Care Home: Mill House, The

What the care home does well The service is run in a way that uses examples of good practice in the care of people with dementia, such as "life maps". The manager and staff understand the importance of supporting the privacy, dignity, autonomy and choice of people with dementia. The service employs a care manager whose role is to oversee and review people`s care arrangements. This makes sure that care plans are up to date and makes sure that staff are aware of how to work in a way that supports individuals in the way they like. People`s health and personal care needs are met. The service employs an activities coordinator who has compiled life histories of people using the service to support her work. Activities are appropriate, and there is a lot of one to one and small group activity. People have access to their community through trips out and visitors. Meals and meal times are a sociable and enjoyable part of the day. The atmosphere of the house is friendly, warm and welcoming. People using the service appear happy and relaxed and can be seen engaging with each other as well as staff. People have freedom of movement around the house and the layout supports the needs of people with dementia. Staff are well trained and knowledgeable about the needs of people with dementia. They respond and interact well with people using the service. Staff understand how to keep people safe and how to act in situations that may be challenging. What has improved since the last inspection? The service has improved the information it provides to people who are interested in using the service. The care plans have been redesigned and provide the detail needed for staff to support people appropriately. Staff have had up to date medications and dementia training. The service has updated its policy and procedure on protecting and safeguarding adults. All staff have a proof of their identity. The quality assurance system has been updated. The registered provider is carrying out monthly visits. There has been extensive refurbishment including the creation of a sensory garden. What the care home could do better: The service should keep a record of when formal reviews happen, so that a record is kept of the opinions of people using the service, their relatives and any other professionals. This can be used to develop the service and explain changes to care plans. People using this service have communication needs arising from dementia which makes it extremely important that the service provides alternative means of recording dissatisfaction and well being. A recorded review could be a way of doing this. Care staff should provide more detail when recording personal care tasks in daily records. This makes sure that people are receiving the personal care support that is written in their plan and shows that staff are responding to any changes made to the plan. The service could develop their activities programme still further by making use of current good practice guidance about dementia, to make activities more innovative and specific to the needs of people with dementia. Training for staff on the Mental Capacity Act 2005 might improve the skills of staff and their understanding of how to work with people with a diagnosis of dementia. The service should record when staff are working extra to the rota to support any extra activities that are happening. This is so the service can demonstrate the support they are providing to people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mill House, The Mill House, The Kington Flyford Flavell Worcestershire WR7 4DG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emily White     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Mill House, The Mill House, The Kington Flyford Flavell Worcestershire WR7 4DG 01386793110 01386793259 office@themillhousecarehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Ann Wills Type of registration: Number of places registered: Mrs Joanne Carroll,Mr Anthony William Carroll care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The home may also accommodate people over 65 years of age who have an additional physical disability. Date of last inspection Brief description of the care home The Mill House is a large, purpose built property situated in a rural area in the village of Kington. The premises are registered as a residential care home for a maximum of 30 older people with a dementia illness. The service users may also have a physical disability. People are accommodated in single bedrooms on two floors. All of the bedrooms have en suite facilities. The home has a passenger lift to enable the people who are accommodated on the first floor to access their bedrooms more easily. There are four lounges, a dining room and a conservatory. The home provides communal bathroom and toilet facilities. The garden includes two safe enclosed areas and there is 0 Over 65 30 Care Homes for Older People Page 4 of 32 Brief description of the care home adequate car parking space near the front of the building. The fees are #2,300.00 per month. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we looked at the information we had about the service since the last inspection. This included an annual service review, a random inspection, the notifications of incidents sent to us by the service, eight surveys sent to us by relatives of people using the service, and the Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment is completed by the manager and tells us about what the service is doing well, how they are improving and plans for the future. We visited the service during the day. We spent a lot of time observing daily life, and we met many people who use the service. We also spoke to staff, the senior staff, management and the owner of the service. We looked at care files and records completed by the service. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 The service should keep a record of when formal reviews happen, so that a record is kept of the opinions of people using the service, their relatives and any other professionals. This can be used to develop the service and explain changes to care plans. People using this service have communication needs arising from dementia which makes it extremely important that the service provides alternative means of recording dissatisfaction and well being. A recorded review could be a way of doing this. Care staff should provide more detail when recording personal care tasks in daily records. This makes sure that people are receiving the personal care support that is written in their plan and shows that staff are responding to any changes made to the plan. The service could develop their activities programme still further by making use of current good practice guidance about dementia, to make activities more innovative and specific to the needs of people with dementia. Training for staff on the Mental Capacity Act 2005 might improve the skills of staff and their understanding of how to work with people with a diagnosis of dementia. The service should record when staff are working extra to the rota to support any extra activities that are happening. This is so the service can demonstrate the support they are providing to people. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. Improvements have been made to the information provided to interested people. People moving to the service have a detailed assessment to ensure the service can meet their needs. Evidence: The Annual Quality Assurance Assessment tells us that the service has improved its guide and amended the statement of purpose, to cover all standards required, and has amended the terms and conditions. The service has met the three requirements relating to information made following the last inspection. We looked at the guide to the service and checked on peoples files and care plans when the guides and brochures had been issued. We saw that the most recent CSCI inspection report is available in the entrance hall with other information leaflets. We also spoke to three relatives of people using the service, who had all moved there in the past year. Everyone told us that they had been given enough information about the service Care Homes for Older People Page 11 of 32 Evidence: before their relative moved in. We also received eight surveys from relatives of people using the service. Six people say they always have enough information about the service to help them make decisions, two people say they usually have enough information. The Annual Quality Assurance Assessment also tells us that the service carries out a robust initial assessment process, involving visits in peoples homes or in hospital to accommodate the persons individual circumstances. The assessment that the service uses has been updated with all the headings in standard three of the National Minimum Standards, and meets the requirement from the last inspection. The manager plans to further improve the assessment as she does not feel it is detailed enough or leaves enough room for all the information needed. The Annual Quality Assurance Assessment tells us that the service encourages people to visit the home on different occasions before moving, and appointments are not necessary. Many peoples families visit the service on their behalf. The manager tells us that she spends a lot of her time working with families, because although the service does not take emergency admissions people often come to the service after reaching crisis point either at home or in another service. Staff training records and observations during our visit show that the service is able to meet the needs of people with moderate to advanced dementia. The service does not operate a key worker scheme but has a care manager who oversees the development of all care plans which cover physical, mental and scoial well being. The care manager spends time with the person and their representatives after the person has moved in to find out relevant background information and to monitor their progress. This is done in the first few weeks and makes sure the person settles in. The information is used to build up a more detailed care plan. Care Homes for Older People Page 12 of 32 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. Peoples health needs are met through good care planning. Peoples privacy and dignity is respected and their medications are managed safely. Evidence: We looked at the experiences of four people using the service in detail. This included looking at their files, meeting them, speaking to relatives if possible and observing their life in the house. The last inspection required the service to amend the care plans so that they set out in detail the action which needs to be taken by the staff. The last inspection report also required the service to provide accredited training for all staff administering medications. We were able to see that the service has made improvements and met these requirements. The service has appointed a new care manager who has reviewed how the service supports peoples health and personal care and has made changes to care planning. The service does not operate a key worker system because the manager found this to cause distress for a large number of people using the service, many of whom experience significant memory loss. The care manager has responsibility for reviewing care plans which makes sure peoples care is Care Homes for Older People Page 13 of 32 Evidence: continuous and the service can keep an overview of peoples development. We received eight surveys from relatives of people using the service. Five people said the service always meets the needs of their relative and always provides the support that was expected or agreed. Three people said this is usually the case. We also spoke to three relatives of people during our visit. Comments include: her health is managed very well, they really take care of her, they always let me know if things change. Peoples needs are detailed in their care plans, which focus on health, physical and mental well being. Everyones care plans start with their admission sheet which shows their personal details, health professionals involved in their care, and a photograph. Everyone also has a care map which has been developed from an example from the Alzheimers society. This map looks at the persons past life and tries to give a picture of their employment, school, place of birth, siblings, where they lived, childhood memories, interests, marital status, pets, children, grandchildren, holidays, and dreams. This is good practice and a good start to a more personalised way of care planning. One person also has a short autobiography in their care plan written by their wife. Peoples physical health care plan is set out under headings of communication, personal care and presentation, diet, mobility and continence. The care plan looks at the persons care need under these headings, their aim or goal, and the staff intervention needed. There is space to record the review dates and signatures. The tasks for staff to carry out with the person are set out in detail, for example, any emotional changes observed report to senior on duty, offer guidance to dining area or alternative areas of choice where feels settled, staff to be observant. Risk assessments for particular areas of care add to the care plan. These are regularly reviewed and people have their own risk assessments according to their needs. We saw examples of risk assessments for pressure care, mobility, manual handling, behavioural changes, continence, and relationships with other residents. Changes in peoples needs are recorded in a timely way, for example one person who has recently been discharged from hospital had their care arrangements updated immediately with appropriate actions for staff to assist with poor mobility and risks to pressure areas. Peoples care files contain a statement about personalised care, which says that the service uses informal chats with residents and their representatives to gather information, create an action plan and show the person they are valued. We saw that most plans are updated monthly and past plans show changes and development in people using the service. The care manager tells us that one person whose care plan has not been updated since September is having regular reviews by her occupational Care Homes for Older People Page 14 of 32 Evidence: therapist and social worker. The wife of one person tells us she meets with the care manager every two or three months, but there was only one record of a meeting. It would be good practice for the service to make a record of when more formal reviews occur, and to record input from professionals or representatives if necessary. This will support any decisions or changes that are made about a persons care, particularly when they are not able to contribute to these decisions themselves. The service has notified of us of several falls in the home in 2008, resulting in injury to the person. The service carries out a risk assessment for falling and monitors numbers of falls for all those identified as at risk. Care plans also contain falls prevention strategies. The service provides an environment where people with dementia are able to move about freely and accepts that there is an element of risk of falls. The Annual Quality Assurance Assessment tells us that they provide access to all external health teams to make sure that peoples health needs are fully met. In peoples care plans there are full records of professional contact and the reason why this happened, for example they show doctors visits to follow up a swollen ankle, and district nurse visits. In addition to falls records there are monitoring records of foot care, weights recorded monthly, and sleep pattern if needed. Daily notes are recorded by the senior care staff member on duty. In these notes staff comment on sleep patterns, eating, personal care, activities, behaviour, and any incidents that may occur. All of these records link to the care plans and visits from health professionals, however some comments include gave herself care and full care given. It would be good practice for staff to provide more detail in this area, for example whether a bath or shower, whether there was anything different from the care plan. This would make sure that people are receiving the personal care support that is written in the plan and would show that staff are responding to any changes made to the plan. The Annual Quality Assurance Assessment tells us that the service has achieved the required standard of medication training and improved the system and documentation. There are no people who are able to take their own medications. The senior staff member on duty administers medication. We looked at staff files and saw that appropriate medications training has been provided. We observed that the storage of medications is in lockable trolleys. Staff measure out medications and lock the cabinet before taking medications to the person. We saw that records are filled out with no gaps in recording, and medications to be given as needed are recorded. The service has one controlled drug in use at the time of the inspection, which is stored and recorded appropriately. The care manager carries out regular medications audits and all medications received and returned are accounted for. Care Homes for Older People Page 15 of 32 Evidence: The Annual Quality Assurance Assessment tells us that the service promotes and maintains peoples dignity by using person centred language, individuality, personalising their environment and maintaining a happy, safe and respectful home. It says that staff are trained to always respect the privacy of people by ensuring that all toilet, bedroom and bathroom doors are shut when in use, knocking on doors before entering, and where possible staff wait outside the door. People are encouraged and assisted in completing personal hygiene tasks with independence. We saw that care plans are written in ways that support the dignity of the person, and written in supportive language, for example, staff to take time to observe, listen and respond to give peace of mind and reassurance. We observed staff interacting with people showing respect for privacy and dignity, for example no private discussions are held in front of others, there is a calm atmosphere, and staff show understanding of dementia by responding to everyone in a friendly conversational way. The manager tells us that all people using the service are treated as though they have insight and there is a philosophy that no one says no. One relative of a person using the service told us the staff are really patient, there are no negative words used. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain independence and choice in their daily lives including activities, relationships and the local community. The service has a good understanding of the needs of people with dementia. Meals are varied and nutritious. Evidence: Most people using the service are not able to talk to us in detail about what they have been doing recently, so we spent time sitting in the communal areas observing daily life. We also spoke to peoples relatives, staff and looked at activity and daily records. We looked at eight surveys sent to us from peoples relatives, who all said that the service always helps people to keep in touch, and always meets the needs of different people. Four surveys said the service always helps people to live the life they choose, and four said it usually helps people to live the life they choose. The Annual Quality Assurance Assessment tells us that the employment of a new activities coordinator has enhanced the activities and variation of activities as she is focused, committed and very caring, for example she has implemented life history pages in the care plans, giving the service a better understanding of peoples individuality and past history. The activities coordinator is employed from 11am till Care Homes for Older People Page 17 of 32 Evidence: 5pm Monday to Friday. We spent some time with the activities coordinator who showed us the activity plans. The care map used for the personal care plans is used, and a blank one is given to families to complete. This information is used to build a life story. Each person has a record which shows their likes, dislikes, for example favourite songs and photographs. The activities coordinator completes an activities diary which shows who she has spent time with that day, so she can keep track of who is and is not participating. She estimates that people have one to one time with her every three days, in addition to the group activities. Activities are decided on daily, examples from the diary include hand massage, gardening, cookery, household tasks, craft, singing, walks, flowers, drawing, knitting, and one to one chats. During our visit we observed painting and craft, reading books and newspapers, people walking around and karaoke. The relative of one person using the service tells us he does a lot of singing and dancing which he loves, they know all about him. The Annual Quality Assurance Assessment tells us that people using the service are able to interact with the local community through visits to the local church, garden centres, shopping, the local theatre, boat rides, local tea rooms, blossom trail drives and other places of interest. We saw from records that people had been out shopping the day before our visit, and there had been several trips as described. The service has a car which seats three people using the service as well as two staff and a wheelchair. The manager tells us that if there are large trips out the care staff are supernumerary, which means no care staff are taken away from day to day care duties. They also have one volunteer who helps out. The service tries to organise one big trip per year, this year to a safari park. The service encourages contact from the community into the house. Records show that people have a music for health session every two weeks, a vicar once a month for those who wish and visits from the older persons forum once a month. Peoples relatives are encouraged to continue their relationships. There are no restrictions on visiting times, free meals for visitors are offered and families are invited to in house activities. One persons relative is not able to get to the service so staff pick them up once a week to visit. Another relative tells us they have started to do more small trips out for example to garden centres. These trips are splendid, and they listen to suggestions from us. The service tries to promote autonomy and choice within the home. The Annual Quality Assurance Assessment tells us that they have worked to improve the bathrooms with signs and putting up reminiscent picture boards. One person who has recently moved to the service has an Independent Mental Capacity Advocate who works on her behalf. This is good practice and the service should consider further training and development for staff in understanding mental capacity and the Mental Capacity Act 2005. The staff we observed during our visit showed understanding of the needs of people with dementia and ways to support their choices and independence. Requests for cups of Care Homes for Older People Page 18 of 32 Evidence: tea are always brought even if a person has just had one. We observed one person asking for a piece of bread and butter just before lunch and staff replied Im sure you can and would you like cheese. We observed a frail person with limited mobility attempting to get up, staff asked them where would you like to go and walked with them. The Annual Quality Assurance Assessment tells us that people using the service are very happy with their meals, and the service has been awarded with an excellent 5 star rating for Food Hygiene. We observed a lunch time, where most people sit together in the dining room and some chose to sit in arm chairs in the lounge. We observed staff asking would you like to come for lunch or would you like it later, telling people what the options are, and offering alternatives if they did not like it. Staff tell us that choices are not made before lunch as people often do not remember what they have chosen. The menu for the day is clearly displayed by the dining area. We observed a calm relaxed atmosphere, staff offering more to people when they had finished, and one staff member was observed holding a persons hand with the spoon to assist them with eating. Some people wore aprons made from discreet material which respected their dignity. We met the cook and looked at the kitchen. The list of people with special dietary needs is clearly displayed. The cook records all meals prepared and makes sure there is a variety. They show a variety of meat fish, and vegetables. The only area for improvement suggested by a relative is that that there should be more fresh fruit available. Care Homes for Older People Page 19 of 32 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. People are kept safe by good policies and procedures for complaints and managing abuse and neglect. Evidence: The Annual Quality Assurance Assessment tells us that the service issues a Complaints, Compliments and Comments procedure to all people and their representatives. The guide and complaints notice is also in the main entrance. The Annual Quality Assurance Assessment also tells us that representatives receive a six monthly questionnaire which includes questions on their knowledge of the complaints procedure. The service tells us the results audited from these are excellent. All the surveys sent to us by relatives tell us they know how to complain, and the three family members we met all say they know how to complain. We looked at the complaints records which showed us one complaint had been received by a family member. The service had encouraged the person to put their complaint into writing and had responded to this appropriately and according to their policy. In 2007 a complaint was received by us, CSCI. A random inspection was carried out and no evidence was found to support the complaint and no requirements were made as a result of the visit. The last inspection report required the service to amend its policy and procedure on abuse. The Annual Quality Assurance Assessment tells us the service has changed its policy in accordance with this, and introduced and implemented the Mental Capacity Care Homes for Older People Page 20 of 32 Evidence: Act guidelines into care plans. The eight surveys we received all tell us that the service responds appropriately when concerns are raised. Comments from people we met include they always ring if there are problems and they always keep in touch. We spoke to two members of staff who both understand procedures relating to protecting people, such as whistleblowing and safeguarding, and both said they feel well supported by their managers. It would be good practice for the service to carry out training on mental capacity and the Mental Capacity Act 2005 to improve staff understanding of this area. Staff files show us that all staff have up to date training on prevention of abuse and have all been recruited with the proper background checks. The service does not manage peoples money for them. During 2008 the service notified us of a serious incident involving two members of staff. The manager has acted appropriately, conducting disciplinary action which has resulted in the staff members being removed from the service. The service should be able to demonstrate ways in which it enables people with communication difficulties to express dissatisfaction or concerns, particularly those without regular family contact. We have mentioned previously in this report that more formal recording of reviews would demonstrate that the service looks closely at and addresses peoples mental well being and how they express themselves. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is a safe clean and comfortable place for people to live, with consideration for the needs of people with dementia. Evidence: During our visit we looked around the house and observed the way people living there use the house. The house has been designed to offer several seating areas which provide quiet areas, television, music and activities. The seating is arranged in groups and gives a relaxed and homely feel. During our visit we observed the main lounge area where most people chose to spend time. During the day jazz style music was playing in the background, we observed people chatting to each other, some reading papers and books, others walking, others sitting, and a few people sleeping. We also observed the other lounge areas which people freely walk between. One of these is a quiet area, another is used for television and karaoke where the noise does not disturb people. There are also tables for activities where we observed craft and reading. The dining area is nicely lit with spotlights, and there are appropriate signs for bathrooms. People have been supported to design their own name cards for their bedrooms. Outside there is a sensory garden which has recently been completed. This has soft floor covering in a red colour and raised beds with herbs for people to touch and smell. The service is aware that the step from the lounge to the garden may cause a trip Care Homes for Older People Page 22 of 32 Evidence: hazard and has arranged for work to be done to lower the step to floor level. There is an internal courtyard visible from the inside which also houses a sensory area, at the time of our visit it was used for a nativity scene. The service clearly understands the important of physical environment for people with dementia, however it would be good practice to consider developing sensory aspects of the inside of the house. For example, the service could consider use of photographs on bedroom doors and communal areas, and the use of different objects, textures and materials for people to touch and feel. The service keeps a list of all the improvements and purchases made, such as a new digital 42 television. The Annual Quality Assurance Assessment tells us that the maintenance persons working hours have been extended to 34 hours per week. The service has refurbished the lounge and dining areas with new carpets, curtains and non slip flooring. Two bathrooms have been upgraded with new suites and decor, and some bedroom carpets, curtains, blinds and bedding have been replaced. There are planned refurbishments to the other lounge areas. All areas of the house are clean with no unpleasant odours. All staff have up to date food hygiene and infection control training. The kitchen is clean with all relevant checks completed by the cook. The service has been awarded the five star food hygiene certificate from the local environmental health officer. The Annual Quality Assurance Assessment tells us that the service has employed a new cleaner for the weekends. We observed the bathrooms and toilets all have gloves, aprons and cleansing facilities, and that staff use the appropriate equipment when necessary. Care Homes for Older People Page 23 of 32 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 are supported by the right number of well trained staff to meet their needs. Evidence: We spoke to the manager and staff, and observed staff throughout the day. The staff duty rota shows that five care staff are on duty during the day which includes a senior worker. In addition to this there is the manager, care manager and activities coordinator who are all supernumerary. One member of staff tells us there are enough staff members to get the job done, there is nice relaxed atmosphere and we dont feel rushed. The manager tells us that when needed extra care staff work to support the activities coordinator with activities outside of the house. It would be good practice for the service to document when supernumerary care staff are working, as this shows the level of support the service is providing for people. The rota shows three waking night staff. There is also good domestic and maintenance cover for the house and very little use of agency staff. The Annual Quality Assurance Assessment tesll us that an area for improvement is to retain care staff for longer periods. The Annual Quality Assurance Assessment tells us that the service has increased the number of NVQ trained staff and that all senior staff within the home are over 25 years old and trained to a level 3 NVQ. The activities coordinator is also undertaking an NVQ in activities. We met two members of staff, one of whom was new, who has relevant Care Homes for Older People Page 24 of 32 Evidence: previous experience and is undergoing a full induction programme that meets the required standard. Speaking to and observing staff with people using the service shows that they have the right knowledge and understanding of the people they are supporting. Of the eight surveys we received from relatives of people using the service, four said the staff always have the right skills and experience to support their relative, and four said they usually have the right skills and experience. Comments from relatives we met include there is a nice lot of staff, they always speak nicely, staff are relaxed, the staff dont dive to the staff room, the staff can relate to people. The recruitment of a full time care manager whose role is to oversee care plans and focus on person centred care has improved the way staff work with people using the service. Observations of staff show that they have a good understanding of how to work in a way that supports the individual. We checked two staff files of a senior member of staff and a new member of staff, which supported their background qualifications and showed that the proper background checks had been carried out before their employment. The files contained proof of identity and a photograph of staff which meets a requirement from the last inspection report. Staff files show that they have had all mandatory training as well as a three hour dementia course and training in the protection of vulnerable adults. The Annual Quality Assurance Assessment tells us that the service aims to continually develop staff skills and knowledge based on person centred dementia care. All staff have a training plan that identifies the goals they are aiming for. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is managed well and safely with a focus on individual needs of people using the service. Staff are supported, health and safety practices are observed and the opinions of people using the service and their representatives are used to improve quality. Evidence: The registered manager has been registered at Mill House for eight years and has consistently provided a service rated as good, recognising where improvements can be made and meeting legal requirements and recommendations for improvement. In the Annual Quality Assurance Assessment she tells us that the protection and wellbeing of people using the service has always been first and her training is imperative to ensure she is able to lead by example. The manager continues to study for a degree in Health and Social Care which is benefiting staff and the service. The service has met all the requirements from the last inspection and has made other improvements to the quality of life of people using the service, notably through the Care Homes for Older People Page 26 of 32 Evidence: appointments of the care manager and activities coordinator which have significantly impacted peoples day to day quality of life. During our visit we spent some time with the owner of the service, the manager and care manager. All demonstrate a good understanding of the needs of people with dementia. The manager and care manager undertake regular training in dementia care, and attend conferences and relevant events to the care sector. The lines of management accountability are very clear within the service, and surveys returned to us all say that they are always kept up to date with important issues affecting their relative. Evidence from this report shows that the manager encourages innovation, creativity and development in her service. Through the new care plans and work of the activities coordinator they demonstrate that they are aware of current good practice and ideas in dementia care. The manager is also aware of areas for development and improvement. Observations and discussions with staff and relatives show that there is an open, positive and inclusive atmosphere, a clear sense of direction and leadership which everyone is able to understand. The manager tells us that she tries to spend a part of every day with people using the service, and this was observed during our visit. Staff tell us we try not to rush, the residents care comes first, and people are well cared for, I wouldnt improve anything. As mentioned earlier in this report, the manager encourages a philosophy of no one says no which we observed in the practice of the staff. The Annual Quality Assurance Assessment tells us that the quality assurance system has been brought into one system which involves relatives and representatives of people using the service. Questionnaires are sent out every six months, and there are regular meetings with people and their representatives to discuss any concerns. During our visit we noted that peoples likes and dislikes are regularly updated and the activities log, care plans and the map of life are regularly reviewed to gauge peoples well being and wishes. The requirement from the last inspection has been met. Staff tell us they are well supported and have regular supervision, and that the mangers are approachable. Staff tell us whatever I need they are there and things are much more organised, peoples care seems easy now, we always know what to do. Supervisions are six times per year, there is an annual appraisal and staff meetings, and a separate staff meeting for senior staff. The service does not manage peoples money. Many small items and activities are paid for by the service. Health and safety practices are observed, with relevant health and safety checks being carried out. Staff have regular training in fire safety, moving and Care Homes for Older People Page 27 of 32 Evidence: handling, food hygiene, infection control, and first aid. Risk assessments have been carried out for these areas and an accident and incidents book is kept up to date. The service uses an external company who carried out a health and safety audit in January 2008. This made several recommendations which have since been met. Care Homes for Older People Page 28 of 32 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 32 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 1 7 It would be good practice for the service to make a record of when more formal reviews occur, and to record input from professionals or representatives if necessary. This will support any decisions or changes that are made about a persons care, particularly when they are not able to contribute to these decisions themselves. It would be good practice for staff to provide more detail when recording personal care tasks, for example whether a bath or shower, whether there was anything different from the care plan. This would make sure that people are receiving the personal care support that is written in the plan and would show that staff are responding to any changes made to the plan. It would be good practice for the service to develop its activities still further by using the dementia specific research and guidance that is available. It would be good practice for the service to carry out training on mental capacity and the Mental Capacity Act 2005 to improve staff understanding of this area and help them to support the decisons made by people using the service. It would be good practice for the service to consider developing sensory aspects of the inside of the house to Page 30 of 32 2 8 3 12 4 18 5 19 Care Homes for Older People provide stimulation for people who use the service. For example, the service could consider use of photographs on bedroom doors and communal areas, and the use of different objects, textures and materials for people to touch and feel. 6 27 It would be good practice for the service to document when supernumerary care staff are working, as this shows the level of support the service is providing for people. Care Homes for Older People Page 31 of 32 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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. 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