Care Home: Millbridge

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What the care home does well The service provides nursing and care from a very well presented property, set in lovely gardens, which are accessible to people living there. They ensure that people are treated as individuals, with detailed individual plans of support, and regular residents meetings offer people living in the home the chance to make any views they have known, and this is also possible through regular satisfaction surveys. We received questionnaires from nine people who live in the home, all said they received information about the home to enable them to choose to live there, and all were happy with the support received, making comments such as `everything is well planned` `staff are always there if we need help` I`m looked after very well` Professionals visiting the home, and staff working in the home also submitted questionnaires, and again all were positive in the comments they made. Health care support from local professionals is very good, and they assist the home in some staff training, adding to a variety of training opportunities already available to staff. Staff morale in the home is good, and the staff team on the day of our visit were seen to treat people they support with dignity and respect What has improved since the last inspection? Since the last inspection, continued refurbishment of the home has taken place, including the complete refurbishment of the upper floor of the main home, which is now ready to admit new residents. Care plans have been revised, and the AQAA indicated that a new menu and orientation board showing details of events , staff and the menu introduced. This was seen during our visit. Better facilities have been made available to staff, and a regular audit of personnel records is now undertaken by a member of the head office staff. What the care home could do better: Although care plans are in place and in a format that was complimented by health professionals working alongside residents of the home, they did not include sufficient detail on the involvement of the individual resident, or show that they were being reviewed as regularly as required. In spite of a recent audit which had identified gaps in records, the staff files we examined still failed to include all the required detail. Other improvements that are planned and were detailed in the AQAA include redecoration of the exterior of the property and improvements in parking, possible new hairdressing facilities and the continued updating of facilities. Key inspection report Care homes for older people Name: Address: Millbridge 4 Lynn Road Heacham Norfolk PE31 7HY     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: Alan Buttery     Date: 1 8 0 9 2 0 0 9 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 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Millbridge 4 Lynn Road Heacham Norfolk PE31 7HY 01485570349 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): millbridge@ehguk.com IntegratedNursingHomesLimited Integrated Nursing Homes Ltd Name of registered manager (if applicable) Mrs Sarah Ruth Tilley Type of registration: Number of places registered: care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Millbridge is a 52-bedded Care home with nursing, and provides care for elderly people and elderly people over 65 who have Dementia. It is a large detached home which has had a number of extensions added, one of which was recently completed to a high standard. It is set in its own grounds on the edge of the village of Heacham, three miles from Hunstanton. The home receives its medical services from the local Medical Centre. The home was purchased by Integrated Nursing Homes in 2004. Care Homes for Older People Page 4 of 25 Over 65 52 52 0 0 0 1 Brief description of the care home The home charges between 370GBP and 650GBP depending on assessment and need. Care Homes for Older People Page 5 of 25 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: This was an unannounced inspection, and as part of the inspection process we visited the home, met with the manager and some of the staff and spoke to people living in the home. We also received an Annual Quality assurance assessment from the service, which gave us details on changes they had made and plans for the future. We sent a number of questionnaires to people living and working in the home and to professionals who visit people living there This report includes information we gathered during our visit, and from paperwork we examined, as well as information and comments from the AQAA and questionnaires received. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 25 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 8 of 25 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 9 of 25 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. Before any new resident moves into the home, detailed information is gathered to ensure that the persons needs are known, and the service is able to meet them, in a way suited to the person. Evidence: The home is one a of number under the same ownership, and follows a set admissions procedure, in use in the providers other services. During this inspection, we discussed the procedure with the manager of the home, spoke with some of the residents and looked at individual resident records for those people we spoke with. Following an initial enquiry, either direct from the prospective resident or family, or from a health or social care professional, information about the home would be provided, and any visit welcomed. Care Homes for Older People Page 10 of 25 Evidence: The AQAA indicated that the service has a full colour brochure telling people about the home, and this is available in large print. It also told us that they hope to introduce an audio version of the brochure in the next year. Following this, an initial assessment visit would be carried out by the manager, either at the prospective residents home or in hospital. The information gathered would be added to details gained from health professionals and social workers to ensure that the service was able to meet all the identified needs. The proposed service would be discussed with the commissioners of the care where this was the case, or with the prospective resident and family, to ensure that all involved were aware of the costs and conditions of admission, and arrangements then made for the support package to begin. All staff are made aware of any new admissions, and the required paperwork completed, including a detailed written contract for people who self fund their care. Initial care plans are prepared by one of the qualified nursing staff, and necessary risk assessments arranged, and the new resident registered with the local doctors surgery. During our visit, we examined in detail four individual residents files, and these contained details of the assessments, and showed that the process in place was being followed. The service does not offer intermediate care. Care Homes for Older People Page 11 of 25 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. Individual plans are in place, showing how identified needs can be met, but should show how the person has contributed, and evidence of more frequent review. Evidence: As indicated earlier, initial care plans are prepared in readiness for any new resident to move into the home, and these are monitored reviewed during the first few days of a residents stay in the home. We examined the files of four residents living in the home, and spoke with three of these people. They were aware of their care plans, indicating that they had been involved in their preparation, The care plans covered most aspects of the individuals day to day lives and identified needs, including plans around communication, nutrition, continence, personal hygiene night time routines and mobility. The plans did not show sufficient evidence that the person had been involved in the Care Homes for Older People Page 12 of 25 Evidence: planning, although people we spoke to did confirm they were involved, as mentioned earlier, and need to show clearly that the plans are reviewed on a regular basis. For example, one care plan we examined only showed 3 reviews in the current year. The information contained within the plans was very comprehensive, and the AQAA advised us that their layout and content had been praised by local health professionals, although a comment card received from one did feel that the plans could contain more specific information on the outcomes expected from the plans. Although the main plans do not include a record of social activities, these are recorded in a separate file kept by the activity co-ordinator, and this was examined during our visit, and will be discussed in more detail later in this report. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are available to people living in the home, and suited to their individual likes and dislikes, and a choice of well prepared food provided throughout the day. Evidence: The service provides a wide range of activities for residents of the home, some arranged in groups, others individual. They also ensure that activities are also available suited to people who may spend their time in bed for example stories, poetry and hand massage. The home now has two specific activity co-ordinators, and this has enabled them to provide activities throughout the week, including weekends. On the day of the inspection, some of the residents were having their nails done. Other activities that are available include music, flower arranging, carpet bowls and other games, sing songs, art and crafts, knitting and bingo. The local vicar visits on a regular basis, and offers a monthly communion service, and a local catholic priest is happy to visit anyone in the home who wishes to see him. One Care Homes for Older People Page 14 of 25 Evidence: of the ladies we spoke to told how happy she was to be able to speak with the vicar when she needed to. A presentation board is in the hall of the home, which shows the days activities as well as information about staffing and the days menu. The kitchen in the home is staffed throughout the day, ensuring that people can have snacks when they wish, as well as their main meals. A rolling 5 week menu is followed, with alternatives always available, and residents that we spoke to during our visit felt the food was very good, one said she was able to have a snack at any time, and two of the professionals questionnaires that were returned indicated that the food was well presented and individual likes and dislikes taken into account. The dining room has been redecorated since our last visit, and visitors are encouraged to eat with their family member when visiting. Other residents who choose to have their meals in their own rooms are able to do so and those that need assistance are looked after well. During our visit, we saw the support that was being given to some of the residents at lunchtime. The AQAA gave details of some of the local events that the home participate in, for example, the local Scarecrow Festival. This is held in the grounds of the home and is enjoyed by residents and family members as well as the local community. Regular residents meetings are held, giving people living in the home the opportunity to contribute to decisions made about their home, and to identify improvements they would like, and following a recent meeting a new wide screen television has been purchased, which was suggested by some of the residents, and is now in the main large. Everyone we spoke with commented on the television, and how much they liked it. Care Homes for Older People Page 15 of 25 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. Procedures are in place to ensure that residents in the home know how to make concerns known, and that they will be dealt with quickly. Evidence: In line with other homes in the group, Mill bridge follows a corporate complaints procedure. The AQAA confirmed that the policy reviewed in March this year. The procedure is on display in the entrance hall, and included within the service user guide, and this is available in large print where required. The AQAA indicated that the service had received 4 complaints in the last year, and that all had been dealt with within the timescales contained in their procedure. The commission had not received any concerns in this period. Procedures are in place to ensure that any safeguarding issues are dealt with in line with local authority procedures. Staff receive training within their initial induction, and annual updates. Evidence of this was seen within the staff files examined as part of our visit. The AQAA indicated that no safeguarding issues had arisen in the last year. Care Homes for Older People Page 16 of 25 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 service is based in suitable premises which are safe and clean and provide appropriate facilities for the people who live there. Evidence: The home is set in very attractive grounds, and these are well maintained, with access for people living in the home. As detailed earlier in the report, the grounds are used for some activities which involve the local community. The home is two distinct parts, staffed separately, and since the last inspection, the upper floor of the main property has been renovated. During this period, the rooms have not been in use, but as works have now been completed, th rooms are being made ready for people to move in. A programme of refurbishment is ongoing, and all vacant rooms are decorated prior to new residents moving in. Plans for the coming year include improvements to parking and some external redecoration. As mentioned earlier, a new wide screen television has been installed in the main lounge, a very popular move with all the people we spoke to, and in response to suggestions the residents had made. Care Homes for Older People Page 17 of 25 Evidence: During our visit, we looked around the home at the facilities available to people living there, and spoke with some of those people, all saying how satisfied they were with the facilities. The home was clean and free from unpleasant odours. Care Homes for Older People Page 18 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although procedures are in place to ensure suitable recruitment checks are undertaken trees are not always followed, which may place people living in the home at risk Evidence: During our inspection visit, we looked at the recruitment procedures used, which again follow those in use throughout the group. The AQAA informed us that all new staff are taken on a three month probationary period, undertake a structured interview, following which a criminal records bureau check and two written references are obtained. At the present time, the service has 2 qualified staff during the day time and 5 or 6 care staff together with domestic and catering staff and activity workers, and during our visit, staff that were working appeared unhurried, with time to talk to residents. People we spoke to during the inspection told us the staff team were wonderful and always prepared to help As part of our inspection, we looked at the staff records of four people working in the home on the day of or visit. Although the files contained much of the information Care Homes for Older People Page 19 of 25 Evidence: required by the regulations, there were some significant gaps. One file we examined, for an employee who joined the service in February 2009 contained only one reference, another had no information about a conviction disclosed on the individuals CRB and a third file had no details of the training received by a new staff member, a qualified nurse, in her previous employment. These issues had already been discovered in a recent head office audit, and must be addressed, and the required information placed on the relevant files. Training records are kept in separate files, and these were examined for the same staff members. The training records showed that they had all received training appropriate to their role since starting work with the provider, and this training included, Moving and Handling, health and safety, first aid, safeguarding. Basic induction training in the home has not been at the standard the service required, and a new package is now being used, which addresses this shortfall for all new staff. Care Homes for Older People Page 20 of 25 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. Procedures are in place in ensure the health and safety of people living and working in the home, and regular meetings ensure that the views of the residents are taken into account in all aspects of the day to day running of the home. Evidence: Since our last inspection, a new manager has been appointed, and an application is shortly to be submitted to register the new manager with the commission. In addition, the service are recruiting into the deputy manager post which is currently vacant. The new manager told us that he was receiving a lot of support from the company, and during our visit, the regional manager of the home joined us. The service has had fewer residents in recent months, whilst refurbishment work has been carried out to the upper floor of the main property, and at the time of our inspection had a total of 40 residents living in the home. The service ensures that the views of people who live in the home are taken into Care Homes for Older People Page 21 of 25 Evidence: account, with a twice yearly survey of their views, and regular residents meetings, and ideas and suggestions that residents may have are discussed within these meetings. One example mentioned earlier of a change introduced following a residents meetings was the installation of the new wide screen television. Health and safety procedures are in place, and regular maintenance checks undertaken. The AQAA indicated that all the required statutory checks are undertaken, and from the staff files examined, it was clear that training is provided to staff in terms of health and safety procedures. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 7 15 Individual plans must show 30/11/2009 the involvement of the person they relate to where possible, or close family, and be kept under regular review. To ensure that they are up to date and reflect the wishes of the person they are about 2 29 19 The service must ensure that 30/11/2009 recruitment policies are followed To ensure that all the required information is obtained to enable residents to be confident suitable staff are available to meet their needs Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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