Care Home: Mill Lodge Care Home

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What the care home does well Before being admitted people had their needs assessed to establish if the service could provide the right care and support before a placement in the home was offered. Records showed admissions were planned for. Residents` who provided written comments for this inspection indicated that they `always` receive the care and support they needed. Staff were available when needed and they were listened to. Relatives were pleased too with standards in the home. Comments such as, `The girls at Mill Lodge are very good with my mum. At last she is OK.` `They are kind to all the people who live in the home.` And `Mill Lodge provides excellent care and attention to all my mothers needs. She is kept clean and well fed.` And `Since my mother has been in Mill Lodge we have seen a big improvement. She is very happy to be there.` Residents living in the home benefited from the support of a named worker referred to as a key worker. They also benefited form additional specialist support where needed such as health care. A health care professional who visited the home was satisfied the home was responsive to health care needs of residents. Care staff who provided written comments considered they were given enough information about residents to do their job well. They informed us what they did well such as, `The home works well to meet all individual needs.` And `We care for our residents very well`. `We carry out a very high standard of care.` Acknowledgments from relatives received at the home showed relatives were happy with the standard of care given. Staff were described as `very professional`. People at risk of falls, pressure sores, poor nutrition and other risks had also been identified. Residents thought they were well cared for, and their privacy and dignity was taken into consideration. They did not have to conform to any institutional practice such as set times for getting up or going to bed. Activities for residents were organised and offered a good variety. Additional support was commissioned by the home from an agency to support people to get out and about. Visiting arrangements were very good. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was `very good`, and they could have what they wanted. They said they had choices all the time. Staff were observed as courteous and attentive when assisting residents requiring support to eat. People were confident to use the complaints procedure. Residents and relatives, who completed surveys said they knew who to speak to with any problems they may have or if they were unhappy with the service. Staff working at the home had been trained in Safeguarding Adults and knew their duty and responsibility in this area. The home was maintained, very clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents said they were comfortable in their rooms. Assisted bathing aids were provided. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. The level of staff trained to a National Vocational Qualification in care level 2 and 3 was impressive and the variety of additional training was very good. Staff working in the home was considered to be `very good`, and `helpful`. Staff interviewed appeared very happy in their work. They said they worked well together, communication was good, and they were appreciated for their work and were valued in the home. Staff interviewed had a good knowledge of understanding the needs of older people. The manager/provider and deputy managers skills combined has supported changes made for improvement in service delivery, the environment, and staffing. Quality Assurance was carried out and residents, relatives and professional people could give their view on the service provided. The home was well managed and run in the best interests of the people living and working there. What has improved since the last inspection? Before any person is admitted an assessment of need is completed to make sure a decision can be made to accept them into the home. This included for example requirements for personal care, physical and mental health wellbeing, health care and social care. There had been some improvements in writing care plans and residents needs were reviewed regularly. Assessments were completed and included areas of risk such as nutrition, pressure care, and falls. Medication management had improved. Records were maintained properly and medication information at hand for staff to refer to. A copy of current Royal Pharmaceutical Societies guidelines was available. Training in Mental Capacity Act and Deprivation Of Liberty had been provided to ensure residents were protected in the home. Records were organised and readily available for inspection. Quality Assurance had been carried out and information recorded in the AQAA included changes made as a response to listening to people. For example, they had `improved menus`, `Key workers introduced to all residents`, and `use an outside care agency to take residents out into the community on a regular basis`. What the care home could do better: To improve the assessment record used when no other information is available such as with self funding residents, information recorded should be sufficient to support a decision made to admit. It should also include peoples views and expectations of what they would personally like from the service. This will help them to have confidence their needs will be met as they need, want, and wish for. When writing `needs assistance`, it should be made clear what this will entail. This will make sure staff provide a consistent approach to resident care and allow residents to experience the right level of support they want and need, therefore maintaining their independence Risk assessments should have more detail and be specific as to the support staff will provide to minimise risk and keep themselves safe. Any program of activity such as physiotherapy should be written into a plan of care. This will make sure activity will be carried out at regular intervals. Residents should have a daily living plan to include preferred routines and special requirements they would like when being supported throughout the day and night. This will help them retain their individuality and prevent them falling into an established homes routine. More attention is required to ensure all residents with eating disorders are effectively supervised during meals. This will help to support and encourage them to eat a normal diet. Notes taken during interviews should demonstrate equal opportunities, with structured questions, and show care has been taken to confirm information provided on the application form is accurate. Better records of full induction should be made. This will help to keep track of learning and competencies achieved. It is also recommended staff supervision include more one to one meetings with their supervisor. This will give staff more opportunities to discuss work issues in private. Individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk should this eventuality occur. Key inspection report Care homes for older people Name: Address: Mill Lodge Care Home Belmont Road Great Harwood Lancashire BB6 7HL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Dickinson     Date: 0 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Mill Lodge Care Home Belmont Road Great Harwood Lancashire BB6 7HL 01254883216 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Karamchand Jhugroo,Mrs Pryamvada Jhugroo Name of registered manager (if applicable) Mrs Pryamvada Jhugroo Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The care home should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 16 service users to include: Up to 16 service users in the category of DE(E) (dementia over 65 years of age) requiring personal care. Up to 6 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 3 service users in the category of MD(E) (mental disorder, excluding learning disability or dementia over 65 years of age) requiring personal care. When any of the service users in the category of MD(E) leave the care home, the registered person must apply for a variation to have maximum numbers of 3 reduced Care Homes for Older People Page 4 of 29 Over 65 16 3 6 0 0 0 accordingly. Date of last inspection Brief description of the care home Mill Lodge is situated within walking distance of the town centre of Great Harwood. There are 14 single bedrooms and one double bedroom situated on two floors. Access to the first floor is via a passenger lift. Communal space consists of a separate lounge and a dining room that leads to a furnished conservatory. Some internal areas are ramped. Toilets and baths are located near to communal rooms and bedrooms. Residents have access to all community health services, and activities and functions are available to everyone living at the home. A statement of purpose and service users guide is available for residents or their families to be informed of the facilities and services the home provides. The documents need updating to inform prospective residents of the change of ownership. Information regarding the level of fees charged can be obtained from the home. Not included within the fees are hairdressing, newspapers or periodicals and outings. 3 0 0 9 2 0 0 9 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection was conducted in respect of Mill Lodge on the 5th March 2010. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the provider/manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager/provider and observing care practice and routines in the home. The premises were inspected as part of the process. Areas that needed to improve identified in the last key inspection were looked at to assess the progress made. The home was assessed against the National Minimum standards for Older People. Care Homes for Older People Page 6 of 29 What the care home does well: Before being admitted people had their needs assessed to establish if the service could provide the right care and support before a placement in the home was offered. Records showed admissions were planned for. Residents who provided written comments for this inspection indicated that they always receive the care and support they needed. Staff were available when needed and they were listened to. Relatives were pleased too with standards in the home. Comments such as, The girls at Mill Lodge are very good with my mum. At last she is OK. They are kind to all the people who live in the home. And Mill Lodge provides excellent care and attention to all my mothers needs. She is kept clean and well fed. And Since my mother has been in Mill Lodge we have seen a big improvement. She is very happy to be there. Residents living in the home benefited from the support of a named worker referred to as a key worker. They also benefited form additional specialist support where needed such as health care. A health care professional who visited the home was satisfied the home was responsive to health care needs of residents. Care staff who provided written comments considered they were given enough information about residents to do their job well. They informed us what they did well such as, The home works well to meet all individual needs. And We care for our residents very well. We carry out a very high standard of care. Acknowledgments from relatives received at the home showed relatives were happy with the standard of care given. Staff were described as very professional. People at risk of falls, pressure sores, poor nutrition and other risks had also been identified. Residents thought they were well cared for, and their privacy and dignity was taken into consideration. They did not have to conform to any institutional practice such as set times for getting up or going to bed. Activities for residents were organised and offered a good variety. Additional support was commissioned by the home from an agency to support people to get out and about. Visiting arrangements were very good. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was very good, and they could have what they wanted. They said they had choices all the time. Staff were observed as courteous and attentive when assisting residents requiring support to eat. People were confident to use the complaints procedure. Residents and relatives, who completed surveys said they knew who to speak to with any problems they may have or if they were unhappy with the service. Staff working at the home had been trained in Safeguarding Adults and knew their duty and responsibility in this area. The home was maintained, very clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents said they were comfortable in their rooms. Assisted bathing aids were provided. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. The level of staff Care Homes for Older People Page 7 of 29 trained to a National Vocational Qualification in care level 2 and 3 was impressive and the variety of additional training was very good. Staff working in the home was considered to be very good, and helpful. Staff interviewed appeared very happy in their work. They said they worked well together, communication was good, and they were appreciated for their work and were valued in the home. Staff interviewed had a good knowledge of understanding the needs of older people. The manager/provider and deputy managers skills combined has supported changes made for improvement in service delivery, the environment, and staffing. Quality Assurance was carried out and residents, relatives and professional people could give their view on the service provided. The home was well managed and run in the best interests of the people living and working there. What has improved since the last inspection? What they could do better: To improve the assessment record used when no other information is available such as with self funding residents, information recorded should be sufficient to support a decision made to admit. It should also include peoples views and expectations of what they would personally like from the service. This will help them to have confidence their needs will be met as they need, want, and wish for. When writing needs assistance, it should be made clear what this will entail. This will make sure staff provide a consistent approach to resident care and allow residents to experience the right level of support they want and need, therefore maintaining their independence Risk assessments should have more detail and be specific as to the support staff will provide to minimise risk and keep themselves safe. Any program of activity such as physiotherapy should be written into a plan of care. Care Homes for Older People Page 8 of 29 This will make sure activity will be carried out at regular intervals. Residents should have a daily living plan to include preferred routines and special requirements they would like when being supported throughout the day and night. This will help them retain their individuality and prevent them falling into an established homes routine. More attention is required to ensure all residents with eating disorders are effectively supervised during meals. This will help to support and encourage them to eat a normal diet. Notes taken during interviews should demonstrate equal opportunities, with structured questions, and show care has been taken to confirm information provided on the application form is accurate. Better records of full induction should be made. This will help to keep track of learning and competencies achieved. It is also recommended staff supervision include more one to one meetings with their supervisor. This will give staff more opportunities to discuss work issues in private. Individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk should this eventuality occur. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. The admission process ensured peoples needs were assessed, which informed staff how to look after them properly. Evidence: There had been several new admissions to the home since the last key inspection. Where people had been referred to the home by a social care professional, their needs had been assessed and information regarding their needs given to the home. The level of assessment provided by social services was very good, providing the home with essential information that helped to make sure residents receive the right care and support they needed and clearly identified skills staff required in meeting these needs. This included for example requirements for personal care, physical and mental health wellbeing, health care and social care. As required in the last key inspection, to support a decision to accept a person into the home, records showed the provider or deputy carry out their own assessment. Care Homes for Older People Page 11 of 29 Evidence: Information recorded for one resident who was self funding, although very brief, gave an indication of what level of support they would require. There was evidence relatives were involved in the process. To further improve the admission process a more person centered approach should be taken. This should provide staff with sufficient information about the residents circumstances and level of support required to give the right care. It will also help people during the admission process to be confident staff will know all they need to know about them, and be aware of what is important to them in receiving a personalised service. The specialist care residents required, and the skills, ability, and knowledge of staff that will be caring for them had been considered. Records showed staff were given good training to help them to develop and know current good practice issues in caring for older people. Care Homes for Older People Page 12 of 29 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. Residents had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Medication was managed safely. Evidence: Residents who provided completed surveys for this inspection, indicated that they always receive the care and support they needed. They considered staff were available when needed and listened to what they said. Relatives who provided written comments considered the home did well and said, The girls at Mill Lodge are very good with my mum. At last she is OK. They are kind to all the people who live in the home. And Mill Lodge provides excellent care and attention to all my mothers needs. She is kept clean and well fed, and since my mother has been in Mill Lodge we have seen a big improvement. She is very happy to be there. Staff worked to a key worker system, having responsibility to make sure residents were provided with support from a named carer. Information seen on care plans linked to residents assessed needs. Needs identified such as personal care, mobility, Care Homes for Older People Page 13 of 29 Evidence: communication, personal safety, medication, medical, and social were listed. Care plans however should make it clear who will have responsibility in meeting those needs, such as a carer, management, the resident or family. This will ensure there is some accountability to make sure those needs are met. Whilst residents needs identified may be similar, how they are to be supported should be clearer as writing, needs assistance does not explain what the assistance is. It was also identify what residents can do for themselves placing them at the centre of the plan and include their preferences and expectations and help to ensure a personal service. Care plans as seen had been reviewed and updated. Care staff who provided written comments considered they were given enough information about residents to do their job well. Comments included, The home works well to meet all individual needs. And we care for our residents very well. We carry out a very high standard of care. Acknowledgments from relatives received at the home showed relatives were happy with the standard of care given. Staff were described as very professional. Residents benefited additional specialist support where needed. This included health care. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included for example visits from the district nursing team. One GP who completed a survey said health care and social care needs were usually properly monitored reviewed and met. Pressure care was promoted and pressure-relieving aids were used on medical advice. Risk assessments had been basically completed for moving and handling. People at risk of falls, pressure sores, poor nutrition and other risks had also been identified. More detail should be recorded to enable staff to know what to look for, and help prevent these happening. Observations were made of wheelchairs being used safely. Where specialist input is provided such as physiotherapy as identified in one residents file, to ensure a planned program is followed regularly, this should also be written into a care plan, have accountability, and include for example planned time for activity. The right of residents to be treated with dignity and respect was included in staff training. Staff were instructed on the basic principles of care with consideration given to maintaining residents dignity. A professional visiting the home considered this is what happened and observations made during inspection showed how personal care was provided in privacy, such as toilet doors shut and residents spoken to discreetly re these needs. Complimentary remarks about the staff were made, such as very good, and helpful. Observations showed care and attention had been given to Care Homes for Older People Page 14 of 29 Evidence: residents appearance, and staff showed how in the course of their duties they were respectful to residents. Communication difficulties had also been considered such as poor hearing and sight. For example, instructions such as staff to be patient as she struggles and gets her words mixed up were recorded. The home operated a monitored dosage system for the administration of medication. Training records showed a good number of staff had been trained in medication procedures. Residents had the opportunity to say how they would like their medication managed and an appropriate risk assessment carried out. A recording system was in place to record the receipt, administration and disposal of medication. Medication records seen were up to date and completed properly. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, recreational activities, and lifestyle, generally met with residents needs and expectations. Catering arrangements were satisfactory in providing for individual taste, and choice. Visiting arrangements were good. Evidence: The residents preferences in respect of social activities had been recorded as part of their assessment. Assessments were clear whether residents would enjoy group activities or preferred not to join in. A record of activities provided by the home offered a good variety, such as pamper sessions, film nights, exercises and bingo nights. During inspection residents were observed reading, enjoying music, and generally socialising with staff on duty. Birthdays and festive dates were celebrated. Surveys from residents returned to the Commission as part of the inspection showed they considered activities were arranged they could join in. Although care plans did not include a daily living plan with preferred routines recorded to support residents personalise their day, from observations and discussion with staff, residents appeared to have freedom of choice over their lives within their capability. For example residents got up when they wanted and went to bed when it suited them. Care Homes for Older People Page 16 of 29 Evidence: Residents were able to receive visitors at any time and were able to entertain their guests in private. There was evidence seen in care records that relatives regularly visited the home. Residents were also supported to continue with their chosen religion. This was recorded in residents assessment. Visiting clergy to the home completed Quality Assurance stating, We come from the Church every month to give Communion, the home is excellent. Being near to the town centre meant residents were able to get out more easily, and the services of an agency was commissioned for this purpose. Residents bedrooms were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. Residents could choose where to eat their meals. Those residents spoken to during inspection said the food was very good, choices were offered and no complaints in this department. Resident supervision was generally good however more attention is required for residents with eating disorder problems to ensure they are given more one to one time during meals. Records showed, food and fluid intake was closely monitored by staff and residents weight maintained satisfactorily. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted Evidence: The complaints procedure was given to residents when they were admitted to the home. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. There had been no complaints received at the Commission and no complaints recorded at the home. Residents who provided written comments for this inspection and those spoken to said they knew who to speak to if they had any concerns, and who to speak to if they were not happy. They said they generally had no concerns regarding their care by staff. Staff working at the home said they were trained in adult protection and were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would report bad practice if ever the need arose. In addition to this staff training was provided regularly to ensure new staff understood procedures. Contractual arrangements for staff require compliance with the homes policies and procedures for example the ruling on nonacceptance of gifts, or being involved in wills or bequests. To keep up to date with new legislation staff had attended training in topics such as Deprivation Of Liberty Care Homes for Older People Page 18 of 29 Evidence: Safeguard, (DOLS) and Mental Capacity Act (MCA). Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained, safe, clean, and odour free, and provided a homely and pleasant environment for residents, visitors, and staff. Evidence: Mill Lodge is situated very close to the town centre of Great Harwood. Its locality means that local amenities such as shops are close at hand. Accommodation is provided in 14 single bedrooms and one double bedroom. There are parking facilities at the front. Entrance to the home is secure. Accommodation on the upper floor can be accessed via a passenger lift for people with difficulty managing the stairs. Outdoor areas are limited but garden furniture is provided for residents to sit out, weather permitting. The home was furnished, fitted and maintained to a relatively good standard. Residents spoken to said they were pleased with their accommodation. There was easy access into the building for people in wheelchairs, and some areas inside the home were ramped to support people who may find negotiating a step difficult. Other aids and adaptations were provided such as grab rails and a hoist for safe moving and handling of residents. Bedrooms were pleasant and there was evidence residents had personalised them with Care Homes for Older People Page 20 of 29 Evidence: items brought from home. Residents spoken to were pleased with their rooms which could be locked safely. Information received at the Commission from the provider showed essential maintenance was carried out. The home was found to exceptionally clean and fresh smelling during inspection. There were policies and procedures and staff training provided for infection control. Care Homes for Older People Page 21 of 29 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. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. Evidence: Rotas completed showed the compliment of staff was sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, with senior staff on duty at all times. Written comments from residents for this inspection showed they considered staff were always available when needed. Staff files showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check being applied for, prior to employment. Applicants had attended the home for interview and interview notes were taken. Notes taken during interviews should however demonstrate equal opportunities, with structured questions and show care has been taken to ensure the information provided is accurate, such as exploring and confirming gaps in employment. References had been received and on appointment staff were issued with a contract of terms and conditions of employment that covered their probationary period of working at the home. Staff who provided written comments for the inspection said they had received good Care Homes for Older People Page 22 of 29 Evidence: induction training that covered everything they needed to know to do their job. Better records of full induction should be made as records with one day induction only was evidenced. However other training was provided to help staff understand and meet residents individual needs, keep them up to date with new ways of working and gave them enough knowledge about health care and medication. Training in specialist areas such as dementia care was provided. The home is commended for the level of training provided with the majority of staff trained to National Vocational Qualification in care level 2 and 3. Staff interviewed showed a high degree of job satisfaction within a noticeable good team environment. They felt they were appreciated for their work and were valued in the home. Staff who provided written comments for this inspection said the home did well with Regular training given to all the staff. The home was selective with employees. And Care for all the staff too with all training that they are given. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of the residents and the staff working there. Evidence: The registered provider manages the home in the capacity as manager. She is a qualified nurse with many years experience caring for older people and has completed the Registered Managers Award. She is supported in her role in day to day management of the home by a deputy manager who also is qualified and competent for this position. There was evidence she continues to update her knowledge for the benefit of residents and staff. Quality assurance had been carried out in the home and relatives, residents, and professionals were given the opportunity to have their say. Written comments from relatives included I am satisfied with everything, and We think Mill Lodge is the best place for us to place my mum. My mum was in another home and comparing her care. Mill Lodge is far better. A health care professional commented, Homely atmosphere, pleasant to visit, and hands on owner/manager. Care Homes for Older People Page 24 of 29 Evidence: All the records required for the efficient running of the home were available to look at. They were stored securely, readily available for this inspection, and organised. Records showed staff supervision was given as required and staff had appraisals providing them with an opportunity to express themselves, their concerns, and their plans for the future, or to receive feedback on their performance. Staff one to one meetings with their supervisor was limited as supervsion appeared to be observational. Staff meetings were usually held at regular intervals during which staff received information on polices and procedures and had an opportunity to voice their opinion and share information. Staff who provided written comments for this inspection considered the home did well as the staff and management work well together. Money held at the home for safekeeping was managed safely and systems used protected residents from possible financial abuse. Information received at the Commission showed essential services were serviced and maintained as required for safety. Staff were trained in health and safety. Individual risk assessments to support residents and staff health, safety, and welfare had been completed and taken into account when planning care. However an individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. Care Homes for Older People Page 25 of 29 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 26 of 29 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 3 To improve the assessment record used when no other information is available such as self funding residents, information recorded should be sufficient to support a decision made to admit. It should also include peoples views and expectations of what they would personally like from the service. This will help them to have confidence their needs will be met as they need, want, and wish for. Risk assessments should have more detail and be specific as to the support staff will provide to minimise risk and keep themselves safe. When writing care plans it should be clear who will take responsibility to ensure needs are met such as carer, management, resident, family or health professional. This will provide clear accountability of peoples tasks in meeting needs. When writing needs assistance, it should be made clear what this will entail. This will make sure staff provide a consistant approach to resident care and allow residents to expereince the right level of support they want and need. Any program of activity such as physiotherapy should be Page 27 of 29 2 7 3 7 4 7 5 8 Care Homes for Older People 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 written into a plan of care. This will make sure activity will be carried out at regular intervals. 6 12 Residents should have a daily living plan to include preferred routines and special requirements they would like when being supported. This will help to ensure they retain their individuality and prevent them falling into an established homes routine. More attention is required to ensure residents with eating disorders are effectively supervised during meals. This will help to support and encourage them to eat a normal diet. Notes taken during interviews should demonstrate equal opportunities, with structured questions, and show care has been taken to ensure the information provided is accurate, such as exploring and confirming gaps in employment. Better records of full induction should be made. this will help to keep track of learning and competencies achieved. It is recommended staff supervision include more one to one meetings with their supervisor. This will give staff more opportunities to discuss work issues in private. Individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. 7 15 8 29 9 10 30 36 11 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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