Care Home: Mill House Nursing Home

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What the care home does well The home is clean, attractive and well maintained. People enjoy the food and variety of meals on offer. The staff are friendly, kind and caring. People`s comments describe a happy and homely environment where visitors are made welcome. The home is well managed and some staff we spoke to said the staff team work well together to provide a good standard of care to the people living here. There are good systems in place to audit and check that the standard of cleanliness and care are maintained and that staff consistently follow the homes policies and procedures, so that residents well being and safety is protected. All staff have access to opportunities for training and development that improve their skills and the standard of care for the people living here. What has improved since the last inspection? The recommendations and requirements for improvements that we made in our last inspection report have been addressed and met. We see this as an indication that the provider organisation has taken appropriate action to make the necessary improvements to the standard of care and the environment, for the people living here. The home has appointed a full time activities organiser and is working to increase the opportunities for residents to have more outings and take part in activities and events that suit their individual preferences and interests. The number of care staff who have achieved the national minimum qualification in care has increased in the last 12 months and now the home has over 50 per cent of care staff with a recognised qualification. Better trained staff should continue to improve the care and support for residents. The appointment of two carers to a senior and more supervisory role has improved the way in which care staff are allocated and know what work they are responsible for during each shift. The senior carers also monitor the standard of care and support of residents to make sure that it meets their needs and preferences. What the care home could do better: The home needs to employ more registered nurses to make sure that they can provide the agreed number and ratio of registered nurses throughout each 24 hour period without over tiring the existing staff. The organisation is taking action to employ more nurses and full time care staff so that the people living here have continuity of care from a full complement of permanent staff. We consider that this home now provides a good service and have made no requirements or recommendations in the report. Some observations and recommendations were made at our feed back at the end of the inspection and are included in the report content - for example, in relation to meal service and safeguarding information - that the manager said she will follow up. The manager has identified the organisational plans for ongoing improvements and development and is currently applying to become the registered manager for the home. Key inspection report Care homes for older people Name: Address: Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY     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: Delia Styles     Date: 2 1 0 1 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY 01993775907 01993776388 millhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chiltern Care Homes Ltd (part of the Southern Cross Healthcare Group) Name of registered manager (if applicable) Mrs Magaret Spooner Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 43. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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) Date of last inspection Brief description of the care home Mill House Nursing Home is an old house in the market town of Witney, Oxfordshire, owned by the Southern Cross Healthcare Group since 2005. It was renovated and extended in 1996 and has accommodation for 43 residents. The rooms are single and double, with en-suite facilities of toilet and hand wash-basin. It is situated close to the town centre and within easy reach of all local amenities. There are three dining rooms Care Homes for Older People Page 4 of 31 0 Over 65 0 Brief description of the care home and two sitting rooms, communal bathrooms and a garden room overlooking a landscaped courtyard garden. Mill House was closed following severe flooding during extreme weather in July 2007, and the home was reopened after major refurbishment in May 2008. The fees range from 552 pounds (sterling) to 900 pounds (sterling) per week. Care Homes for Older People Page 5 of 31 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 last inspection of this service was on 17.07.2009. This inspection of the service was an unannounced Key Inspection during which we assessed a number of the standards considered most important by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 6 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of their most recent Annual Quality Assurance Assessment (AQAA) - a self assessment and summary of services questionnaire that all registered homes and agencies submit to the Commission each year. The home had not been requested by us to complete an AQAA for 2009 but the manager and home administrator were able to update the inspector with the most recent information about the home on the day of the inspection. We were not able to send out our own questionnaires to get feed back from service users in time to include in our report on this occasion. However, we looked at peoples Care Homes for Older People Page 6 of 31 responses to the homes own Satisfaction Surveys sent to residents, relatives and visiting professionals in October and November 2009. We also talked to several residents, visitors and visiting professionals during our visit. Talking with a number of residents and staff gave us information about the home and peoples opinions about what it is like to live here. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. We would like to thank all the residents, staff, and manager for their welcome and the time taken to help us with the inspection process. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to employ more registered nurses to make sure that they can provide the agreed number and ratio of registered nurses throughout each 24 hour period without over tiring the existing staff. The organisation is taking action to employ more nurses and full time care staff so that the people living here have continuity of care from a full complement of permanent staff. We consider that this home now provides a good service and have made no requirements or recommendations in the report. Some observations and recommendations were made at our feed back at the end of the inspection and are included in the report content - for example, in relation to meal service and safeguarding information - that the manager said she will follow up. The manager has identified the organisational plans for ongoing improvements and development and is currently applying to become the registered manager for the home. Care Homes for Older People Page 8 of 31 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 31 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 31 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. There is a good range of information about the home and the services provided so that prospective residents can make an informed decision about whether it is likely to be right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move into the home. People admitted for short stay rehabilitation are helped to regain their independence and return home if possible. Evidence: At our last inspection we were concerned that the information provided by the home for people who may want to come to live here in their Statement of Purpose was not accurate in its claims about the standard of care and the choices available to people. At this inspection we looked at the homes updated Statement of Purpose and Service Users Guide. They describe the home and facilities and the admission process clearly and accurately and we consider do reflect the current improved standard of care and facilities offered. Care Homes for Older People Page 11 of 31 Evidence: A relative told the inspector that they had received lots of information about the home before their family member was admitted. The manager confirmed that all prospective service users are provided with copies of the Statement of Purpose and Service users Guide. A copy of the Commissions last inspection report is on display in the entrance hall. The home manager confirmed that people coming into the homes intermediate care unit for rehabilitation are assessed by National Health Service staff - with input from a registered nurse, occupational therapist and physiotherapist. This information is faxed to the home so that the manager can decide whether the home is able to meet peoples assessed needs. For other prospective residents the manager or another registered nurse will visit the individual in hospital or other care environment to meet them and discuss their care and support needs. Information from family members and professional carers is also used to assess whether the home is likely to meet their needs. We looked at the pre-admission information for 3 people admitted in the last 12 months and this was sufficiently detailed for staff to start planning for each individuals admission. Care Homes for Older People Page 12 of 31 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. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff have the information they need and meet residents care and support needs in a way that promotes their dignity and wellbeing. Evidence: We looked at a sample of three residents care records. These had detailed information set out in Southern Cross own paperwork. Information included how much support and care individuals need and what care staff need to do to help individuals remain as independent as they can and make choices about how they are cared for. Peoples care plans and records are kept in individual named files in the nurses office. The sample seen was largely up to date and showed that staff check them and record the care they have given throughout the day and night. We consider that the home has taken action to improve the way in which it monitors and records peoples nutritional status since our last inspection. The home has requested advice from NHS dieticians. However, the homes staff have been informed that the NHS can no longer provide advice to care homes where someone is Care Homes for Older People Page 13 of 31 Evidence: considered to be at risk because of eating problems - unless the resident is receiving feeds through a gastric tube. Individual residents did have dietary advice sheets in their care plans and residents are regularly weighed (using the homes new hoist scales). The home confirmed in an Action Plan returned to us in December 2009 that 88 per cent of the homes staff had received training in nutrition, including the use of nutritional supplements; 4 staff had also completed a course with the community speech and language therapist about the management of eating and drinking difficulties. At our last inspection we found that peoples preferences about whether they have a bath or shower, and how often they would like one, were not always taken into account by staff. Now these preferences are recorded in peoples care plans and they are asked on a daily basis about their wishes. The home manager and senior carers check daily with residents to make sure their personal care is given as they wish. The shower and bathroom facilities have also been improved since our last visit. The home has a new first floor shower wet room and is planning to improve the layout of one bathroom with an assisted bath to make it more accessible for residents. Additional equipment such as shower seats have also made access and independent use of shower facilities easier. We found from talking to the manager and several staff during the day that they had a very good understanding of individuals care and support needs in practice. However, there were a few instances when the care records needed more information written in them to show that residents and their relatives are kept informed about a change in someones condition or planned treatment. This was discussed with the manager during feedback at the end of the inspection. The home had recently sent satisfaction surveys (October 2009) to residents and visiting professionals. The surveys include questions about whether people feel involved in the planning of their care, their satisfaction with the the nursing and medical care they receive, and how well the home communicates with residents, their families and visiting professionals about changes in residents conditions. Results of the homes surveys show a high level of satisfaction overall. Comments relating to what the home does well and where people feel there is room for improvement were equally matched. For example, positive comments were made about the nursing and care staff - cheerfulness of carers; carers on the whole are attentive and kind; kindness, caring and friendly atmosphere. Respectful and courteous; Nursing care is very good, communication with relatives is much improved; very pleased with medical care. However, some felt there was room for improvement - Perhaps not Care Homes for Older People Page 14 of 31 Evidence: kept informed enough when mother unwell - had visit from doctor but not contacted after visit from him; better liaison between carers and nurses. Letting relatives know about illness and medication. The manager said that in response to our inspection report last year, and the survey responses, they are continuing to improve the ways in which care staff are supervised and how they report the care they have given to residents to the registered nurses on duty. Also, the manager and senior carers are readily available to talk with relatives to keep them up to date about any changes (where residents are not able to do this for themselves). Residents spoken with during this inspection were very pleased with the care and support they receive. One person said this is the best place Ive been in so far (they have been in several hospital and care environments). Another person said how they would miss the home when they go back to their own home from the intermediate care unit. Visiting professionals told us that the service is good at providing support for the people who are receiving intermediate care. Survey responses returned to the home included staff are helpful with any queries, a welcome and friendly atmosphere at Mill House. The GP who provides medical cover to most residents at the home has provided a letter of commendation about the standard of care. Residents are able to keep their own GP of the practice is local and the service can be continued or the home will assist people to locate a different GP if they do not wish to change to the GP who provides the regular service. The home has good policies and procedures in relation to the safe storage, administration, recording and disposal of unused or unwanted medicines. A check of a sample of residents Medicines Administration Records (MAR) was done and the records seen were accurate and up to date and showed that people were being given their medicines correctly and as prescribed. The registered nurses are responsible for giving out medicines. All the nurses have annual safe handling of medication updates. Peoples medicines are supplied from a local branch of a national chemist. The pharmacist visits the home regularly to check that their systems are safe and the most recent and satisfactory report (September 2009) was seen at our inspection. The provider organisation, Southern Cross, sets out its philosophy of care for the home in the Statement of Purpose and this includes the statement that it offers a home that recognises and respects the dignity of everyone and we seek to defend and uphold each individuals human rights...our service users will be treated with respect, Care Homes for Older People Page 15 of 31 Evidence: regardless of age, gender, sexual orientation, race or religious belief. During the inspection we noted that staff were friendly, respectful, patient and helpful towards residents. Residents spoken with said they appreciated being able to have a joke with staff and felt they had a good relationship with each other. The homes survey responses to the question Do you feel the staff are polite and friendly was answered yes by all the respondents. Care Homes for Older People Page 16 of 31 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. Since our last inspection the home has improved the range of activities on offer and gives opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed and social occasions. The food is varied, nutritious and meets peoples needs and expectations. Evidence: Since our last inspection the home has worked to improve the range of activities and number of organised social events and outings on offer to residents. Residents and relatives responses to the homes satisfaction survey questions (October 2009) showed that people feel that the social and recreational aspects of life at the home could be improved. Comments included - Some trips out would be nice - more stimulation; trips in mini-bus dont seem to be happening; more planned entertainment and (query) voluntary help from outside; More entertainment The home has responded positively to peoples feedback. They have appointed a full time staff member to organise activities and encourage people to suggest things they would like to do and places they would like to visit. The activities worker is clearly enthusiastic about the role and works flexibly so that there are activities at weekends Care Homes for Older People Page 17 of 31 Evidence: as well as week days. The manager has a small budget for funding activities, but staff and relatives work together to raise money for the residents fund through holding raffles and other sponsored events. The money received is used to fund activities such as music afternoons and other in house entertainments. Staff and residents were looking forward to a sponsored kilt-wearing day (in honour of Burns Night) when 2 male staff members plan to wear kilts to work for the day. The manager said that there will be more outings and short trips arranged when the weather improves. The administrator and manager are actively looking at sources of funding and sponsored events that staff could do to raise more money to further develop the activities and facilities for residents. Residents spoken with during the inspection said that they were satisfied with the activities on offer. People were seen to be involved in various activities during the day - chair exercises, painting miniature bird boxes or pictures, reading in the small atrium library cum sitting room or watching TV. The home has a weekly visit from a volunteer and her Pets As Therapy (PAT) dog whose visits are clearly very popular with residents and staff. The home produces a monthly newsletter for residents and relatives - a colourful and informative format that gives news and information and reports about planned and past activities, and residents meetings. Feedback from relatives and professionals in the homes satisfaction surveys show that people are made welcome when they come to visit. People living here are helped to practice their religious and spiritual observance, through visits from ministers of various Christian denominations and attendance at local church services. There is also a regular church service held in the home to which everyone is invited. Discussion with the manager, staff and a number of residents confirmed that peoples choices about the pattern of their day - times for getting up and going to bed, socialising or spending time privately, and when and how they have staff help with their care - are respected by staff. The care records and home survey feedback indicate that since our last inspection, the home has improved the way in which staff individualise peoples care and get to know their preferences. The home has told us that it has reviewed and improved the home menus and menu Care Homes for Older People Page 18 of 31 Evidence: choices in consultation with residents, the chef and in line with nutritional information. The home offers a number of different areas where people can eat their meals. Residents and relatives are able to book (for a small charge) a family dining table so that a resident can eat with their family in private for lunch or supper on any day of the week. Peoples opinions about the food - presentation, quality, temperature and variety of menus - are sought in the homes regular residents satisfaction surveys. Results from the October 2009 surveys showed that most people felt the food was good or satisfactory though just over 6 per cent of total of the 16 survey respondents considered the quality and temperature of food was poor. The lunch time menu choices had been changed from that printed on menu sheets on the day of the inspection and displayed in the dining room. Staff explained this change was unavoidable - they had had to swap the menus because a food delivery had been delayed because of the bad weather. Residents spoken with said the food was good and they always enjoyed their meals. We saw that staff discreetly and patiently helped those who needed assistance to eat their lunch and made sure they were given a choice of drinks with and after their meals. It was noticed that some plated meals were taken to residents without a cover over the food. Staff serving food should ensure that dishes are covered when carrying them around to the various dining rooms or peoples own rooms, to protect food from contamination and keep hot food at an acceptable temperature during service. One staff member was seen to be feeding a resident with their pureed meal using a fork. Care should be taken to use appropriate cutlery when assisting dependent people with their meals to avoid accidental injury. These observations were pointed out to the senior carer and manager during the inspection. Care Homes for Older People Page 19 of 31 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. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Evidence: The homes complaints procedure is displayed in the hall and is clearly set out in the homes Statement of Purpose, and the Service User Guide that is given to every resident so that all residents and their families know how to make a complaint and whom to address any complaint to. The complaints procedure is available in large print for residents who have impaired vision and can be provided in audio tape form if needed. The Commission has not received information or concerns about the home since our last inspection. We looked at the homes complaints record. The manager said she understood that that one complaint was being investigated by the companys Head office but that it appeared to have been satisfactorily resolved. The manager and senior staff are readily available to greet and speak to relatives and visitors. People feel able to raise any queries or concerns at any time and this helps to resolve any minor problems before they give cause for formal complaint. The manager also holds a weekly surgery so that residents, relatives or staff can talk to her in private about any concerns. Staff members spoken with during the inspection said that the manager is very Care Homes for Older People Page 20 of 31 Evidence: approachable and they feel confident that she promotes the interests and care of residents, and the staff team, very well. The home has policies and procedures in place to safeguard residents from abuse, and training is provided for new staff from their induction and at regular intervals after induction. Training records seen showed that most staff had received training about safeguarding and reporting suspected abuse and more sessions are planned. Two staff members were asked about their understanding of how to report alleged abuse. They were confident about the provider company (Southern Cross) policies and procedures, but appeared to be less familiar with the local Oxfordshire multi agency guidance for safeguarding adults or to know about the lead role of the local authority in investigating allegations of suspected abuse. The home should ensure that all staff are aware of the local Safeguarding team contact numbers, and we suggest that the local authority website information should be made available in the home as a useful source of advice about how to raise concerns about adult protection issues. Care Homes for Older People Page 21 of 31 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. The home provides people living here with a clean, comfortable, safe and attractive environment. Sinceour last inspection, the home has taken action to improve the infection control procedures and equipment needed to protect people from infection. Evidence: The home was re-opened after extensive refurbishment following flood damage in June 2007. The standard of furnishing and decor is very good and communal rooms are light, comfortably furnished and attractive. There is a good variety of sitting rooms on the ground floor so that people have a choice of areas to use. At our last inspection in July 2009, we found that the standard and provision of suitable shower and bathrooms, and sluice disinfectors for cleaning commodes and sanitary equipment, was below standard. We said that the home lacked good infection control procedures and that could put people living and working here at risk. The home took the action we required to address these problems and has since installed a new shower and wet room on the first floor of the home and is in the process of replacing and re-positioning an assisted bath. A new sluice was installed last year and staff have had training in its use and in infection control measures. The homes own satisfaction survey replies show that the home is kept clean - the Care Homes for Older People Page 22 of 31 Evidence: majority of people answered that the standard of cleanliness is good and the rest that it is satisfactory. When we walked around the home during the inspection, we found that the standard of cleanliness and tidiness was very good and there were no unpleasant odours. The home carries out its own audits and checks to make sure that the standard is maintained. The conservatory room leads out to a small landscaped garden at the rear of the home with raised flower beds and seating so that people can enjoy the garden in good weather. The home has a laundry on the ground floor that is well equipped, clean and tidy. There is access to an outdoor drying area. Laundry machinery meets the required standard to deal with heavily soiled or contaminated items. Residents said that the laundry staff are very good and return their clean clothing quickly. Care Homes for Older People Page 23 of 31 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. There are sufficient skilled staff who have received relevant training to meet residents care needs. Since our last inspection, the home has improved the training of staff and the skill mix so that the manager and senior staff monitor practice more carefully to make sure that people have care and support provided in a way that suits their needs and preferences. Evidence: The staffing numbers and ratio of qualified nurses to care staff provide two registered nurses and 7 care staff for the main home and the intermediate care unit. At night there is one registered nurse and 3 care staff on duty for the whole home. The manager said that the home was actively recruiting for new registered nurses there are only 4 nurses (excluding the manager, who is also a nurse) to make sure that all the shifts are covered. There is always at least one registered nurse on duty over 24 hours. Since our last inspection the home has promoted two care staff to a senior carer role. the senior carers have additional responsibilities for supervising new and less experienced staff and checking that the standard and recording of care of residents is maintained. Care Homes for Older People Page 24 of 31 Evidence: The staff training records show that the home has improved the opportunities for training and development for the staff. The proportion of care staff who have achieved the National Vocational Qualification (NVQ) Level 2 in Care has increased in the last 12 months. Eleven out of a total of 21 care staff have the NVQ Level 2 qualification, and 5 have NVQ Level 3. A further 3 staff are to start their NVQ. This means that the home meets the national minimum standard of 50 percent of care staff qualified to NVQ2. All new staff have induction training that meets the national standards and are supervised and appraised over a 3 month probationary period to make sure that they are competent and confident in their work before their permanent employment is confirmed. As mentioned earlier in this report, staff have had recent training in infection control, safeguarding (of vulnerable people), and nutrition. All staff have annual mandatory training in topics such as fire safety, food hygiene, safe moving and handling, and Care of Substances Hazardous to Health (COSHH). We looked at a sample of staff recruitment files and found that they were well organised. The homes procedures for requesting and receiving satisfactory references and police checks, and the interview process, are thorough, and protect people living here from potential harm or abuse from those employed to work here. Residents spoken with were complimentary about the staff and said they are kind, hard working and treat them with respect. The homes own visiting professionals survey responses confirmed that they find staff are welcoming, knowledgeable about the resident(s) they are visiting and are generally prompt in following any advice and making changes that they suggest. Care Homes for Older People Page 25 of 31 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. The management arrangements in this home have improved and provide staff with good leadership and supervision, that in turn affects the standards of care for people living here. People who live here, and their families and representatives, are consulted about, and do influence, the way the home is run. Since our last inspection the home has improved the way it gets formal feedback about the service from visiting professionals. The home is well maintained and has good systems in place to check that staff and residents safety and well being are protected. Evidence: The manager has been in post since August 2009 and is in the process of applying to become registered with the Commission. She has previously managed another Southern Cross home and is a registered nurse and has the registered managers award, so that she has the relevant experience and skill for her work. She is supported in her role by a deputy manager and an home administrator. Two senior care staff also assist in monitoring the way in which residents care and support is carried out. Care Homes for Older People Page 26 of 31 Evidence: Staff spoken with at the inspection said that they found that the manager was approachable and fair, and that the team now work well together for the benefit people living here. The manager ensures that she is available to residents, visitors and staff, both informally and in private so that any concerns about the running of the home can be discussed. The home invites people who live here, and their relatives and visiting professionals to complete a satisfaction survey to get their views about how well the home is doing and to make any suggestions about what is good and what could be done better. We looked at peoples most recent feedback (from October and November 2009) in the homes own surveys and found that the managers had taken action to improve some of the suggestions for improvement - for example, the replacement of an assisted bath so that it can be used by more dependent people who enjoy a bath; and the appointment of a full time activities worker to look at ways of increasing the number and variety of activities available to people living here. Residents are encouraged to manage their financial affairs for as long as they can. When this is no longer possible a named representative for the resident takes on this responsibility. The Southern Cross policy is not to have any staff or volunteers who work at the home acting as appointees for residents finances. The administrator confirmed that the record of receipts and expenditure made on behalf of residents is regularly audited. We found that there are good health and safety procedures in place to protect residents. The home employs a full-time maintenance person to deal with day-to-day repairs, and employs specialist contractors as needed. Maintenance records are kept of safety checks, showing these are regularly carried out. The company provides health and safety workshops for its senior staff to ensure they are up to date with current good practice. The company has an established system of audits that managers undertake in heir own homes to monitor the standard of the environment and care. They also have a system of cross-audit so that a manager from another home will carry out an audit of another Southern Cross service. This was the case on the day of the Commissions inspection - the registered manager from another Oxfordshire home was carrying out an audit at Mill House. Staff had been unaware that the inspections were due to take place so the home standards were seen as they are on any day. Oxfordshire County Council has a new Food Standard Award - Scores on the Doors. A Care Homes for Older People Page 27 of 31 Evidence: recent inspection of Mill House by the Environmental Health Inspector awarded a score of 4 (out of a maximum of 5) for the catering facility standard. Care Homes for Older People Page 28 of 31 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 31 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 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 Care Homes for Older People Page 30 of 31 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. 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