Care Home: Millard House

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What the care home does well The manager provides people wishing to use the service with good information about the service it provides and people have a thorough pre admission assessment prior to moving in, to ensure that the home can meet their needs. People told us that they are made to feel welcome when they visit their relatives, they also told us that the food was good at Millard House and that they had been given a meal when visiting. People told us that they were happy with the activities arranged at Millard House and that they were able to choose whether they wanted to join in. There are good systems in place for managing health and safety and the maintenance of the home. Millard House provides people with spacious, comfortable and clean accommodation. What has improved since the last inspection? Raised flower beds have been built since the last inspection. This allows wheelchair users to plant seeds and flowers. A secure fence has been put up around a large grassed area where there are trees, pathways and plenty of benches to sit on. The maintenance records have improved. The home has decorated the communal areas and some of the bedrooms and has purchased new curtains. There are now PRN protocols for as and when prescribed medication to show staff when, why and how it is to be given. Recruitment practices have improved and the home now keeps all of the required records. What the care home could do better: The Statement of Purpose and Residents Guide must be reviewed and updated when changes are made to the service. The care plans should be streamlined to ensure that they provide staff with up to date information on the level of support that people need and there must be management plans in place for all areas of identified risk. The PRN protocols for as and when required prescribed medication should be accessible to staff when they are administering medication to ensure that it is administered correctly. The complaints records must include details of the outcome and show whether or not the complainant was satisfied with the outcome. There should be a cleaning schedule in place for the laundry room to ensure that it is kept clean. All doors that have a keep locked sign on them must be kept locked when staff are not in attendance.Staff should receive at least six supervision sessions a year to ensure that they are fully supported to do their work. Key inspection report Care homes for older people Name: Address: Millard House 364 Church Street Bocking Braintree Essex CM7 5LL     The quality rating for this care home is:   one star adequate 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: Pauline Marshall     Date: 1 3 0 5 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 30 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 30 Information about the care home Name of care home: Address: Millard House 364 Church Street Bocking Braintree Essex CM7 5LL 01376325002 01376324472 surjit@rushcliffecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rushcliffe Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 43 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Millard House is a purpose built two-storey building situated in the residential area of Bocking near Braintree Essex and it is owned by Rushcliffe Care Ltd. Accommodation consists of thirty-nine single bedrooms and two shared rooms . Access to the home is good and a passenger lift provides access to the first floor. Care Homes for Older People Page 4 of 30 Over 65 0 43 43 0 Brief description of the care home There are two dining rooms and several lounges and quiet areas. Car parking for visitors is available at the front of the property; this area is shared with the older peoples day centre that adjoins the main home. Millard House has a fully enclosed courtyard garden with raised flowerbeds in the centre of the building; it is suitable for use by wheelchair users. There is also a large secure garden area with seating to the side of the building which is accessible to people using the service. The manager provides people interested in using the service with a copy of the homes Statement of Purpose and Residents Guide. The manager told us that weekly fees range between £485.00 and £510.00 and that there are additional charges for chiropody, hairdressing, toiletries and newspapers. Care Homes for Older People Page 5 of 30 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: one star adequate 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: This was an unannounced key inspection that lasted for eight and a half hours; we were assisted by an expert by experience and we have included extracts from their report in this report. All of the key standards were inspected; we checked a random sample of policies and procedures and we looked at some of the records that the service is required to keep. We looked around the building and we spoke to some of the people living in the home, to some of their relatives and to some staff members and to the newly appointed manager. We checked the progress of the requirements that were made as a result of the last inspection that took place on 9/05/2009 and we found that these had been met. The annual quality assurance assessment (AQAA) was completed by a senior manager and it was returned to us within the required timescale; it was detailed and informative and provided us with good information about the service. The AQAA is a self assessment document that the manager or provider is required by law to complete; we Care Homes for Older People Page 6 of 30 have used the information provided in the AQAA throughout this report. We sent surveys to the manager to distribute to ten people that use the service, eight health and social care professionals and to twelve of the homes staff to obtain their views on the service the home provides. At the time of writing this report we have received two completed surveys from the people living in the home, one from an health and social care professional and seven from the homes staff. The surveys that we received were mainly positive about the service and we have included some of the comments in the main body of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Residents Guide must be reviewed and updated when changes are made to the service. The care plans should be streamlined to ensure that they provide staff with up to date information on the level of support that people need and there must be management plans in place for all areas of identified risk. The PRN protocols for as and when required prescribed medication should be accessible to staff when they are administering medication to ensure that it is administered correctly. The complaints records must include details of the outcome and show whether or not the complainant was satisfied with the outcome. There should be a cleaning schedule in place for the laundry room to ensure that it is kept clean. All doors that have a keep locked sign on them must be kept locked when staff are not in attendance. Care Homes for Older People Page 8 of 30 Staff should receive at least six supervision sessions a year to ensure that they are fully supported to do their work. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive sufficient information about the service and they know that their needs will be fully assessed. Evidence: The manager provided us with copies of the homes Statement of Purpose and Residents Guide; both documents were last reviewed in February 2009 and contained out of date information about the homes manager and the Care Quality Commission. The Statement of Purpose and the Residents Guide included copies of Millard Houses 2007 Residents Satisfaction Survey, the complaints and fire procedures together with the size of each of the homes rooms. The Residents Guide included information that is important to people moving into Millard House, such as, how to identify staff and who is in charge of the home, the arrangements for the safekeeping of peoples belongings and the facilities for people of minority communities. People spoken with told us that they had been provided with copies of both documents. Care Homes for Older People Page 11 of 30 Evidence: We looked at four care files and we found a pre admission assessment on each of them. Each of the pre admission assessments that we looked at contained detailed information, such as the individuals need for support with eating and drinking, communication, skin integrity, safety, leisure, recreation and sleeping. In addition to the homes own pre-admission assessment there was a social services assessment on all of the four files that we looked at. After admission the home completes a document entitled Getting To Know You which provides detailed information on the individuals likes, dislikes, memories, family and past employment. These were fully completed on three of the four care files that we looked at. Millard House does not provide intermediate care. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not always receive the correct level of support due to the lack of details in some of the care plans. People may be put at risk due to the absence of management plans for some of the identified risks. Evidence: We looked at four care files and each of them included the persons pre-admission assessment, their getting to know you form, their social services COM5 assessment, a range of screening tools such as nutritional needs and falls. The information in these documents varied; three getting to know you forms were fully completed and provided good information about the person. The manager told us that there is sometimes a delay in completing this form due to relatives not returning or completing the document when the person using the service is not able to supply the information themselves. The fourth form that we looked at did not provide any information about the persons likes and dislikes, their food preferences or their hobbies and interests. The manager told us that all of the care files were in the process of being reviewed to Care Homes for Older People Page 13 of 30 Evidence: ensure that the information in them is made clearer. We found that the four care files that we looked at were at various stages of the reviewing process and that they all contained a huge amount of information in various formats. Each of the care plans that we looked at contained information on the level of staff intervention, however, sometimes we found this difficult to locate within the file. The content of each of the care files that we looked at varied and one of them contained very detailed information on what to do and what not to do to support the person, such as, fill the sink with water and hand me the flannel, do not attempt to wash me as I will get agitated. Another care file just said, to assist with washing. There were risk assessments in place on all of the care files that we looked at and again the content varied; some had very clear plans on how the identified risk was to be managed. One of the risk assessments that we looked at identified the risk of being trapped in the lift; there was no plans on how this was to be managed. Millard House has changed the way that it records peoples daily notes and is currently using a document entitled individual needs chart. We looked at several different completed individual needs charts and we found that they did not provide sufficient information on how the person had spent their day. Entries included ate well, appears fine and watched TV this afternoon. None of the entries showed that people made choices about their daily living nor did they describe the persons mood. People spoken with told us that they felt well treated and that the staff listens to them. Staff said in their surveys we ensure that peoples needs are met and we take care of their well-being and we give a good level of care and treat people with respect. The expert by experience said in her report Staff were very observant and treat people respectfully. I noticed the two staff members distributing medicines to the few who had them at that time and they talked to them very discretely. The staff were prepared to wait for the person to get up on their own when taking them to the table. We received a completed survey from one of the health care professionals that regularly visits the home and she told us in her survey staff are polite and friendly, they are prompt in reporting issues to us and respond well and appropriately to advice and treatment instruction. People spoken with told us that they received the healthcare that they needed such as the optician, dental services, GP and hospital visits, and the inter-agency notes on each of the care files confirmed this. The medication policy was last reviewed in September 2009 and the manager told us that she has obtained a copy of the Royal Pharmaceutical Society of Great Britains The Handling of Medicines in Social Care and there was a copy of the CQC professional advice on the safe management of controlled drugs in care homes on the Care Homes for Older People Page 14 of 30 Evidence: managers desk. The manager told us that as a result of an incident where untrained staff had administered medication, an action plan had been put in place to ensure that all staff were trained and their competence to administer medication assessed. The manager showed us the results of a recent medication audit that had been carried out by a senior manager and this highlighted any discrepancies and the actions that were to be taken to rectify the matter. A random check of the medication system showed that it was difficult to audit because some of the codes looked very similar to the initials. There was no PRN (as and when prescribed) medication protocols in with the medication administration sheets (MARS), however, upon looking in the care files, there was medication profiles that showed how, when and why as and when prescribed medication was to be taken. These should be stored with the medication administration record sheets (MARS) so that staff know when, why and how to administer. We carried out an observation of a senior staff member administering medication and she did this effectively, ensuring that people were offered water with their medication and she ensured that the medication had been taken before signing the records. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live a lifestyle that meets their identified needs and preferences. Evidence: The home employs an activities co-ordinator for three days a week and she told us that some people participate regularly in quizzes, word games, reminiscence, famous faces and bingo. The activities co-ordinator keeps a record of who has and has not taken part in the arranged activities and it is ticked on the persons individual needs chart. There was a list of planned activities displayed in the foyer and outside the lounge area. One member of staff said in their survey the home has a very good activity programme and mostly all join in when they can. People spoken with told us that they spent their time in various ways, such as reading the paper, watching TV, knitting, gardening and visits to the garden centre. The expert by experience spent time throughout the day talking with people using the service and their relatives and the following is an extract from her report. I spoke with nine of the residents and four visitors. They all said they were well looked after. A few said that they did not want to be there but accepted there was no Care Homes for Older People Page 16 of 30 Evidence: alternative. One had come direct from hospital and the others had come with some preparation and had had some choice although none seemed to have come on a visit before arriving to stay. (All had a measure or more of forgetfulness so this may not be true). There was great praise for the food from all of them. One lady was knitting squares which she then stitched together in knee rugs. She also worked in the raised beds in the garden and had seeds ready to plant when the frosty nights finished. Another man said he helped with the garden. There were two enclosed gardens, one courtyard with the raised beds and patio furniture. The other had grass and trees with paved paths and seats. Two residents had been taken by wheelchair to the garden centre where they had tea in the cafe which they liked. Most said they did not go out and did not seem to want to. Two ladies were doing a jigsaw with a little help from me got one corner done. The table was too small which limited further progress and lunch was ready. I had lunch with four residents. Tables were laid nicely with cloths (which were taken away for laundering after and replaced with clean ones). Each person had a paper napkin. One man wore a clothes protector but he was sitting in his wheel chair leaning back so that he was far from his plate. There was a choice of lamb casserole or savoury mince pie or salad. Everyone seemed to have lamb. Residents choose from the menu earlier in the morning for lunch and for supper which was three courses with soup and cauliflower cheese and a pudding. They would have chosen that morning but the people at my table did not remember or maybe did not say. At least one person had a second helping. There was a choice of pudding, lemon meringue pie or angel delight or ice cream. One person at my table decided she did not like the angel delight and asked for ice cream which was brought with no fuss. Later she asked for some fruit and that also was brought with no fuss. I asked about special diets. There are no vegetarians or coeliacs at present but there are a number of diabetics and special choices are available for them. There is no resident from an ethnic minority. I was told by a resident there was a notice of some activity happening although I didnt see the notice. There had been a quiz on the previous day. The manager said that staff carried out exercise with residents as these were recommended by a physiotherapist. I do not know if this was for one resident or for a group. This resident had come from hospital after a broken hip and had no physiotherapy in hospital. Everyone seemed relatively content although most said they would rather not be in a home. People were making choices about where to sit and who to sit with as there were the 4 lounges downstairs. There did not seem to be a lot of organised activity or stimulation. This may change with the new manager. They mostly seemed to be happy with what they were doing. There had been a residents meeting a few days Care Homes for Older People Page 17 of 30 Evidence: earlier which had made a decision to have a home shop with a trolley which residents would organise and where residents could purchase toiletries etc. There was a table of knick-knacks which residents had contributed for sale. The profits would go to the comforts fund. A priest came in regularly from the Roman Catholic church and held a mass for Catholic residents. The manager said the others seemed not to be practicing Christians. The residents were all white and those that I spoke to had lived fairly locally before coming to the home. One was Dutch and one German but had been married to Englishmen and their English was fluent. I liked the atmosphere in the home. Although almost all the residents had very limited mobility and most were a bit forgetful or confused there seemed to be an independence of spirit about. The several lounges enabled a choice to be made and they had taken it. Millard House offers people a choice of meals from the four week rolling menu. People chose their meal earlier in the day and the cook then prepares sufficient amounts of each choice to allow for any changes that may be requested. People told us that the food was really good and the records showed that people were able to choose from a range of home cooked meals such as chicken casserole, cottage pie, braised steak with onions, gammon steaks, fish and chips, steak pie, liver and onions and homemade beefburgers. The cook told us that homemade soup is prepared daily and the menu showed that a range of home made soups were offered at tea time. People told us that they were offered chicken soup, tomato soup, leek soup, vegetable soup and others such as carrot and coriander soup. The last food hygiene visit took place on 24/6/09 and Millard House was awarded 3 stars. The manager told us that all of the requirements made at the food hygiene inspection had been met. Care Homes for Older People Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns will be listened to and acted upon, but they cannot always be confident that they will be effectively managed. Evidence: The homes complaints procedure was last reviewed in September 2009. The complaints records showed that there had been five complaints made in 2010; two were about the general care at Millard House and were being dealt with by the senior manager. Some of the paperwork to show that the complaints had been dealt with was not in the complaints file and the manager told us that the senior manager held these until the complaint was finalised. The home should keep a record of all complaints and their outcomes in its complaints folder to evidence that complaints have been dealt with appropriately. One of the complaints records that we looked at described the complaint, showed that an acknowledgment letter had been sent within the agreed timescale, listed the actions and showed the conclusion. There was no investigation report attached and the record did not show that the complainant had been informed of the outcome of their complaint. The complaints records must show full details of the complaint including the outcome and whether or not the complainant was satisfied. Staff spoken with were aware of safeguarding procedures and we saw certificates of training on the staff files. The training matrix showed that eighteen staff have undertaken training in safeguarding adults since the last inspection. There has been Care Homes for Older People Page 19 of 30 Evidence: two safeguarding issues raised since the AQAA was completed by the senior manager in January 2010. Both safeguarding issues were raised by professionals outside of the home and are still under investigation by the Adult Safeguarding Unit. Millard House is currently being monitored by Essex County Councils Quality and Development department and there is an action plan agreement in place, which is being monitored at regular intervals. There are currently twenty nine people living at Millard House and Essex County Council will not be making any referrals until the action plan has been fully completed to a satisfactory conclusion. Care Homes for Older People Page 20 of 30 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. People live in a homely, comfortable and safe environment. Evidence: There are three small lounges and a large lounge/dining room on the ground floor. On arrival we looked around the home and we found that some areas of the home had been decorated and some areas had not been decorated but were in need of decoration. There was some minor damage in some of the bedrooms and the manager told us that they was due to be repaired and redecorated soon. Each of the bedrooms contained wash basins and were of a reasonable size; none of the bedrooms had ensuite facilities. There are ample toilets within easy reach of each of the bedrooms. All of the bedrooms contained personal photographs and some personal furniture. There were pictures on each of the bedroom doors; some were photographs of the person using the room but others were pictures that meant something to the occupant. The expert by experience told us that one person had brought all of their own furniture including their bed and that people were able to choose the decoration of their room and arrange the furniture as they chose. The expert by experience said in her report There was an attractive sitting area at the entrance with two budgies in a cage and another sitting area at the top of the stairs and another lounge on the upper floor. The rooms and the furniture were all attractive and well-cared-for. The large lounge had large windows overlooking the Care Homes for Older People Page 21 of 30 Evidence: entrance and car park for a garden centre which made an interesting and active view. Millard House has a large secure garden with seating and people told us that they go for a walk in the garden to get some fresh air. The grassed area outside the dining room window was quite long and needed cutting. The handyman told us that the large sit on lawn mower that he had been using had recently broken and that he was now using a very small mower and it was taking longer to get round to all of the grassed areas; he confirmed that this was on his list of jobs to do. We noticed that several of the doors with keep locked signs on them were left unlocked and unattended; the manager said that she would address this issue with the staff team. We also noticed that the laundry area needed a thorough clean as although clothing was nicely folded and stored, there was thick dust on one of the cabinets and the machines and sinks were not clean and hygienic. All other areas of the home were clean, tidy and fresh. The senior manager said in her AQAA in the past twelve months we have added raised planting areas to the courtyard in order to allow residents to be involved in gardening. We saw that the raised planting areas were in use and one person told us how they had helped with some of the planting in the raised beds. The maintenance records showed that jobs are first reported to the handyman and that if he is unable to carry out the repair it is reported to head office to arrange for a contractor to visit and do the work. The maintenance records showed that repair works had been carried out in a timely manner. Millard House has policies and procedures in place for the control of infection and the senior manager told us in her AQAA that twelve staff had received infection control training and the training matrix confirmed this. Staff spoken with had a good awareness of infection control procedures. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent well trained staff team. Evidence: The senior manager said in her AQAA the home is staffed to an appropriate level, with regard to the number, dependencies and needs of the residents. Millard House is currently providing a service to twenty nine people. The staff duty rosters showed that there was four care staff plus a care team leader working in the morning and three care staff plus a care team leader working in the afternoon and that there was three care assistants working each night. The care staff are supported throughout the day by two staff in the kitchen, two domestic staff and one laundry staff. The manager and the administrator work five days a week and an activities co-ordinator works three days a week in addition to this. Staff said in their surveys if we are short staffed everyone will pull together. The duty rosters showed that there was sufficient staff on duty to meet the needs of the people that are currently using the service. The AQAA showed that twelve care staff were either working towards or had obtained an NVQ level 2 in care or above. The training records showed that this has now increased to twenty one staff. Staff members said in their completed surveys and when spoken with that they were supported to do their NVQ. We looked at four staff files and they contained all of the required documentation that Care Homes for Older People Page 23 of 30 Evidence: included, application forms, references, Criminal Records Bureau (CRB) checks and Independent Safeguarding Authority 1st (ISA) where necessary. There was evidence of induction either having taken place or in progress on the three newest staff files that we looked at. Staff told us that the induction process was good and included all that they needed to know. All of the staff files that we looked at contained copies of certificates of training, which included moving and handling, food hygiene, fire safety, safeguarding adults, infection control, first aid, palliative care, dementia and medication. The training co-ordinator told us that staff are scheduled to attend training in moving and handling, first aid, infection control, safeguarding adults, food hygiene and the Mental Capacity Act within the next three months. One staff member said in her survey I love working at Millard House, the residents seem happy and content most of the time, I did a course on dementia which gave me a better insight into the problems that people face on a daily basis. One health professional told us in their survey the staff do well with available resources, and are a hard working, polite and friendly team. Care Homes for Older People Page 24 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of staff supervision and the period of unsettled management could potentially affect the outcomes for people living in the home. Evidence: Millard House has had several changes of manager and a period of time without a manager. The current manager started work at the home on 29/03/2010; she is very experienced and holds the registered managers award and an NVQ level 4 in care; she is an NVQ assessor and an NVQ internal verifier. The manager told us that she regularly updates her practice and has recently had training in safeguarding adults, medication, first aid, food hygiene, dementia, health and safety and the common induction standards. The expert by experience said in her report the new manager has noted many things for improvement and has instituted some changes, e.g. to medication recording, which a member of staff was working on when I spoke to her. Senior managers are currently visiting the home on a weekly basis to support the new manager in her role and to carry out regular audits. We looked at a recent audit and Care Homes for Older People Page 25 of 30 Evidence: this showed that the areas of concern had been addressed. The manager was not able to locate the business plan or the last quality assurance report. The senior manager said in her AQAA a yearly satisfaction survey is conducted (across company) to ascertain the views of residents and relatives and senior managers ask the residents for their views on the service they receive and will attempt to resolve any issues raised. The manager told us that she is planning to hold relatives meetings on a monthly basis to allow family and friends to discuss any issues. We looked at the notes of the last four staff and residents meetings and they showed that people were fully involved. Members of staff and people living in the home said when spoken with that they participated in regular meetings. We were unable to check peoples cash as a member of staff had taken the safe key home with them, however, we were able to check some of the transaction records and they showed that the cash and the cash transaction records had been recently checked by the senior manager. We checked some random receipts against the cash transaction records and they all agreed. We looked at four staff files and they showed that staff had received some supervision but that it was not as often as required in the National Minimum Standards. The manager said that she was devising a supervision plan to ensure that all staff receive regular supervision sessions. Staff members said when spoken with that they felt that they received sufficient support and one staff member said in their survey we get good support when we have a manager and we are a good caring team and support each other. Another staff member said in their survey we usually get enough support but staff morale has been low. The head office senior management are always available at the end of the phone and visit weekly. Although we have not had a manager in place, we are a dedicated staff team that worked together to keep the home running as smoothly as possible. All staff should receive at least six supervisions each year as laid down in the National Minimum Standards to ensure that staff are fully supported to carry out their work. We looked at a random sample of safety certificates and they were all found to be in place and up to date. The fire risk assessment was last reviewed in March 2010 and regular fire drills take place. Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The manager must ensure that all care plans provide staff with sufficient information on the level of support that people need. To ensure that staff know what they must and must not do to when assisting people. 30/06/2010 2 8 13 The manager must make 30/06/2010 sure that all identified risks have a clear plan on how the risks are to be managed. To protect people from the risk of harm. 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 1 It is recommended that the home amends its Statement of Purpose and Service User Guide as changes occur to ensure that people using the service are given up to date information. Page 28 of 30 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 2 7 It is recommended that the care plans are made easier to read to ensure that staff know what to do and what not to do to support people correctly. It is recommended that the PRN (as and when prescribed) protocols are stored with the medication records to ensure that staff are fully aware of when, why and how to administer it. It is recommended that the complaints records show the full details of the complaint including the outcome and whether or not the complainant was satisfied. It is recommended that the home continues its observations of practice to ensure that people using the service are fully protected from the risk of harm. It is recommended that a cleaning schedule is devised for the laundry room to ensure that it is kept clean and hygienic. It is recommended that all doors with a keep locked sign on them are kept locked when not in use to ensure that people using the service are kept safe. It is recommended that people using the service have access to their money at all times to ensure that they can purchase items when required. It is recommended that all staff receive at least six supervisions each year as laid down in the National Minimum Standards to ensure that they are fully supported to carry out their work. 3 9 4 16 5 18 6 26 7 26 8 35 9 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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