Care Home: Mill Lane Nursing Home & Retirement Home

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What the care home does well The home is tastefully decorated, comfortable and appropriately maintained. The atmosphere was warm and friendly, and visitors and friends are made to feel welcome. Some of the residents told us, `The nursing home provides a well run, clean residence with excellent nursing care`, or `I am very happy here and the management has done much to make me comfortable`. The home provides residents with opportunities which usually allows choice and control over their preferred lifestyle. This includes opportunities for the residents to access leisure activities and entertainment, and opportunities for contact with the local community. Residents are supported by a professional, well trained, and a hard working staff group, who are qualified and able to meet their care and support needs. Staff provided care to the residents in a respectful and dignified way. There is a commitment by management to provide residents with a quality service, demonstrated by an appropriate management structure, appropriate quality assurance systems, and a supportive staff group. The home showed us they have robust recruitment and selection processes in place, which would protect the residents. The health and care support received was good. Medication processes were good, which would ensure that residents` received their medicines as prescribed. What has improved since the last inspection? Since the last inspection, the manager had addressed the following concerns by improvements to the residents` care records including their end of life care records. The chief has improved the consistency of food after direct consultation with the residents, and residents needing assistance with their meal, are now assisted by extra lunch and tea time staff. Concerns around staffing levels were reviewed and new care and domestic staff have been appointed last year. Concerns around the size of the kitchen are being addressed, with a new kitchen extension due to commence shortly. What the care home could do better: The home showed us that they usually provide a quality service that met the needs of the residents, but this is sometimes compromised by shortages in staff numbers. This was seen by delays in care staff being able to provide a more responsive service for the residents. These issues were raised with the management and it was recommended that the service should consider new strategies to provide more consistent staffing levels including more bank staff, and a review of the adequacy of the current staff rota and shift times. We also made recommendations around the need for improved storage facilities for the hoists to ensure that there are no safety hazards in the home, and that the home considers how it will meet the Skills for Care recommendations of 50% care staff trained to national vocational qualification, level 2. This is to ensure that the home has an appropriately skilled workforce, to meet the residents` needs. CARE HOMES FOR OLDER PEOPLE Mill Lane Nursing Home & Retirement Home 79 Garrison Lane Felixstowe Suffolk IP11 7RW Lead Inspector Kevin Dally Unannounced Inspection 20th January 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill Lane Nursing Home & Retirement Home Address 79 Garrison Lane Felixstowe Suffolk IP11 7RW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01394 279509 01394 279509 manager@milllane.healthcarehomes.co.uk Pri-Med Group Ltd. Lorraine Barker Care Home 25 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (25) of places Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. Care can be provided for six (6) named service users with a diagnosis of dementia (as named in the application of variation dated 29th January 2007) 14th February 2007 Date of last inspection Brief Description of the Service: Mill Lane Nursing and Retirement Home belongs to the Healthcare Homes Group and is registered as a care home with nursing, for up to 25 places for older people. It is situated in Felixstowe at the junction of Garrison Lane and Mill Lane, and stands back from the junction, in its own pleasant gardens. It is not central to the town of Felixstowe, although there is easy access to both the shopping area and the sea front, about half a mile away. The building is a converted three-storey house with car parking to the front with ramped access to the front door. A large passenger lift serves the first floor, and there are ample assisted bathrooms and WC’s. There are 21 single bedrooms and two double bedrooms. The lounge and dining room are located on the ground floor. The company has a strong commitment to training, with a comprehensive inhouse training programme, employing dedicated training staff. There is a good management structure, overseeing a suitable quality assurance programme, and staff are well supervised. The company has consistently achieved the Investors in People award, and in 2005 also received a Work Life Balance award. Fees are calculated depending on the needs of the resident and range from £380 - £725 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries, receipt of daily newspapers and any transfers to hospital. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of Mill Lane Care Home, which took place on the 20th January 2009, over a 9 hour period. During the inspection we assessed seven outcome groups for the people who lived at the home. Ms Lorraine Barker, manager, and Mrs Maggie Smith, regional manager, provided us with information that was relevant to the inspection. We were able to spend time with a number of the residents and a relative, and we spoke with some of the staff group. This gave us information about what people thought about the quality of the service provided. We also observed staff serving the lunch, and we followed a medication round. A selection of residents’ care plans and medicine records; staff records, maintenance and training records were also checked, as were a selection of other documents, including the staff duty rotas and the residents’ menu. Surveys were sent to the home to distribute to the residents and staff before the inspection took place. Nine residents, and 3 staff members responded to our questions. A selection of their views and opinions about the home are included within this report. An expert by experience (E by E) also accompanied me at the inspection. Experts by experience are people who have experience of accessing care services, and can provide feedback on the home, from the residents’ perspective. At the writing of this report, we had not received written feedback from the E by E, so were unable to include their comments about the home. The manager also completed the CSCI annual quality assurance assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. What the service does well: The home is tastefully decorated, comfortable and appropriately maintained. The atmosphere was warm and friendly, and visitors and friends are made to feel welcome. Some of the residents told us, ‘The nursing home provides a well run, clean residence with excellent nursing care’, or ‘I am very happy here and the management has done much to make me comfortable’. The home provides residents with opportunities which usually allows choice and control over their preferred lifestyle. This includes opportunities for the Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 6 residents to access leisure activities and entertainment, and opportunities for contact with the local community. Residents are supported by a professional, well trained, and a hard working staff group, who are qualified and able to meet their care and support needs. Staff provided care to the residents in a respectful and dignified way. There is a commitment by management to provide residents with a quality service, demonstrated by an appropriate management structure, appropriate quality assurance systems, and a supportive staff group. The home showed us they have robust recruitment and selection processes in place, which would protect the residents. The health and care support received was good. Medication processes were good, which would ensure that residents’ received their medicines as prescribed. What has improved since the last inspection? What they could do better: The home showed us that they usually provide a quality service that met the needs of the residents, but this is sometimes compromised by shortages in staff numbers. This was seen by delays in care staff being able to provide a more responsive service for the residents. These issues were raised with the management and it was recommended that the service should consider new strategies to provide more consistent staffing levels including more bank staff, and a review of the adequacy of the current staff rota and shift times. We also made recommendations around the need for improved storage facilities for the hoists to ensure that there are no safety hazards in the home, and that the home considers how it will meet the Skills for Care recommendations of 50 care staff trained to national vocational qualification, level 2. This is to ensure that the home has an appropriately skilled workforce, to meet the residents’ needs. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New potential residents can expect to receive detailed information about the service, and have their needs assessed prior to commencing their stay in the home. EVIDENCE: Healthcare Homes provide prospective residents with an information pack about the service. The pack includes several colour brochures, social care information, a statement of purpose and a service user guide. There is reference to the management structure of the home, and how a resident can make a complaint, if they have any concerns. This information would help potential residents to make an informed decision about whether the home would be suitable to meet their particular care needs. The information provided by the home (the AQAA) told us, ‘We encourage prospective residents to visit Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 10 the home before admission and to stay for a meal or the day to enjoy the activities’. Feedback received from seven of nine residents told us that they ‘had received enough information about the home before moving in’. One said ‘no’, and one did not comment. One relative we spoke with told us, ‘We were given pamphlets and information about the home, and how we could make a complaint’. Two residents’ care plans and records were checked and both included a ‘preadmission assessment’ for each resident. This showed us that the home had completed a detailed assessment of the residents’ care needs. For example, twelve areas of personal care needs had been assessed including important key information about their previous history, current health, and personal care needs. The information gained would provide the home with the basis for producing an informative residents plan of care. Feedback from three staff members told us that they were ‘always or usually’ given up to date information about the needs of the people they supported. Both the manager and staff showed us they had a good knowledge of the residents’ needs. The staff we spoke with and records checked showed us that staff had attended a range of training (please refer to the staff section) so that their knowledge and care skills would be suitable to meet the needs of people who live at the home. The home uses around eight part or full time trained nurses (there is always one nurse on each duty) who are qualified to direct and provide nursing care for the residents. Information provided by the home told us that 6 of 17 support care staff (36 ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 2 working towards an NVQ 2 or higher care qualification. (Please refer to the staffing section). This showed us that over a third of the care staff had a care qualification so would be trained and competent to support nursing staff to meet the residents care needs. A selection of feedback received from the residents or a relative around what they think the service does well, or how the service could improve included the following views. ‘I am very happy here and the management has done much to make me comfortable, even giving me a room with a view to a small exquisite garden, when they learned that this was important to me. I am pleased to say I am happy and content to stay here, and regard Mill Lane as my home’. ‘The nursing care and attention of the doctor, when required is good.’ ‘The members of staff are generally very approachable’. ‘They could improve by answering the call bells more quickly’. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 11 ‘The nursing home provides a well run, clean residence with excellent nursing care’. ‘The home could improve by more staff to residents, as this remains the same regardless of the level of dependency’. ‘There is always a homely environment as well as activities to keep residents occupied’. ‘Although there has been some improvement to the food recently, there is still room for improvement, particularly fresh vegetables’. The home does not provide intermediate care; subsequently this standard is not applicable. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents will receive appropriately planned care, which meets their health care and support needs. This may sometimes be compromised when there are shortfalls in the staffing levels. EVIDENCE: The information provided by the home told us, ‘Care plans are developed from the perspective of the resident and are regularly reviewed and risk assessments are carried out and evaluated each month to ensure they remain appropriate’. Two residents’ care plans were checked and both provided detailed healthcare information about the residents’ nursing care needs. An assessment was provided around 11 areas of peoples daily living requirements, and this showed us that the home were aware of their residents’ medical care needs. One example we saw was with a person identified as a diabetic. The medical Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 13 problem was identified with a statement of the expected outcome, and the care instructions for nursing and care staff to follow, to ensure that their medical care needs were fully met. Each care plan was dated and signed to confirm the resident’s or their advocate’s agreement with their plan. The daily care records we checked provided a current description of the changing needs of each of the residents, and this showed us that nursing staff regularly monitor medical care problems. The manager told us that home are now in the process of updating plans using a new Healthcare Homes care plan format, which is easy and contained detailed information relating to the individual’s health, and social care needs. This is being trialled with one resident, and an of the care plan we saw was very comprehensive. the care to follow personal example Additional nursing assessments had been completed to promote and maintain the residents’ health. These included moving and handling, pressure area assessments, care dependency profiles, continence assessments, falls assessments, nutritional screening, and bedrail risk assessments. To meet the specific needs of one resident who was a diabetic, the assessment showed us that the home regularly monitored the resident’s blood sugar levels, twice a week. Another resident at risk of falls was identified as needing a ‘high-low bed and crash mat’ to reduce and better manage these potential risks. These were examples of good practice. It was good to see that the home provided each resident with a ‘social profile’, which was entitled, ‘This is your life’. The profile recorded important social information like the resident’s family tree, previous education information, career years, happy memories, events and interests, family life, and ‘my favourite things’. The purpose was to provide staff with an insight to ‘the person’, and so obtain a holistic view of the individual, their past and ‘likes and dislikes’ etc. One care profile for a person living with dementia revealed they had formerly been an aviator in the RAF, and a scientist. This provided staff an insight into their life background, and a better understanding of their past working life. The records we checked also showed us the contact residents had received with various healthcare professionals, including their general practitioner (GP) and the chiropodist. One resident told us, ‘If I need access to the doctor or chiropodist, I get immediate help. The response is excellent’. Another relative said, ‘There is access to the doctor, who will come to the home, and there is a private chiropodist we can call’. Feedback received from residents surveys said they ‘usually or always’ received the care and support they needed, and ‘usually or always’ received the medical support required. Residents praised the staff group for the care received and made comments like, ‘People here are very helpful. The standard of care is very high’, or ‘Nursing care and the attention of the doctor when Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 14 required is good’, or, ‘I am very well cared for’. However, feedback from 5 residents surveys and 3 residents we spoke with did raise some concerns around how staff shortages periodically impacted on staff responsiveness, to the care they needed. (please refer to the staffing section for more details) People told us, ‘Sometimes there are long delays in [staff] responding to call bells’, or ‘It is difficult for staff to be available instantly, at any one moment of the day. There will always be delays when staff are busy elsewhere in the building, but eventually, my call will be answered’, or ‘Sometimes, I have had to wait 4-5 minutes’. During the morning shift, it was noted several times that call bells went unanswered for several minutes, as staff were engaged with other residents. One resident was asked if they could chose when they wished to go to bed. They said, ‘I don’t know that you always have this. I ask to go at 6:30pm because staff get busy by 7:30pm and you may have to wait until 9pm’. Feedback from staff said, ‘Staffing can be an issue’. These concerns were discussed with the manager who said that there had been a number of staff vacancies but that these were now filled, including extra assistance over busy lunch and tea periods. Further, that one resident did frequently use the call bell, but often did not have any specific care requests. Feedback from some of the staff group told us, ‘the quality of the care is good, when we are able to offer it. Sometimes it is not so good due to staffing levels’. The manager and area manager said that they would reappraise the staffing at the home to determine how to resolve this matter. We observed residents were being called by their preferred name as identified in their social plans and residents’ spoken with felt that staff respected by staff. Staff were observed to be hardworking throughout the inspection, were patient, polite and caring towards the residents they helped. Residents’ dignity was maintained during care sessions, and residents were positively included in conservations. Staff were seen knocking on the residents’ doors before entering, and respected their privacy. When asked, ‘Do you feel well treated?’, one resident told me, ‘I think so’. Another said, ‘The staff are very helpful. polite and caring. Any suggestions are resolved the following day. I have no concerns about the staff attitude’. The information provided by the home told us, ‘The home has protocols in place for managing medicines and carries out regular audits. Staff benefit from medication best practice workshops, which has resulted in raised awareness of common problems’. The home uses the monitored dosage system (MDS) with blister packs and MARS sheets, for safe usage. Each resident’s details and a photograph of the resident, is maintained on the records for identity and safety purposes. Medicines are kept locked in the medicine trolley, which the staff take to the residents. The lunchtime medication round was observed and the medication administration records (MAR) sheets were checked, and three residents’ medicines were audited. The nurse in charge was seen to sign the MAR sheets Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 15 appropriately after medicines were administered and no signature gaps were noted on the MAR sheets. Records checked showed that the home used ‘non administration codes’ to identify if a resident refused any medicines. An audit of three residents’ medicines showed that the records were correct and accurate. The home confirmed that there was medicine guidance around the control, storage, disposal, recording and administration of medicines, although this was not checked on this occasion. Controlled drugs (CD’s) were found to be appropriately stored in a locked room and appropriate cabinet. A check of one resident’s CD records confirmed the number of controlled drugs held was correct and accurate, and two staff members had checked and signed the records. Each of the care plans has a section for the resident’s ‘end of life arrangements’, which had been completed with information around what the residents choices to be followed and their chosen funeral arrangements. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a lifestyle that matches their expectations. EVIDENCE: The information provided by the home told us, ‘we have a varied activities programme involving people from the local community, including combined activities with two local residential homes’. On arrival at the home, there was a calm and relaxed atmosphere with some of the residents being assisted to undertake their daily routines. Several residents were up and dressed and seated in the day room, with some reading, some watching the television, and some enjoying a cup of tea. The television volume was sufficiently low not to disturb other residents. One resident told us, ‘I try to do things’ and recalled that there had been a piano concert, a visit by the clergy, and a summer fete. Exercise and massage sessions are provided every Tuesday. Another resident said they largely ‘enjoyed their own company’ so preferred their own room. However, they remained very active with ‘reading Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 17 and letter writing to the grandchildren’. They had their own telephone, and received frequent calls from their family, so were able to stay in touch. Activity events were posted in the hallway in two large display cabinets, with pictures of interest to the residents and the events they had previously enjoyed. Features included the home fete 2008, which raised £850 for the local RNLI, a visit to ‘the hut’ at Felixstowe beach, and a painting display byone of the residents painting classes. There was a weekly guide to forthcoming events and these included reflexology sessions, reminiscence therapy, the hairdresser, activities with staff, a bus outing, and a ‘pat the dog session’. Feedback from one resident said, ‘Yes a number of activities are arranged, and I do attend them’. The staff group told us, ‘Residents can go shopping on the bus twice a week. During the summer there are trips to local villages, the beach including fish and chips, and local walks’. Family and friends are able to visit the home when they choose, and no restrictions are placed on visiting times. Visitors were seen calling on the residents throughout the day, and one relative told us, ‘the home is very nice, and comfortable’. Staff were seen to encourage and relate with the residents. One resident told us ‘I have no concerns. Staff are friendly and we have a laugh’. Their attitude was courteous, friendly and supportive. At the previous inspection concerns were raised around the lack of support for some residents who needed assistance with their meals. The home now provided some part time staff to cover most lunchtime and tea periods, so the assistance was available. No concerns were raised at this inspection around this particular issue. Residents who wish to are encouraged to take responsibility for their own finances, and some are supported to handle small amounts, for any personal needs they may have. Residents can keep their money with the home for safekeeping, and this is protected by good recordkeeping procedures and checks. Three residents’ money held was checked against the records and were found to be accurate. The home provided a four week rolling menu guide for residents with a choice of two hot meal options. Examples of some of the weekly choices available included chicken casserole or chicken curry, pork steaks or cheese and potato pie, roast lamb, steak and kidney pie or corned beef hash, poached plaice or battered haddock, roast chicken. The main meal was served in a well maintained light and airy dining area. The meal on the day we visited was pork steaks or cheese and potato pie, served with carrots, cauliflower and potatoes. Dessert was custard sponge or fruit. The tables were set with table cloths, flowers, condiments and cutlery. The food looked and smelt appetising. Several residents we spoke with said that the meal was tasty and sufficient for their needs. During lunch the residents were served by staff and used the occasion to converse with friends about the events of the day. Feedback from Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 18 7 of 9 residents when asked, ‘do you like the meals at the home?’, said ‘usually or always’. Two 2 residents said ‘sometimes’. Comments about the meals included the following selection of views. ‘Prior to the meal, we are given a chance to pick out something we would like. The quality of the food is good, and served nicely’. ‘We do not get enough fresh vegetables’. ‘We are asked everyday what we want. The meal are very good’. ‘On the whole the food is good. Sometimes this could be improved. We have a choice of 2 meals and for supper there are sandwiches. There is plenty of food’. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect their concerns to be listened to and action taken when required, and they would be kept safe from abuse, neglect or self-harm. EVIDENCE: The information provided by the home said, ‘The home adheres to the protocol of safeguarding and protecting vulnerable adults through its robust recruitment process and staff training. Our complaint procedure is clearly displayed in the home’. The home has a complaints procedure available for the residents and a copy was provided in the service user guide. The complaint book was checked and 2 complaints had been received during the previous year. One complaint received by the CSCI around personal care had been referred to the home, and this had been appropriately investigated by the organisation. A second complaint around a resident’s health, had been investigated with the assistance of the local doctor. It was determined that the matter was a health related matter. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 20 Feedback received from 7 of 9 residents said that they ‘always or usually’ know who to speak to, if they are not happy. One said ‘sometimes’, and one did not say. Further, 7 of 9 residents said they know how to make a complaint. One said ‘no’ and one did not say. On resident told us, ‘I feel the manager would deal with any concerns I may have. I could talk with them and it would be addressed’. The home has policies and procedures in place for the safeguarding of vulnerable adults including whistle-blowing procedures. The home has access to the Suffolk inter-agency policy on the protection of vulnerable adults, June 2004. The manager was aware for her responsibilities in reporting any allegations of abuse to Social Services via customer first, for referral to the safeguarding team. The home has not made any safeguarding referrals in the past 12 months. Recruitment procedures checked (please refer to staff section) showed us that new employees would be checked and cleared before they work with any vulnerable adults. Staff training records checked and feedback from staff members informed us that they had been provided with safeguarding training by the home. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 ,20,21,22,23,24,25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a home that is comfortable, well maintained and decorated to good standards. Their safety may be put at risk until alternative storage is found for mobile hoists. EVIDENCE: Mill Lane is situated on a in Felixstowe in its own pleasant gardens. It is not central to the town of Felixstowe, although there is easy access to both the shopping area and the sea front, about half a mile away. The building is a converted three-storey house with car parking to the front with ramped access to the front door. A large passenger lift serves the first floor, and there are ample assisted bathrooms and WC’s. There are 21 single bedrooms and two double bedrooms. The lounge and dining room are located on the ground floor. The home is nicely decorated, Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 22 comfortably furnished with good quality furniture, fixtures and fittings providing residents with clean, homely and comfortable accommodation. Grab rails and other moving and handling equipment were seen around the building. Throughout the entire building, storage space is limited, but to the home’s credit, all storage area is well utilised by very effective management and organisation of the space available. At the previous inspection we raised concerns around the storage of hoists in the corridors, which are fire exits routes. Although no corridors were actually obstructed by the hoists, these did pose a potential to cause problems. When we spoke with the management about this, it was agreed that a new storage area would be investigated to provide a more appropriate and safe area for these. The residents’ rooms we checked were comfortable and were provided with appropriate furnishings and fittings, and some residents were able to bring small personal items of their own. For example pictures or a favourite chair etc, so reflecting individual choice. Communal bathrooms and toilets were suitable for the residents. The home showed us that they maintained regular checks of hot water tap temperatures close to the recommended 44 degrees centigrade for baths and showers, and 41 degrees centigrade recommended for hand washbasins. Staff had access to a suitable supply of disposable gloves and aprons and appropriate hand washing facilities of liquid soap and paper towels in the bathrooms and toilets where they might be required to provide assistance with personal care. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be supported by appropriately recruited and trained staff but cannot be assured that there will be sufficient numbers to meet their care needs. EVIDENCE: Mill lane is registered to provide care for up to 25 residents. The staff team consists of the manager, 8 registered nurses, 17 care staff and additional ancillary and maintenance staff. Care staff for the morning shift (8-2pm) includes 1 registered nurse (RN) and 5 carers, the late shift, (2 - 8pm) 1 RN and 3 care staff, and the night shift (8pm - 8am) 1 RN and 2 care staff. There was also lunch and teatime cover some days between 12:30 to 3.30, and 4.30 to 7.30pm. The information provided by the home also informed us that 16 nursing or care staff have left in the past 12 month period, and that agency staff have been used to fill gaps in the rota. Staffing levels were discussed with the manager in response to feedback we received from the residents, prior to, and during the inspection. Some of the residents had raised concerns that there were not always sufficient staff numbers to meet all their care needs. A check of the rota for a 4 week period from the 23rd December 2008 to the 20th January 2009, showed us that full staff numbers for the early and late shifts as described above, were maintained Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 24 for around 70 of the time, but 30 of the shifts during this time had operated at less than this minimum. Agency staff were requested wherever possible to fill in the rota gaps, but the home had not always been able to cover all the shifts. The residents and staff group confirmed these observations. Some of the impact on the care of the residents has already been discussed in the healthcare section. Feedback from 8 of 9 residents surveys when asked, ‘Are staff available when you need them?’ said, ‘usually’, one said ‘sometimes’. Residents via the surveys and at the home made the following comments about the staffing levels. ‘Lack of staff means attention from staff can be slow, and agency staff are not always satisfactory, as they do not know the residents’. ‘Sometimes it can seem a long time before our bell is answered’. ‘Sometimes there is a long delay in responding to bells’. ‘At times, they could probably do with more staff to meet individual needs’. ‘I feel the home is always one member short. There are normally 5 members of staff on at any one time, so it should be 6’. The management acknowledged these concerns and recognised that care staff levels and the rotas needed to be more consistently maintained, to ensure that there are sufficient care staff, to meet all the residents’ needs. The home also needs to consider any residents who are becoming more dependent and who may need extra staff support. Two staff files were checked and these confirmed the home operates a thorough recruitment process, to ensure that staff are checked and cleared to work with vulnerable adults. The staff members’ paper work included Criminal Bureau Records (CRB) checks and Protection of Vulnerable Adults (POVA) checks. Further, staff had completed an application form and provided a record of pervious employment. There were three references per person and proof of their identity by way of a passport or birth certificate. Staff training records checked showed us that the home provided good support for staff to receive core training, relevant to their job roles. Healthcare Homes have their own training manager and extensive courses are available at all homes owned by the organisation. Induction training is provided for new staff based on the Skills for Care Common Induction Standards (CIS). Staff files checked showed us that they have attended training for safeguarding, fire, food hygiene, moving and handling training, the roles of a care worker, dementia awareness, first aid, infection control and health and safety training. One new staff member’s files we saw included detailed induction training based on the skills of care induction standards. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 25 Information provided by the home told us that 6 of 17 support care staff (36 ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 2 working towards an NVQ 2 or higher care qualification. This showed us that over a third of the care staff had a care qualification so would be trained and competent to support nursing staff to meet the residents care needs. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home that is managed by an appropriately qualified and experienced manager, however residents health welfare and safety is at risk until more appropriate storage of food is created. EVIDENCE: The registered manager is a qualified nurse and has obtained the National Vocational Qualification (NVQ) level 4, Registered Care Managers Award (RMA). She has around 26 years experience in the care sector and told us she ‘keeps up to date with current trends through regular seminars and publications, as well as regular management meeting with healthcare homes’. The manager demonstrated a good knowledge and understanding of the residents’ nursing care and support needs. The residents, visitors and staff Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 27 spoken with were supportive of the manager and felt she was approachable, should they have any concerns. Residents’ meetings are held to ensure feedback is received from the residents and to allow any concerns to be discussed. The minutes of one of the meetings was checked, and the manager had provided an ‘action plan’ to ensure that the residents issues raised were followed up, and resolved. There was a quality assurance programme in place to receive feedback from the residents and relatives around the service provision, and an annual quality survey was completed in April 2008. Analysis and comments from the survey had been checked and the home used this to try to continually improve the service. The residents told the home what they do the best. They said ‘100 staff had an efficient, courteous, friendly and approachable manner, 100 the care and support received was appropriate, and 78 found the activities programme stimulating, with a range of activities’. The residents said that improvements could be made with ‘better communication with the relatives, an improved dining experience and a better laundry service’. The home had also received a number of compliments about the service from relatives, and hospital staff, and the following is a selection of their views. ‘Thank you seems too small to cover it but your team were so kind and gentle with my relative, and respectful’. ‘We wanted to tell you and your staff that since our relative moved in, they have improved 100 on how they used to be. The staff we have encountered have been caring, considerate, thoughtful and so very kind, not only to our relative, but to us’. ‘Thank you all your staff for their efforts during our visits to the home. On both occasions your staff were extremely efficient, helpful and courteous’. The home does not normally manage the financial affairs of any of the people living in the home. Where residents are unable to manage their own finances this is managed by their power of attorney or family. Residents can choose to have their personal allowances held in the office. Records are kept in a register, which showed that transactions were witnessed and had two signatures against them. These are audited monthly. The balance for three of the residents tracked during the inspection were checked and found to be accurate. Staff spoken with confirmed that they receive supervision training and support to do their job. Supervision records we checked showed us that regular sessions were taking place. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 28 A selection of policies and procedures were checked which included the statement of purpose and user guide, complaints, protection of vulnerable adults and whistle blowing. The home showed us that there was a staff health and safety training programme in place, which included fire, food hygiene, infection control and first aid training. Staff records we checked show us that staff receive this training. Records checked, including fire records and hot water tap temperature records, showed us the home continues regular health and safety monitoring at the home. Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 3 Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations The registered person/s should provide alternate storage facilities for the hoists. This is to ensure that all parts of the home are free from hazards so keeps the residents safe. The registered person/s should consider new strategies to provide more consistent staffing levels including more bank staff and reviewing the adequacy of the current staff rota and shift times. The registered person/s should consider how it will meet the Skills for Care recommendations of 50 care staff trained to national vocational qualification, level 2. This is to ensure that the home has an appropriately skilled workforce, to meet the residents’ needs. 2. OP27 3. OP30 Mill Lane Nursing Home & Retirement Home DS0000024448.V374210.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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