable home, which is overall safe and well maintained Peoples needs are met from staff that is suitably recruited, inducted, trained and deployed. The home is well managed by a dedicated, competent and professional general manager and peoples overall health, safety and welfare is promoted. What has improved since the last inspection? We made two requirements at our last key inspection of this service relating to medicines record keeping. These are both complied with at this visit. The service is pro active in quality assuring and monitoring their own performance against recognised standards and in developing their service in consultation with people. They work well with us and let us know about things that are happening there. They gave us a lot of information in our AQAA return about improvements they have made and plan to make. These are detailed under the relevant sections of this report. Some of the improvements they have made include, > Development of their approach to documentation for individual needs assessment and care planning. > Review of their arrangements for the management and administration of medicines, developing these in accordance with good practise, including staff competency assessments for these. > Developments in their approaches to care concerned with tissue viability, continence and bowel management and End of Life care. > Appointment of a dedicated activities co ordinator and development of their arrangements for activities and entertainments and also food menus in consultation with people. > Working to promote peoples rights by introducing information for people in respect of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and commencement of staff training in this area. > Specified areas of environmental upgrading and renewal. > Development of infection control practises to promote higher levels of cleanliness and hygiene throughout the home. > Ensuring compliance with recommendations made from outside authorities who may inspect the home. > Developments in staff skill mix and training opportunities. > Ongoing development of their quality assurance and monitoring systems and replacement of some equipment as necessary. What the care home could do better: Formalise and assure clinical leadership arrangements in the home in peoples best interests. Provide a suitable type thermometer for the recording of temperatures of the medicines refrigerator. Provide suitable storage for equipment in the home (aids to mobility). Consult with people and monitor room temperatures throughout the home to ensure their satisfaction and comfort with levels of heating. Review seating provision in the conservatory and provide variable height chairs to assist people with mobility problems. Introduce policy and procedural guidance for staff as to how the considerations of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards are to be introduced into their day to day practise. Key inspection report Care homes for older people Name: Address: Milford House Derby Road Milford Nr Belper Derbyshire DE56 0QW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Richards     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Milford House Derby Road Milford Nr Belper Derbyshire DE56 0QW (01332)841753 01332841753 milford@milfordcare.co.uk www.milfordcare.co.uk Mr Gerald Hudson,Mr Keith Sidney Dobb care home 65 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Milford House is a converted stone country house located in a rural setting near the villages of Milford and Duffield, set back from the A6 within extensive grounds. The home is comprised of two link adjacent units being Milford House and The Coach House. Milford House provides personal care and support for up to 38 older persons, and The Coach House provides personal and nursing care for up to 27 residents. There is a majority of single room accommodation with a number of shared rooms available. Each unit is well appointed, with its own private and communal facilities, having suitable adaptations and equipment to assist those with mobility problems, including a shaft lift and emergency call system throughout. There are also centralised kitchen and laundry facilities. The home is successfully run with a general registered manager whose original appointment was on the condition of an appointed full time clinical nurse lead. People are provided with care and support from a team of nursing, care Care Homes for Older People Page 4 of 33 Over 65 65 0 Brief description of the care home and hotel services staff. There is also external management support. Up to date information can be obtained directly from the home as to fees charged per week and what they cover. Fees are individually agreed in writing and determined in accordance with individuals assessed needs. These may include contributions for those eligible from the local authority, in respect of personal care and acccommodation and/or the local primary care trust in respect of nursing/continuing care funding. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the Care Homes for Older People Page 6 of 33 service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. The inspection visit of 02 December 2009 included assessing compliance with previous requirements made and the meeting of key national minimum standards. We sent out 10 surveys to people living in the home and received 5 responses. We sent out 10 surveys to peoples relatives or representatives via individual service users and 10 staff surveys. We received 6 responses from peoples relatives or representatives and 6 and 6 from staff. There were 49 people accommodated in the home on the day of the inspection visit, with 24 in the Coach House receiving nursing care and 25 in Milford House, personal care only. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the Registered Manager and the Care and Development Manager. (Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff). Case tracking was used during our visit where we looked more closely at the quality of care and services received by people 4 living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. All of the above was done with consideration to the diversity needs of people accommodated at the home. At the time of our visit all people accomodated were British white and of Christian faith. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? We made two requirements at our last key inspection of this service relating to medicines record keeping. These are both complied with at this visit. The service is pro active in quality assuring and monitoring their own performance against recognised standards and in developing their service in consultation with people. They work well with us and let us know about things that are happening there. They gave us a lot of information in our AQAA return about improvements they have made and plan to make. These are detailed under the relevant sections of this report. Some of the improvements they have made include, Development of their approach to documentation for individual needs assessment and care planning. Review of their arrangements for the management and administration of medicines, developing these in accordance with good practise, including staff competency assessments for these. Developments in their approaches to care concerned with tissue viability, continence and bowel management and End of Life care. Appointment of a dedicated activities co ordinator and development of their arrangements for activities and entertainments and also food menus in consultation with people. Working to promote peoples rights by introducing information for people in respect of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and commencement of staff training in this area. Specified areas of environmental upgrading and renewal. Development of infection control practises to promote higher levels of cleanliness Care Homes for Older People Page 8 of 33 and hygiene throughout the home. Ensuring compliance with recommendations made from outside authorities who may inspect the home. Developments in staff skill mix and training opportunities. Ongoing development of their quality assurance and monitoring systems and replacement of some equipment as necessary. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well informed and supported in choosing the home and their needs are suitably assessed and accounted for. Evidence: In our AQAA the home described a thorough approach to ensuring people receive all the information and support they need to assist them in choosing the home and in ensuring their needs are assessed before they move there to determine that the home can meet peoples needs. Care Homes for Older People Page 11 of 33 Evidence: They told us about some improvements they have made since their last inspection, including further development of their format and approach to individual needs assessment. Improvements aimed for by the home over the coming months focus on continuing and developing good practise in these areas. We saw at our visit that peoples recorded individual needs assessments were comprehensive and person centred. They accounted for any risks to peoples safety, had recorded reviews and provided a daily living plan as agreed with the service user or representative. The standardised needs assessment format used incorporates peoples equality and diversity needs in respect of age, gender, race or ethnic origin, religion or faith, disability and gender. At our visit people told us they received all the information they needed to help them choose the home, including written information about their terms and conditions for their accommodation and support. Comments received included, I was made to feel welcome from the outset. Staff were friendly and supportive. We saw that people are provided with a Service User guide in their own room, detailing key information about the care and services they can expect to receive. These can also be provided in alternative formats. We saw that the home routinely measures its own performance against the standards in this section by way of a formalised quality assurance and monitoring system, including formal consultation with people. The home does not provide for intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are met from an inclusive and person centred approach to their care and they are treated with dignity and respect. Evidence: In our AQAA the home told us about things they do well. These include involving people in the care planning process. Promoting peoples dignity and privacy and ensuring their health care needs are met. They also said they work in partnership with peoples relatives, advocates and outside health and social care professionals in their best interests. They told us about improvements they have made and are making. These include a review of their policy and procedures concerned with the management of peoples medicines, including by way of staff training and storage review. Introducing revised competency assessments via the group clinical traininer and in developing their approaches to continence care and management. They tell us they have good established links with external health care professionals, Care Homes for Older People Page 13 of 33 Evidence: including the local primary care trust infection control and tissue viability nurse leads. That they have improved access to dental services and are developing some of their approaches to ensuring good nutrition for people. They also told us about improvements aimed for over the coming months. These include full implementation of Living Well, the national dementia care strategy and for implementing the considerations of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009. At our visit we saw that all staff have received training in assisting people to eat and drink and that two staff have specialist training in malnutrition and with a recognised risk assessment scoring tool used in this area. People told us that they usually receive the care and support they need, including medical care and that they are treated with dignity and respect. Comments received from people who use the service include. The home does well in generally everything. Medicines arrangements are done well. I am highly satisfied with the home and and the care and support I receive. We also received comments from a visiting healthcare professional indicating excellent developments in practise concerned with tissue viability and pressure ulcer prevention and also relating to that care for a named individual. Peoples representatives also told us that the home provides excellent or good quality care and in a flexible manner. That people are treated with respect and dignity and their personal routines upheld. Written care plans that we looked were reflective of recognised practise concerned with the care of older people and in accordance with peoples risk assessed needs, with regular reviews recorded. They were person centred and each person had a daily living plan as agreed with them or their representative. We saw that people were provided with the equipment they need and that arrangements for their access to outside healthcare professionals, including for the purposes of routine health screening, were in accordance with their assessed needs and wishes. There are overall suitable arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines. At the time of our visit an independant medicines audit was being undertaken. Although for two people prescribed specified medicines to be given on an as required basis, there were no Care Homes for Older People Page 14 of 33 Evidence: written care plans in place for staff to follow as to their administration. However, we saw that a standardised care plan protocol format was devised for this purpose. Since our visit the manager has confirmed in writing that these are now completed where necessary. We also found that although daily checks are undertaken and recorded of the temperatures of the refrigerators used for storing medicines. That the correct type thermometers were not used for this. The manager agreed to rectify this. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples chosen lifestyles and routines are respected and promoted in the home and they receive a nutritious and well presented diet. Evidence: In our AQAA the home told us they aim to promote a person centred focus to life for people in the home, including flexible daily living routines. With social and recreational activities and food menus planned in consultation with people. That they welcome families and friends and promote contact with and access for people to local community. They told us about some improvements they have made here and as a result of listening to peoples views about the service. These have included the appointment of an activities co ordinator, developing arrangements to enable peoples chosen spiritual practise and establishment of menu planning meetings held with service users. Improvements aimed for include increasing hospitality, promoting better access for people to library services and continuing to develop activities and entertainments in consultation with people. Care Homes for Older People Page 16 of 33 Evidence: At our visit we saw people on both units enjoying singing and banjo playing from a visiting entertainer. People told us that there are usually activities they can join, with some saying there sometimes are. Most people surveyed said they always enjoy the meals provided with a few saying they sometimes do. We received many positive comments about what the home does well. These include, Close involvement with the local community, church and school. Provides excellent quality meals. My father who is 90 has been to Skegness for 3 nights. He has not stopped talking about his wonderful experiences and he even danced, which was one of his hobbies. Visitors are made very welcome. We saw that information about activities and entertainments is displayed around home and that drinks and fresh fruit are left out on each unit for people and their visitors to help themselves. Sherry and mince pies were also left out for the Christmas festivities. The atmosphere on entering the home was relaxed and comfortable with Christmas Carols playing softly in the lounge. Staff were seen to be responsive and courteous to visitors. Peoples recorded needs assessments and care plans detailed their social needs, preferences and arrangements, including for maintaining contacts with their families and friends, their preferred daily living routines, choices, likes and dislikes. People told us they were looking forward to the hearing the school children who were due to come into the home and sing Carols. Plans were also in hand for Christmas Day lunch with waiting staff planned to wear black and white. One person we spoke with told us they regularly go out to the local garden centre, attend church services held in the home and join in a variety of activities and entertainments provided. They also went out with a family member during the morning of our visit. Another said they like to spend time in the conservatory and in their own room. That they enjoy the gardens, regularly attend church services and have a daily newspaper delivered. They also said that their preferred daily living routines were known and upheld by staff. That they are very satisfied wtih their lifestyle at the home and said the food was very good and the cook excellent. Some told us about the menu planning meetings that are now regularly held. Although one person accommodated in the Coach House, nursing unit said they had difficulty Care Homes for Older People Page 17 of 33 Evidence: accessing the menu meetings, which are usually held at Milford House. However, the cook speaks with people on an individual basis. This person also told us they regularly have trips to Derby on the local community bus and enjoy reading and visits from family and friends. Some residents had recently taken part in a national art project with 3 peoples paintings selected for display in a local public area. We saw lunches served in Milford House. Tables were attractively set and people were assisted where necessary. The daily menu was displayed in the dining room and the three course lunch was well presented with a choice of drinks offered and a vegetarian alternative. People said that the cook will always provide something else on a individual basis if any one decides they do not wish to receive food from the menu. We saw that one person spoke with the cook whilst lunches were being served and arranged to have soup as they did not wish to have a full meal. This was provided. The home quality assures their service some of the standards in this section, including by way of satisfaction surveys. We saw the results of their last annual satisfaction survey conducted in March 2009. At that time, fifty five percent of people rated the meals as excellent, thirty five good and ten fair. Thirty three percent of people rated social activities and entertainments as excellent, fifty percent good, eleven fair and six poor. The action plan from that survey included the setting up of menu meetings with people, appointment of an activities co ordinator and improving information about activities for people. All of which we saw implemented at our inspection. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to raise concerns and to complain are taken seriously, listened to and acted on and they are suitably protected from harm and abuse. Evidence: In our AQAA the home told us they seek to promote peoples rights to raise concerns or to complain and safeguard people from harm and abuse. They also told us some of the ways they do this, including providing written information about how to complain, by regular consultation with people and by way of staff training and instruction. They told us about some improvements they have made in this area. These include all senior staff attending training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and by implementing training improvements concerned with promoting peoples rights and safeguarding people. Improvements planned include further training for staff in complaints handling and in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009. They also gave us some statistical information that we asked for about complaints received over the last twelve months. People told us that they knew who to speak with informally if they have any concerns Care Homes for Older People Page 19 of 33 Evidence: about the service and that they knew who to make a formal complaint. We saw that their complaints procedures is openly displayed in the home, including in large print and that people are provided with written information about how to complain within the homes Service Guide. People also said that any concerns raised are usually dealth with without the need to complain. One person told us about areas of concern they had raised with the home recently. We saw that these were well recorded in their individual care records, including action planned as agreed with the service user and the arrangements for monitoring and review of progress. Staff spoken with were conversant with procedures to follow in the event of suspected or witnessed abuse of any service user and described satisfactory training arrangements for this area. Complaints identified in the AQAA return were also fully recorded in the home, including action taken and outcomes. The homes has received two complaints during the last 12 months. One was partially substantiated as referred to above and the other, investigated via local joint agency safeguarding procedures was not. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a clean and comfortable home, which is overall safe and well maintained. Evidence: In our AQAA the home told us they provide people with a clean and safe environment that is well maintained and siutably furnished decorated and equipped. That people are encouraged to personalised their own rooms. They also told us about improvements they have made and are are making, some of which are as a result of listening to people who use and visit the service. These include upgrading of toilet, bathroom and sluicing facilities, promoting higher levels of cleanliness and hygiene with revised cleaning schedules, equipment provision and increase of domestic staff hours. Revised procedures for maintenance reporting together with replacement of some furnishings and the review and upgrading of medicines storage facilities. They also told us about recent inspection visits to the home from the local authority Fire Officer, Environmental Health and Health and Safety officers and the local primary care trust infection control lead nurse who has conducted an infection control audit throughout the home. Care Homes for Older People Page 21 of 33 Evidence: At our visit we saw that the local authority Fire Officer found matters appertaining to fire safety satisfactory and the manager advised that a small number of recommendations made by the Environmental and Health and Safety Officers were achieved. The manager was not able to locate a copy of the infection control audit undertaken by the local primary care trust infection control nurse. People told us the home is always fresh and clean and that they were generally satisfied with their environment. However, we did receive some comments from people about what the home could do better. These included better regulation of heating, which is said by a number of people who live, work at and visit the premises to be either too hot or too cold. Address the poor state of the driveway to the home. The need for variable height seating in the conservatory where chairs were said to be too low causing difficulty for some people to get out of independently and the need to provide sun blinds there. Lighting provision, to be sufficiently bright and positioned to facilitate reading. We saw that entrance areas were welcoming. Lounge and dining areas were well decorated and furnished, although low seating remained in the conservatory. We also saw that works were underway for the upgrading of bathroom, toilet and sluice facilities including the provision of large walk in shower wet rooms on each unit and changes to some ceiling lighting in the Coach House. We did observe that not all waste bins in communal areas were fully occlusive, although the manager advised that these were in process of being replaced to a suitable type as part of their infection control improvement plan. In the Coach House one person complained about the lack of heating in their own room. Their room was cold and the radiator cold to touch. We discussed this with the manager who since our visit has confirmed in writing the action taken to remedy this and to ensure ongoing room temperature monitoring there. The dining room in the Coach House had numerous items of equipment inappropriately and pemanently stored there. With around twelve wheelchairs, zimmer frames and 2 moveable hoists, including one awaiting repair. A number of aids to assist people in their orientation around the home were provided in various locations, including differing bold colour bedroom doors in the Coach House and a large faced clock in the lounge area there, together with some signage for peoples rooms, bathrooms and toilets. The homes does not currently have a loop system, although there are a signficant number of people accommodated with hearing difficulties who wear hearing aids and who may benefit from this. Care Homes for Older People Page 22 of 33 Evidence: Peoples own rooms were personalised and suitably furnished and equipped in accordance with their assessed needs. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met from staff that is suitably recruited, inducted, trained and deployed. Although overall clinical nurse leadership is not best assured, which in the long term may impact on peoples best interests. Evidence: In our AQAA the home described satisfactory arrangements for the recruitment, induction, training and deployment of staff. They identified improvements they have made and some that are planned. These related to stated staff appointments and developments in their staff skill mix and their training and development opportunities. At our visit we saw some of the developments to their staff induction and training programme and of their monitoring and evaluation methodology for these. Examples include training for internal NVQ assessors, organising shadowing opportunities for staff with outside healthcare professionals and employment of a dedicated training co ordinator. Aims for further improvement, include supporting staff whose first language is not English, by way of language training. They also gave us some statistical information that we asked for relating to the staff employed. This told us that more than fifty percent of care staff have achieved at least Care Homes for Older People Page 24 of 33 Evidence: NVQ 2 or above. All senior care staff have at least NVQ level 3. Most people told us that staff is always or usually available when they need them and that they listen and act on what they say. Although one person told us staff are sometimes available and sometimes listen and act on what they say. At our visit and with their consent, an action plan was agreed between the manager and that person to address and monitor the issues they raised. Two people surveyed commented that an overall senior nurse in charge in the Coach House would benefit there, although did not provide further comments in support of this. Staff described suitable arrangements for their recruitment, induction, training and deployment and records that we examined reflected these. All staff on duty except one newer staff starter had achieved at least NVQ level 2 and with senior carers having level 3. We spoke with the nurse in charge at the Coach House who was not aware of any formal arrangements for overall clinical leadership, governance and lines of clinical accountability in the home. There was no known full time substantive clinical lead nurse appointed. Duty rotas did not provide for a named clinical lead, either substantive or acting and indicated nurse vacancies, with use of bank staff. We discussed this with management with emphasis on the need to clearly and formally determine clinical lead responsibility in the absence of an appointed clinical lead and to recruit to post as soon as practicable. The registered manager and external management advised of the very recent appointment of a registered nurse, who was allocated two shifts per week on the duty rota. They were not able to assure us or confirmed any formal interim or substantive arrangements for the clinical nurse lead post. Appointment of a full time nurse lead was an initial condition of the managers registration, who is a general manager. There have been three clinical lead appointments since our last inspection of this service, with the longest appointment duration of approximately 10 months. We have referred to matters relating to the clinical lead appointment under the management section of this report and also made a requirement there. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall well managed by a dedicated, competent and professional general manager and peoples overall health, safety and welfare promoted. Although clarity and formalisation of clinical nurse leadership arrangements would be in peoples best interests. Evidence: In our AQAA the home told us they strive to promote a management culture of openness, respect and consultation with people. Ensuring their heatlh and safety is promoted and protected. They told us about some improvements they have made which relate to health and safety promotion by way of staff training and provision of new equipment. Ongoing development of their internal quality assurance systems, including development of their internal health and safety audit tool and use of the AQAA as a measurement tool. Care Homes for Older People Page 26 of 33 Evidence: They also told us about improvements they are making. These include formalising the application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards into their day to day working practise. Completing their group level review of all health and safety policies. Revising written policies concerned with residents monies and improvement of the format and content of their annual development plan. They gave us some other information that we asked for, including statistical. This tells us that all required equipment maintenance and servicing in the home is undertaken and up to date and that there are suitable arrangements in place to ensure staff training and updates for all core health and safety areas. At this inspection, we received many comments from people who live, visit and work at the service about the registered managers high standards, professionalism, efficiency, kindness and approachability. Staff said they are well supported and supervised and we saw that the manager continues to keep up to date with practise, including by way of her own training and development. However, as referred to specifically under the Staffing section of this report. There is no substantive clinical lead nurse in post, which has been vacant for some time and with no named nurse identified as interim acting clinical lead. The registered manager for the home is a general manager and not a registered nurse. The appointment of a full time lead nurse was an original condition of her registration. We were not given any previous notice in writing as to recent changes in clinical leadership arrangements and are not fully assured as to the arrangements for this from our inspection. The homes operates a quality assurance and monitoring system, which includes formal consultation with people who use and visit the service, including way of an annual satisfaction survey questionnaire. The results of these, together with action plans are openly displayed in the home, which are also shared with people at residents and relatives meetings that are regularly held and minuted. Areas included in the questionnaires ask people who live at the home to rate being treated as an individual, meals, social activities, staff, environment, management and welcoming for visitors. Although results are broken down into each area, combined results showed that 49 percent of service users rated their overall satisfaction with these are excellent, 42 percent said good, 8 percent said fair and 1 percent said poor. We saw that people were provided with an action plan telling them about the action to be taken by the home and by when, to address matters arising from their survey. We have referred to some of these under the relevant sections of this report, including Care Homes for Older People Page 27 of 33 Evidence: where we saw improvements made. We spoke with the staff and manager about the implications of the Mental Capacity Act 2005 for care practises in the home. To date senior staff have received training in this area with plans for all staff to undertake this. There was no policy and procedure in place for staff as to how the considerations of this Act are to be transferred into day to day practise. We have referred to the arrangements for ensuring peoples health and safety in the Environment section of this report and also the Staffing section in respect of staff training arrangements, which are satisfactory. Staff also confirmed their understanding of procedures to follow in the event of an accident or incident and we saw from sampling the recording of these that they are suitably accounted for. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 23 Suitable storage areas must be provided for aids and equipment, including wheelchairs and hoists. To ensure that the dining room is free from obstacles and potential hazards to peoples safety. To promote a homely environment and to prevent institutionalised practise here. 28/02/2010 2 31 39 The registered person must 31/01/2010 give notice in writing to the Commission as soon as possible of any changes to the management of the home. To ascertain effective clinical management and leadership arrangements. To promote peoples best interests. Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 31 9 A substantive first level 31/03/2010 nurse must be appointed as clinical lead at the home To promote effective clinical leadership, governance and lines of clinical accountability in the home. To promote the best interests and health and welfare of service users who receive nursing care. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The thermometer used for the recording of medicines refrigerator temperatures should be of a suitable type for this purpose, indicating both minimum and maximum temperatures. The driveway to the home should be kept in a good state of repair to ensure safe access for people to the home. A review of seating provision in the conservatory should be undertaken. With consideration to providing variable height seating as may be necessary to assist people to use these independantly and comfortably Room temperatures should be closely monitored in all areas of the home accessed by service users with any action taken as may be necessary to ensure heating is suitably controlled and sufficient for peoples warmth and comfort. A review of lighting should be undertaken in communal areas and service users own rooms and in consultation with them to ensure it is sufficiently bright and positioned to facilitate reading and other activities. 2 3 19 19 4 19 5 20 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 22 Consideration should be given to the provision of a loop system in the home to the benefit of any existing and potential service users with hearing impairment. The arrangements for clinical nurse leadership should be formally determined in the absence of a substantive appointment to this post. In order to best promote and assure effective clinical management, leadership and clinical governance in the home. Policy and procedural guidance should be provided for staff, which determines how the considerations of the Mental Capacity Act 2005 are to be implemented into their day to day care practise. 7 27 8 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!