Care Home: Mill House

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What the care home does well Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. The people who live in this home will receive an excellent standard of care, their individual needs will be met and they will be treated with respect and dignity. The people who live at Mill House are very well fed and can choose to spend their time as they wish. There is a range of different activities that they can participate in if they want to.Those who live in this home, and their relatives, can be assured that any concerns they have will be listened to and acted upon. They will be safeguarded from harm. Mill House Nursing Home is a newly purpose- built, safe, well-maintained and well-equipped home. It is beautifully furnished, clean and comfortable. Staff who are skilled and competent, and who will have been carefully recruited will care for the people who live in this home. This means that they can be assured they will be well looked after. This home is well managed with the best interests of the people who live here, at the heart of all decisions making processes. What has improved since the last inspection? This is the first key inspection of this service. What the care home could do better: It has not been necessary to issue any requirements following this inspection, however one good practice recommendation has been made. The proposed documentation to be used in respect of manual handling risk assessments and safe systems of work should be introduced as soon as is possible. This will ensure that safe working practices are much more clearly recorded and staff know what is expected of them. CARE HOMES FOR OLDER PEOPLE Mill House 55 Sheep Street Chipping Campden Gloucestershire GL55 6DR Lead Inspector Mrs Vanessa Carter Key Unannounced Inspection 28th April 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mill House DS0000070410.V361316.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. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House Address 55 Sheep Street Chipping Campden Gloucestershire GL55 6DR 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) 01386 848990 01386 849136 millhouse@caringhomes.org Caring Homes Healthcare Group Limited ****Post Vacant**** Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Mill House DS0000070410.V361316.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 with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 45. First Inspection of a newly registered service Date of last inspection Brief Description of the Service: Mill House Nursing Home was registered by the Commission for Social Care Inspection (CSCI) on 19 November 2007. It is a brand new purpose-built care home, constructed from local Cotswold stone, surrounded by delightful rural countryside. It is situated just a few minutes walk from the centre of the charming Cotswold market town of Chipping Campden. The town has a wide range of shops and amenities, and enables residents to maintain close links with the local community, Mill House can provide residential and nursing care for up to 45 people, of both gender, aged 65 years and over. Mill House will consider admitting people under the age of 65 years, if their primary care needs require nursing and their needs can be met. The weekly fee’s range from £750 - £900, but four beds are made available at current ‘social services rates’. Additional charges are made for a number of services and these are detailed in the home’s brochure. Mill House DS0000070410.V361316.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, although in a number of areas, they provide an excellent service This key inspection was unannounced and took place over one day. A total of eight hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the Home Manager • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of the home • Case Tracking the care of a number of residents • Talking with a number of the residents • Talking with a number of visitors to the home • Looking at some of the homes records • Information supplied by residents and relatives in CSCI survey forms • Information supplied by healthcare professionals This is the first inspection of this service, and it is obvious that achieving a high standard of care and comfort for the people that live in the home is important. Although the home is as yet only looking after about half the number of people that it can accommodate, there is no evidence to suggest that this commitment to quality will in any way be diluted. What the service does well: Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. The people who live in this home will receive an excellent standard of care, their individual needs will be met and they will be treated with respect and dignity. The people who live at Mill House are very well fed and can choose to spend their time as they wish. There is a range of different activities that they can participate in if they want to. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 6 Those who live in this home, and their relatives, can be assured that any concerns they have will be listened to and acted upon. They will be safeguarded from harm. Mill House Nursing Home is a newly purpose- built, safe, well-maintained and well-equipped home. It is beautifully furnished, clean and comfortable. Staff who are skilled and competent, and who will have been carefully recruited will care for the people who live in this home. This means that they can be assured they will be well looked after. This home is well managed with the best interests of the people who live here, at the heart of all decisions making processes. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. EVIDENCE: The Statement of Purpose is rewritten to reflect the services and facilities available at Mill House. It contains all the necessary information for anyone wanting to find out about the home, and to be able to make an informed choice about what is on offer. All the CSCI survey forms returned by people who live in the home and relatives, stated that enough information was given to them. One person said “the decision to move here was made by my family and I am very please with their choice” and a relative commented “this is the only home I visited and I know that it is of an exceptionally high standard, but I knew it would be the right place”. A statement of terms and conditions or a “Contract of Residence” is issued to everyone who comes to live at this home. Most people will be privately Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 9 funding their care at Mill House because of the high fee levels whilst others may be part-funded by the local authority or will have been awarded continuing healthcare funding. The pre-admission processes for one person was looked at to determine what happens before placement is offered to anyone new. The person would be visited in either their own home or in hospital, and a comprehensive assessment undertaken in order to identify the specific care and specialist equipment needs. Information would be gathered from any other relevant sources such as adult community care teams and healthcare professionals. Admissions can be arranged from ‘out of county’ where necessary and in these circumstances, the information gathering process is paramount in deciding whether the service can meet the person’s specific health and personal care needs. Where possible people are invited to visit the home prior to taking up placement. If this is not possible, relatives or other representatives are encouraged to visit and speak with the manager or the staff team. One person said “I used to live locally so watched the home being built. I had a short stay here and liked it”. The home does not offer an intermediate care service however will offer placement on a short-term respite basis, when a bed is available. Since the home is not yet fully occupied, they have been able to provide respite stay on many occasions. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home will receive an excellent standard of care, their individual needs will be met and they will be treated with respect and dignity. EVIDENCE: The care planning documentation for three people were looked at to determine the processes involved in preparing individual personal plans of care for each person. The care planning documentation is clear and well formatted – information is logically set out and is easy to understand. The plans follow a systematic pathway from the information that is recorded at pre-admission stage. Personal plans of care are developed for each highlighted need. As a result each person receives a person-centred package of care and support. The plans contained personal preferences and provided evidence of resident and relative involvement - people can opt not to be involved in the care plan review process if they so wish. Plans are reviewed on a monthly basis and clearly updated and amended as necessary. One person spoken to during the inspection said “I get the care and support that I need”. CSCI survey forms were returned from five people who live in the home and nine relatives, and Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 11 there were many positive comments received about the standard of care “the nursing care is excellent”, “the staff care for my relative in a professional manner with kindness and humour” and “good day and night care – I know my relative is in the right place”. A number of risk assessments are completed in respects of the likelihood of pressure sore development, falls, nutrition and manual handling. The manual handling risk assessments result in a safe system of work being devised but more information is needed so that clear information is provided for all staff and they know how many staff should undertake each transfer and what equipment is required. The manager shared a copy of the new format manual handling risk assessment document that was being considered, and will now introduce this as a result of this inspection. Wound care documentation evidences that the home monitor and review how things are going, each time the dressings are changed. It is recorded how often dressings should be attended to and what products are to be used. Information for staff is clear. Three GP comment cards were returned to CSCI. These said that they were overall satisfied with the standard of care delivered to their patients, but two comments were made about the difficulties in re-ordering medication. On the day of inspection, a meeting was scheduled at the home with the local pharmacist and the GP’s to resolve these issues. Discussions took place about harmonising communication methods and procedures. GPs are contacted as and when necessary and will visit on an individual basis. Other healthcare professionals are arranged as needed, for example during the course of the inspection district nurses visited one person, and hospice nurses are involved in the care of another. Regular monitoring of healthcare status is completed for each person – this includes body weight, blood pressure and pulse and diabetic blood sugar monitoring. Comments received for people who live in the home and relatives include “ I am very well looked after I have no complaints”, “my relative is getting the very best care I cannot fault a thing. The staff are so very kind” and “the care and attentiveness is first class”. Medications systems are safe. There are safe procedures in place for the ordering, receipt, storage, administration and disposal of medicines – although the processes for ordering medications is currently being streamlined. Medications are stored in treatment rooms on each floor – the room on the upper floor is not yet being used but was noted on the day of the inspection to be very warm. The temperature is being recorded daily, and shows that the temperature of the room is at the upper limit – this must be addressed if necessary. One person is currently using oxygen therapy and “home made” warning signs are displayed outside of the room. The manager was advised to make arrangements to have official hazard warning signs supplied and did this Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 12 during the course of the inspection. It is also advisable to make a note of room locations where oxygen is being used with the fire panel or the fire log book. The home provides placement for people who have end of life care needs and staff have the appropriate skills and experiences to meet these peoples needs. Relatives commented “my relative is getting the best possible care and we are being so well looked after as well”. The manager must ensure that where decisions have already been made regarding the wishes of people and their families in respect of end of life care, that these have been verified as still relevant. Mill House DS0000070410.V361316.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 excellent. This judgement has been made using available evidence including a visit to this service. The people who live at Mill House are very well fed and can choose to spend their time as they wish. There is a range of different activities that they can participate in if they want to. EVIDENCE: The home is currently only looking after 23 people out of a possible 45. One activity organiser is employed, and covers each weekday. Of the five CSCI survey forms returned, all said that there were activities arranged that they could take part in. Examples of things that are arranged include a film club, outside people for musical entertainment, ‘gramophone record memory games’, board games, and current affairs discussions. The organiser will spend time on an individual 1:1 basis chatting with people in their own rooms, or taking people into Chipping Campden for a walk and for shopping. A greenhouse has just been erected and there are plans that flowers seeds will be planted and tomato plants grown. A small number of people have computer lessons. A hairdresser visits each week “I like to have my hair done every fortnight. I would hate not to be able to have my hair done” was the comment made by one person who lives at the home. Representatives from the Church (Church of England and Roman Catholic) visit on a regular basis. Parties will be arranged at holiday times and birthdays will always be Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 14 celebrated. The pictures from the recent Official Opening party were displayed in an album and kept in the main reception area. There are plans to set up a “Friends of Mill House” group – as requested by relatives and people who live in the home. There is good selection of books in the Activity Room. Visitors are welcome in the home at any reasonable time and the home manager and staff team ensures that a good relationship is fostered with all families and visitors. One relative said “it is very important to us that we can drop in and see out relative at any time”, whilst another wrote in a CSCI survey form “ the general feel of the home is warm, happy, friendly and relaxed. I do enjoy visiting”. There is plenty of evidence to show that the people who live in this home are in control of their lives and able to make their own decisions. Staff were observed to knock on doors before entering a room and assistance with personal care is given in private. People are encouraged to make choices about where they take their meals, and how they want to be cared for. Where appropriate, they are encouraged to remain as independent as possible. The meals that are provided are of a very good quality. The menu for the day is displayed outside of the dining room “hotel style”. Most of the people take their main midday meal in the pleasant dining room – this is also set out hotel style with linen tablecloths and napkins. Everyone is encouraged to take their meals together to foster a good social spirit, however meals can be served in people’s own rooms if this is what they want. There is a choice of two midday meals but alternatives can be prepared upon request. A new chef has recently started at the home – in the words of one person and the manager “the standard of the catering has greatly improved”. One other person said “I have just had a very nice lunch. He is a good cook”. Those that completed the CSCI survey forms said that they enjoyed the meals that were served. There are facilities in the dining rooms for residents and/or their visitors to make tea and coffee Mill House DS0000070410.V361316.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. This judgement has been made using available evidence including a visit to this service. Those who live in this home, and their relatives, can be assured that any concerns they have will be listened to and acted upon. They will be safeguarded from harm. EVIDENCE: The complaints procedure for this home is included in the statement of purpose and the service users guide that is displayed in each bedroom. All relatives and people who live in the home, who completed the CSCI survey said that they were aware of the complaints procedure. One relative stated “I have had no reason to complain but I am sure that the staff would sort any problems out if I had any”. CSCI have received no complaints regarding this home - the manager will maintain a record any complaints received and will detail the action taken and the outcome. The people who live in this home can be assured that any concerns they have will be dealt with appropriately. The manager and the staff team demonstrated that the best interests of the people who live there, are paramount at all times, and that the appropriate actions would be taken if any adult protection issues were observed or alleged. The staff team are aware of the homes policy and procedures. Abuse training is mandatory for all staff and regular training is arranged. Staff spoken with during the inspection were aware of their responsibility to report bad practice (whistle-blowing) and to safeguard the people they care for. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 16 One senior member of staff has attended the local authority Protection of Vulnerable Adults Alerters training and is fully aware of locally agreed protocols. It would be good practice for the home manager to also attend this session. Mill House DS0000070410.V361316.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Mill House Nursing Home is a newly purpose- built, safe, well-maintained and well-equipped home. It is beautifully furnished, clean and comfortable. EVIDENCE: Mill House Nursing Home is a purpose built care home that has been specifically designed around the needs of older and disabled people. It was first registered in November 2007 and is as yet not fully occupied. It is the only care home in the town of Chipping Campden. The accommodation is arranged in a three-storey building, but the private bedrooms are only located on the ground and first floors. There is level access in to the home from the car parking area. The main entrance is secured by a key padded door entry system. The manager’s office is located off the main reception area. There is one passenger lift that services all floors. There are communal areas on each floor comprising of two lounge areas, and a separate dining room. A loop hearing system is installed in each of the Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 18 communal areas. All areas of the home are very comfortably furnished and tastefully decorated. From the ground floor there is access out onto the courtyard garden and patio area. Here there is quality garden furniture, umbrella’s and recently planted garden plants. The area is private and will be a very pleasant area in which to sit in the warmer weather. A greenhouse has just be sited so that gardening activities can be enjoyed. All bedrooms are for single occupation and have en-suite facilities – four rooms consist of just a toilet and wash hand-basin whilst the others have wet room showers. Each of the bedrooms has matching bed covers and curtains and are well furnished. Each room has its own flat screen TV and telephone – the brochure states that Freeview is available in each bedroom. Everyone is encouraged to bring in any personal possessions to make them feel “at home”. There are two sets of companion rooms – these are two rooms next door to each other, but with an interconnecting door. This allows married couple to “share”, to come and go from each others rooms, but still maintain privacy when it is required (for example when personal care is being delivered). This is a worthy facility. There are in addition a number of assisted bathrooms throughout the home to meet the needs of those who live here. There is equipment to assist with the safe moving and handling of people, and as the numbers of people who live at the home increases, the numbers of hoists will be increased. One person said “sometimes there is a bit of a wait until the hoist that the staff must use with me, is available. It can be frustrating”. The manager was advised of this comment and will ensure that the number of hoists is immediately reviewed. There are at present ten specialist electric beds and all other beds are heightadjustable – there are a whole range of different forms of mattresses including air mattresses to meet the needs of the people who live in the home. The home was spotlessly clean and tidy and free from any offensive smells. “excellent” was how one person described the standard of housekeeping on a CSCI survey form in response to ‘ is the home fresh and clean’. Housekeeping staff cover the seven days per week. The laundry rooms are located on the second floor along with staff facilities. This means that the risk of odours is minimised for the people who live in the home. All the facilities are modern and fully equipped, and able to launder items to meet disinfection criteria. Mill House DS0000070410.V361316.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff who are skilled and competent, and who will have been carefully recruited will care for the people who live in this home. This means that they can be assured they will be well looked after. EVIDENCE: The home is currently only looking after 23 people out of a maximum 45. The process of offering placements has been controlled whilst the staff team has been formed and developed. This is good practice and has ensured that the new people who come to live in the home have been supported to settle in. There have been a number of respite or short stay placements during this time as well. Staffing levels are arranged according to the care needs and dependency levels of the people who are living there. One the day of inspection there was one registered nurse and a team of care assistants on duty along with the home manager and the Customer Services Manager. The home also employs housekeeping, catering, administrative and maintenance staff in addition to the care staff, to ensure that all daily living needs are met. Of the care staff currently employed at the home 36 have already achieved at least an NVQ Level 2 in care. Other staff will be signed up to start their training in the future. Progress in this area will be checked at the next inspection. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 20 The staff files of six members of staff were looked at in order to determine the processes the home goes through in recruiting new staff. Robust recruitment procedures are followed and pre-employment checks are completed. These include written references POVAfirst checks and Criminal Records Bureau disclosures. These measures will ensure that the right staff are employed. All six files were in order. Since this is a new staff team that has been set up, all staff have received mandatory training in the following areas – fire, manual handling, abuse awareness, infection control food hygiene and health & safety. New recruits will be expected to complete an induction-training programme and will be allocated a mentor who will monitor their progress and development. A training record is kept for each staff member and a look through these evidenced that the staff team have received a range of different training including relevant clinical training, dementia care and palliative care. Already there is evidence that the home is committed to ensuring that each staff member is well trained and able to meet the needs of the people they are looking after. Mill House DS0000070410.V361316.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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is well managed with the best interests of the people who live here, at the heart of all decisions making processes. EVIDENCE: The home manager has been in post since January 2008 and has already made application to the Commission to be the registered manager for the home. This process is not yet completed however is well under way. The manager is a registered nurse with previous experience in NHS work and private care homes. She was previously a deputy manager and then the manager with a large private care provider and has already achieved the Registered Managers Award. She therefore meets the criteria and has the necessary experience and qualifications. This is the first inspection she has participated in as a manager and during the process demonstrated her knowledge of the home and the care service, her management qualities and what needs to be done. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 22 It is obvious from visiting the home that there is an open style of management, and staff said that they are encouraged to make suggestions about how things are done. Those people spoken to during the course of the inspection said that the manager and the staff team were “professional and efficient” and “always listened to what we want”. We have been told that new people are given a “new client questionnaire” to fill in on admission in order to give feedback on the admission process. One relative said that the manager and the staff team had been excellent at getting everything arranged and helping the relative to settle in. A full customer service questionnaire has not been completed as yet however this will be undertaken in the very near future. A senior manager with Caring Homes visits the home on a monthly basis and completes a report about how the home is running. A number of audits are completed on a regular basis in order to ensure that standards are maintained. The home looks after personal monies for people who want this service – this means that they can access services such as chiropody, hairdressing or any other services. Written records are kept of all transactions that occur. Staff are supervised regularly on a daily basis and formally by a senior member of staff. Staff confirmed that they have supervision regularly and that the manager is available at any time to answer questions or provide advice. It is very apparent that the staff team work well together and support each other in meeting the care needs of the people who live there. All of the home records that were looked at were kept secure in the manager’s office or the nurse’s office. The standard of record keeping was good and records kept in respect of people daily care were informative and detailed. No health and safety issued where found as a result of this inspection. All the necessary maintenance contracts were up to date and the home is well maintained throughout. A number of problems have occurred in respect of the home being a new building, but these have always been dealt with promptly. Staff were observed to be following safe moving and handling procedures and each person had a safe system of work devised following a manual handling risk assessment. The new format of documentation would ensure that the information is more detailed and informative. Where bed rails were being used to maintain a person’s safety whilst in bed, an assessment had been completed to ensure that this was the most appropriate method, and written consent had been obtained in all but one case. The manager addressed this matter during the course of the inspection. Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 4 3 4 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Not applicable STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP8 Good Practice Recommendations The new style manual handling risk assessments and safe systems of work documentation should be introduced as they provide a much clearer record of what actions the staff are to take in moving and handling procedures. The manager should attend Gloucestershire Council Safeguarding Adult training so that they know of locally agreed protocols. 2. OP18 Mill House DS0000070410.V361316.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Mill House DS0000070410.V361316.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. 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. 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