Care Home: Mill House

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What the care home does well The registered person and staff recognise the importance of individuality, and this needs to be reflected in person centred care plans. Visitors are welcome at any time. People enjoy suitable activities in the home and are able to participate in a range of pastimes. The garden areas are well maintained People living in the home all spoke highly of the staff working in the home, saying `they were kind`, and `they liked the staff`. What has improved since the last inspection? Staff have undertaken Mental Capacity Act and Deprivation of Liberty training There has been some redecoration and refurbishment in areas of the home. The kitchen has been refurbished. The outside of the home has been re-painted What the care home could do better: Staff need to undertake training in infection control and fire safety Further improvement of the environment is needed. Key inspection report Care homes for older people Name: Address: Mill House Salters Lane Faversham Kent ME13 8ND     The quality rating for this care home is:   two star good 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: Sandra Crosby     Date: 0 1 1 0 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 27 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 27 Information about the care home Name of care home: Address: Mill House Salters Lane Faversham Kent ME13 8ND 01795533276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Renuha Francis,Mr Niranjan Romand Francis Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 24. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number of places 12. Date of last inspection Brief description of the care home Mill House is a large detached property, which is a listed building situated a few minutes from Faversham town centre. Faversham is a town steeped in history with a railway service to most parts of Kent. The M2 motorway is nearby and there is a shop within walking distance of the Home. The Home is registered to provide personal care Care Homes for Older People Page 4 of 27 Over 65 0 24 24 0 1 4 1 1 2 0 0 8 Brief description of the care home and support to 24 Service users who are over the age of 65 years. The home can accomodate up to 12 people who have a diagnosis of dementia. Most of the accommodation is provided in single rooms, however there are four rooms available for shared occupancy. All bedrooms have a call bell system, telephone point and television point. The Home has a large rear garden with an ornamental fishpond, bird aviary and seating for Residents. Access to the front garden is restricted as the area is not secure. There is off road parking for several cars. The individual current fees are Kent County Council contract prices of £342.03 per week and £431.62 per week for persons who have dementia. Care Homes for Older People Page 5 of 27 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: two star good 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 2 star. This means the people who use this service experience good quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of 14th November 2008, and a visit to the home. The key inspection visit was unannounced and carried out on Thursday 01st October 2009 between 09.45 and 16.00. During the inspection the inspector spoke with the registered person, two deputy managers, care staff, the cook, and people who use the service. Various records were seen during the visit, together with an accompanied tour of some areas of the premises. Information contained in the completed Annual Quality Assurance Assessment (AQAA), Care Homes for Older People Page 6 of 27 completed by the registered person was clear and informative, but could have been more comprehensive. This information has been used together with information gained and observations made at the time of the inspection visit all of which has been used when completing this report. Twelve service user and eight staff surveys were sent to the home. At the time of writing this report none had been returned. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with the registered person and the two deputy managers. It is indicated that the registered person and all of the staff team are working hard to promote good standards of care and that currently the home provides overall good outcomes for the residents and the quality judgement ratings throughout the report reflect this. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? 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 8 of 27 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 9 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make a decision about moving into the home. Pre-admission assessments ensure that the home can meet the persons needs. Evidence: The home has produced a Statement if Purpose and this was reviewed in March 2008 by our Registration Team following a change in registration to provide Dementia Care at that time. A copy of the Statement of Purpose was seen on display in the reception hall, and the registered person said that it had been reviewed. The document was dated September 2009. It was seen as part of the care plan process that people are provided with a written contract, and the registered person confirmed that this had been amended. The AQAA stated that more detailed pre-admission assessment documentation had Care Homes for Older People Page 10 of 27 Evidence: been implemented, and this was seen as part of the care planning process. This document indicated an improved version of the one previously used. It was discussed that a more comprehensive document in relation to assessing the needs of people who suffer with dementia. This would provide essential information to inform the care plan, and enable the assessor to make an informed judgement as to whether the home were able to meet the persons needs. The deputy manager said that the home was in touch with a person from the Alzheimers Society who would be providing training and support in relation to forms of documentation that may be useful. The deputy manager confirmed that she carried out pre-admission assessments prior to admission of the person to the home, and was reminded that the documentation needs to be signed and dated. The registered person and deputy manager agreed to address this issue. People are given the opportunity to visit prior to moving in and the terms and conditions confirm that there is a trial period. The home does not provide intermediate care. The requirement and recommendation made under these standards at the last inspection visit dated 14 November 2008 are judged to have been met at this inspection visit. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mainly people do not benefit from care planning that shows that person centred care is promoted Peoples health care needs are mostly met, and medication arrangements in the home protect people. People can feel confident that they will be treated with respect and their right to privacy is upheld. Evidence: We viewed the records for three people living in the home in relation to their care plans and risk assessments. All components of care planning as required by regulation were seen for example risk assessments, reviews and daily records. However it was discussed that the documentation in use could be improved, incorporating a more person centred care planning approach. Following discussion with the registered person and deputy managers, the registered person confirmed that they would access and undertake training in relation to person centred care planning prior to updating the care planning system currently in use. Care Homes for Older People Page 12 of 27 Evidence: The AQAA stated that people have access to all healthcare professionals including GP, optician, dentist and community matrons/district nurses. Records viewed contained evidence that people have regular healthcare support. Healthcare professionals were seen visiting the home during the inspection visit. Since the last inspection visit advice has been sought in relation to the use of a nutritional screening tool for the persons living at the home. Documentation was seen in relation to this in the care plan, and the inspector was told that the cook also has copies of the documentation. It was discussed that where necessary further documentation was needed to record food and fluid intake as appropriate in order to fully safeguard the people in the home. Medication is stored in a cabinet, and there is a designated fridge for those medications which need to be stored below a certain temperature. The medication administration records (MAR) sheets were seen and indicated that they were appropriately signed and up to date. Staff who administer medication have undertaken training in relation to the administration of medicines. The registered person is currently obtaining a copy of the Royal Pharmaceutical Guidelines for the Handling of Medicines in Social Care. The registered person informed the Commission on the 13 November 2009 that he had obtained a copy of the British National Formulary Book for staff to use. Care plans clearly respected peoples preferences and acknowledged the importance of respecting the privacy and dignity of people living in the home. Staff spoken with confirmed how they would support people in maintaining their privacy and dignity. People said the staff are very good and they always knock before they come into my room. The requirement and recommendations made under these standards at the last inspection visit dated 14 November 2008 are judged to have been met at this inspection visit. Care Homes for Older People Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to participate in a range of activities that suits their choices and preferences. People are supported to make choices enabling them to have some control over their daily lives. People are supported to maintain contacts with families and friends and are provided with a balanced and healthy diet. Evidence: On the day of the visit staff were observed interacting with people who live in the home. They were spending time playing games and talking to individuals. People spoken with said that they enjoyed the activities provided. Records are kept of individual choices and preferences. People are able to join in activities as they wish. There is no dedicated activities co-ordinator but a member of staff on duty is allocated to activities. Staff have received training in providing activities for people with dementia. Activity records are maintained as part of the individual care plans. People spoken with all said that they were happy and could make their own choices. Relatives and friends are able to visit when they wish. Care Homes for Older People Page 14 of 27 Evidence: Mealtimes are treated as a social event. People either sat around the dining room tables or those who preferred sat in their armchairs. There was a cooked meal at lunchtime and choice of hot or cold evening meal. People spoken with confirmed that they enjoyed the food. Care Homes for Older People Page 15 of 27 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. Concerns and complaints raised by people living in the home are taken seriously and acted upon. Staff have knowledge and understanding of safeguarding of vulnerable adults which protects people from abuse. Evidence: There is a complaints procedure and this is made available to the people living in the home. The registered person stated that they take all complaints seriously and will investigate any concerns. The registered person confirmed that there have been no complaints made in the last twelve months. People spoken with confirmed that they would feel confident about raising any concerns. There is a policy in place for adult protection and staff were able to demonstrate knowledge of any action they should take should they have any concerns about the safety of the people living in the home. There is currently an ongoing adult protection investigation, the outcome of which is not as yet known. Since the last inspection visit, staff have received training in relation to the Mental Capacity Act, and the Deprivation of Liberty. A draft policy has been prepared in relation to people wandering. The registered person is still in the process of reviewing this document. Care Homes for Older People Page 16 of 27 Evidence: The recruitment files showed that staff are subject to appropriate safety checks such as a criminal records bureau (CRB) check and protection of vulnerable adults (POVA) check. Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a mainly clean and comfortable home and can be sure that the environment is safe. People benefit from living in an environment that is being refurbished and reflects their choices and lifestyle. Evidence: The home is situated on the outskirts of Faversham. The rear gardens are well maintained, enclosed and kept secure at all times. The front gardens are not secure and lead directly onto the main road and as such access is restricted due to the risk of people wandering. The front door is kept locked at all time. The outside of the premises has been refurbished. In February 2008 the home applied for and was granted a major variation to enable them to admit people with a diagnosis of dementia. The number of people who could live in the home with dementia was restricted to 12 due to the layout of the home. The deputy manager at the time of the visit confirmed that they were staying within their registration conditions. In order to make sure that all people living in the home can be confident that they will feel safe and comfortable it is the responsibility of the registered person to make sure of the appropriateness of the levels of dementia of the people who are admitted. Care Homes for Older People Page 18 of 27 Evidence: There are two lounge areas and two dining areas. One of the dining rooms also has a seating area. There is a smaller lounge, which is used when people want to sit quietly or meet their visitors in private. People are free to choose where they prefer to spend their day. The home has four double and sixteen single bedrooms, eleven of which are en-suite. Several bedrooms were viewed and these were homely. People are able to bring in their own possession. Overall the home was clean and well maintained. People living in the home said that it was kept clean and that there were no odours. The work required to be undertaken by the Environmental Health Officer in relation to the kitchen has been completed, and the kitchen has been refurbished. There is a range of equipment available in the home including a hoist. There is also a lift to the upper floor. Issues of concern noted whilst being escorted around the home included liquid hand wash not available in some areas, no foot pedal on the clinical waste bin, commode/armchair potential infection risk and needs replacing, some of the furniture looks old and needs replacing. The registered person agreed to address all the issues discussed. The recommendation made under these standards at the last inspection visit dated 14 November 2008, are judged to have been met at this inspection visit. Care Homes for Older People Page 19 of 27 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. People benefit from being cared for by staff who have a good understanding of their needs. The deployment and numbers of staff needs to be kept under review to ensure that there are sufficient people on duty so as to fully meet the needs of the people living in the home at all times. The homes practice regarding the recruitment of staff ensures that people are protected. Evidence: The staff rota was seen. This showed that on the whole there were sufficient staff on duty to meet the current needs of the group of people living at the home. It was discussed with the registered person that on some days there may be insufficient cover at teatime, and also at the weekend as there was no ancillary domestic person working at the weekend. As the registered person is now working at the home as the manager, he was advised to review the staffing levels at the home. The registered provider needs to take into consideration not only the dependency needs of the residents but also the layout of the environment. Two staff files were viewed and contained all the information as required by Care Homes for Older People Page 20 of 27 Evidence: regulation. Employment checks were in place including references and appropriate safety checks. It was discussed that the application forms did not provide sufficient space for people to complete a previous work history. The registered person agreed to address this issue. It was reported at the last inspection that there is a thorough induction programme and this covers all the areas as required by Skills for Care. Staff complete a workbook over a period of time and each section is reviewed by the manager with staff being signed off when they are deemed competent. Staff training is ongoing and the staff training matrix was seen. The staff training matrix and discussion with staff indicates that staff have participated in a variety of training programmes. It was discussed with the registered person that training in fire safety and infection control were needed and that a requirement would be made in relation to this shortfall. The registered person confirmed that most of the staff had qualified at NVQ Level 2 or above, and that others were currently undertaking training. The registered person informed the Commision on the 13 November 2009 that Medication training would be undertaken on the 16 November 2009, Infection Control training on the 18 November 2009, and that Fire control training was booked for the 09 December 2009. Supervision is now being regularly undertaken, and written evidence of appraisals, supervision contracts and supervision records were seen. The requirement and recommendations made under these standards at the last inspection visit dated 14 November 2008 are judged to have been met at this inspection visit. Care Homes for Older People Page 21 of 27 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 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 good management leadership, and can be confident that their home is well run. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and mainly protected. Evidence: The registered person is submitting an application to the Commission to become the registered manager of the home. He is currently undertaking the registered managers award training. He was able to demonstrate a commitment to ensuring that people were cared for in a manner that promoted their privacy and dignity and enabled them to have the opportunity make choices. People spoken with all spoke highly of the registered person and staff. The Annual Quality Assurance Assessment (AQAA) stated that all policies and procedures are in place including one for the home to accommodate and care for Care Homes for Older People Page 22 of 27 Evidence: people with dementia. This policy was viewed at the last inspection visit and showed that it recognises the needs of all the people living in the home including those without a diagnosis of dementia. The registered person stated that the last quality assurance survey was completed in September 2008, and that quality assurances surveys were due to be sent out. Regular residents meetings are held. The registered person informed the Commission on the 13 November 2009 that a residents meeting had taken place on the 9 November 2009 and that a staff meeting was booked for the 18 November 2009. The email further stated that due to the outcome of the residents and staff meetings the staffing level shall be reviewed to meet the necessary requirements of the residents needs. The registered person confirmed that the home does not handle any person monies for residents, and that families are invoiced for any services/goods purchased. The AQAA confirms that health and safety checks are in place to ensure that the building and its facilities are well maintained. Care Homes for Older People Page 23 of 27 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 24 of 27 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 27 18 The registered person must 30/11/2009 ensure that sufficient numbers of suitably trained staff are employed to meet the needs of residents in the home. To ensure the needs of residents can be met review the current staffing levels in the home especially in relation to deployment of staff at teatime and at weekends 2 38 18 The registered person must 31/12/2009 ensure that sufficient numbers of suitably trained staff are employed to meet the needs of residents in the home. To ensure residents health and safety staff to undertake training in relation to to fire safety and infection control Care Homes for Older People Page 25 of 27 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 7 Staff to undertake training in relation to person centred care planning, and to review the current care plan documentation used at the home. Care Homes for Older People Page 26 of 27 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). 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