Care Home: Millbrook House

What the care home does well Pre admission assessments are completed for residents. These were comprehensive. Assessments were also seen from health and social care professionals, which included risk assessments covering various aspects of health and social factors. Following admission the in-house assessments are also good. Relatives are involved in the initial assessment process as they are asked to complete various details and assessments. Relatives reported that contracts and relevant information such as the service user guide for the home, was given them as part of the admission process. The care records contain details of health care input from various professionals and this aspect of care is well monitored. All relatives spoken with reported that staff were very prompt at referring residents if needed and kept them Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 6informed about any health care input. One resident was in need of end of life care and this was being very well monitored with input form relevant health care professionals so that the resident`s care needs, including family support, were well met. Residents were observed to be dressed appropriately with good attention paid to cleanliness so that resident`s dignity was protected. One relative said: `the staff are excellent and deal very well with some very difficult and demanding situations`. All relatives and some residents commented on the food and were pleased with this. The dining room is bright and the dinnertime meal experienced by residents was well presented and sociable. Staff were seen in attendance with those residents that required more assistance and staff were appropriately skilled. Relatives were aware of the complaints process. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. Staff have received appropriate in house training around abuse awareness and how to report any concerns so that residents can be protected. The home offers plenty of day space, which is bright and homely for residents so that residents who like to wander can feel comfortable. Many of the bedrooms have ensuite facilities and there are good provision of amenities such as bathrooms and toilets. Some of the facilities have been further developed and upgraded since the last visit particular attention being paid to disability access. The bathrooms offer a number of options in terms of bathing so choice is available. There is access to green space with a garden area accessible from both the conservatory and dining areas although the manager is aware of the need to develop this further so that people with dementia can access it without staff escort. There is a good compliment of trained staff that are very experienced. Staff reported that the manager is very keen on training and all spoken with had attended various training courses and this was further evidenced from staff training records. One staff commented: ` I have only been here a short time but I`m already booked on an NVQ course`. The comments from relatives regarding the staff were very encouraging: `Staff are very kind` `They are excellent and are easy to talk to` The health and safety checks of the environment are carried out and the certificates of maintenance seen were all up to date including fire safety. Staff interviewed had received basic training in these areas. What has improved since the last inspection? Care plans seen were easy to read and described the care to be carried out for the individuals concerned in a personalised way. They have improved in that relatives are clearly involved in both the assessment process leading to the development of the care plan and also the way that some of the medical and nursing information is monitored. For example one two residents who have wound care were reviewed and we found that records were very clear with photographic records supplementing ongoing reviews so that progress her could be easily tracked. We found that staffing levels in the home were consistent. This had been an issue previously as the home was new and was building up a resident population and recruiting staff at the same time. On this visit the staffing was settled with good support for ancillary staff such as domestics and kitchen staff so that care needs can be met consistently. The home has employed an activities organiser who is full time. This displays a commitment to developing the social activities and life of residents and although there is still work to be done [see below] this is a marked progression over the past year so that residents can benefit from improved social stimulus. The manager has developed a good training programme for staff including in house training on abuse awareness and how to report such incidents and concerns so that residents can be protected. The manager is developing the homes environment with reference to good practise guidance on dementia care. There is still work to do but some appropriate signage has been introduced to assist orientation and the garden continues to be developed so that it will be more accessible for residents and therefore improve the quality of life for residents in the home. Other improvements over the past year are listed in the report. A key factor has been the development of some good quality assurance processes so that the home can continue to develop with reference to the needs of the residents and their relatives and supporters. The owners visit regularly and provide feedback to the manager [regulation 26 reports] and the manager organises surveys for relatives and also conducts relative meetings to get feedback which then helps plan the service. What the care home could do better: There are some good practice recommendations regarding the recording and auditing of the medicines. The activity programme needs to be further developed so that residents can benefit form more structured and diverse input.The activities coordinator should attend training suitable for her role. Currently there is a lack of any choice displayed on the menu although it was reported that the cook would prepare an alternative meal `if requested`. Realistically this does not provide any real choice for residents with dementia who need to be presented with information [choices] in a more appropriate format. A menu board was observed but this was not used and the menus displayed were in small print and could not be seen by anybody with site impairment. The assessment of residents regarding moving and handling is currently undertaken by nursing staff in the home but none have training to `assessor` level and this would be strongly recommended. The garden is still not used as frequently as perhaps it could be. This is linked to anxiety around residents falling and without staff continually being present this is judged to be a high risk. The garden is therefore only accessible when staff have the time to supervise the area. The manager is aware of this and is trying to arrange funding to develop the garden further so that it will be accessible at all times. This is good practice and should be actioned. CARE HOMES FOR OLDER PEOPLE Millbrook House 39-41 Birch Street Southport Merseyside PR8 5EU Lead Inspector Mike Perry Key Unannounced Inspection 20th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millbrook House Address 39-41 Birch Street Southport Merseyside PR8 5EU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01704546177 01704884110 Mr Mark Jonathan Gilbert Mr Luke William Gilbert Janet Elizabeth Hunstone Care Home 40 Category(ies) of Dementia (40) registration, with number of places Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with nursing - code N, to service users of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 40 Date of last inspection 30th August 2007 Brief Description of the Service: Millbrook House provides a service for up to 40 residents being registered as providing services for people with dementia. The building is fairly modern and has day areas on the ground floor and bedrooms on the ground and first and second floors. The day areas consist of two-day rooms, a spacious dining room and a conservatory. Many of the bedrooms are ensuite. There is good provision of bathing amenities and nursing equipment. There is access to an enclosed garden area. The home is set in a residential area of Southport, which is fairly close to shops and bus routes. The Providers are Mr Mark Gilbert and Mr Luke Gilbert. The registered manager is Janet Hunstone. Fees for the service are currently £525 - £560 weekly. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The home has been opened for 18 months and this is the second inspection. All of the key standard the home is expected to meet were assessed. The inspector arrived unannounced and the visit was conducted over 7.5 hours on one day. Prior to the inspection some information had been gathered by the manager completing a self-assessment and review of the service and submitting this to the inspector [AQAA]. On the day of the visit the inspector met with residents and their representatives / relatives, spoke with staff on duty including the nursing staff and the manager as well as the provider who was also on site for some of the visit. Some survey forms had previously been distributed by the manager and two of these were returned. Care records were reviewed and other records such as staff recruitment and training, health and safety and policies and procedures were reviewed. What the service does well: Pre admission assessments are completed for residents. These were comprehensive. Assessments were also seen from health and social care professionals, which included risk assessments covering various aspects of health and social factors. Following admission the in-house assessments are also good. Relatives are involved in the initial assessment process as they are asked to complete various details and assessments. Relatives reported that contracts and relevant information such as the service user guide for the home, was given them as part of the admission process. The care records contain details of health care input from various professionals and this aspect of care is well monitored. All relatives spoken with reported that staff were very prompt at referring residents if needed and kept them Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 6 informed about any health care input. One resident was in need of end of life care and this was being very well monitored with input form relevant health care professionals so that the resident’s care needs, including family support, were well met. Residents were observed to be dressed appropriately with good attention paid to cleanliness so that resident’s dignity was protected. One relative said: ‘the staff are excellent and deal very well with some very difficult and demanding situations’. All relatives and some residents commented on the food and were pleased with this. The dining room is bright and the dinnertime meal experienced by residents was well presented and sociable. Staff were seen in attendance with those residents that required more assistance and staff were appropriately skilled. Relatives were aware of the complaints process. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. Staff have received appropriate in house training around abuse awareness and how to report any concerns so that residents can be protected. The home offers plenty of day space, which is bright and homely for residents so that residents who like to wander can feel comfortable. Many of the bedrooms have ensuite facilities and there are good provision of amenities such as bathrooms and toilets. Some of the facilities have been further developed and upgraded since the last visit particular attention being paid to disability access. The bathrooms offer a number of options in terms of bathing so choice is available. There is access to green space with a garden area accessible from both the conservatory and dining areas although the manager is aware of the need to develop this further so that people with dementia can access it without staff escort. There is a good compliment of trained staff that are very experienced. Staff reported that the manager is very keen on training and all spoken with had attended various training courses and this was further evidenced from staff training records. One staff commented: ‘ I have only been here a short time but I’m already booked on an NVQ course’. The comments from relatives regarding the staff were very encouraging: ‘Staff are very kind’ ‘They are excellent and are easy to talk to’ The health and safety checks of the environment are carried out and the certificates of maintenance seen were all up to date including fire safety. Staff interviewed had received basic training in these areas. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There are some good practice recommendations regarding the recording and auditing of the medicines. The activity programme needs to be further developed so that residents can benefit form more structured and diverse input. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 8 The activities coordinator should attend training suitable for her role. Currently there is a lack of any choice displayed on the menu although it was reported that the cook would prepare an alternative meal ‘if requested’. Realistically this does not provide any real choice for residents with dementia who need to be presented with information [choices] in a more appropriate format. A menu board was observed but this was not used and the menus displayed were in small print and could not be seen by anybody with site impairment. The assessment of residents regarding moving and handling is currently undertaken by nursing staff in the home but none have training to ‘assessor’ level and this would be strongly recommended. The garden is still not used as frequently as perhaps it could be. This is linked to anxiety around residents falling and without staff continually being present this is judged to be a high risk. The garden is therefore only accessible when staff have the time to supervise the area. The manager is aware of this and is trying to arrange funding to develop the garden further so that it will be accessible at all times. This is good practice and should be actioned. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and admitted to the home appropriately so that their care needs can be met by the staff. EVIDENCE: Two care files were reviewed. Pre admission assessments were completed for both residents. These were comprehensive. Assessments were also seen from health and social care professionals, which included risk assessments covering various aspects of health and social factors. Following admission the in-house assessments are also good. These cover activities of daily living and also include a psychological assessment. Relatives are involved in the initial assessment process. On relative commented that they were asked to have input into various risk assessments following admission. Moving and handling, water low [assessment for pressure sore risk] and nutritional assessments are competed. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 11 The relative survey forms returned and the relatives spoken with on the inspection all confirmed that contracts and relevant information was given them as part of the admission process. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards and standard 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s care is planned and managed with good input from other care professionals and involvement from relatives and supporters so that care needs of residents are met holistically. EVIDENCE: Following admission a care plan is draw up which acts as a communication tool for the carrying out of care. Those seen were easy to read and described the care to be carried out for the individuals concerned in a personalised way. The care plans are audited by the manager and there has been improvements in the detail of the recording of care since the last inspection. For example two residents have attention for wound care. Both of these had care plans that were easy to follow and carefully documented the progress of the care including photographic records, so that the care could be monitored appropriately and evaluated and reviewed. There was also evidence that outside professionals were liaised with and any necessary referrals had been made. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 13 The input that relatives have on the assessment of residents has been developed so that relatives are aware of the care plan and have meetings [reviews] to discuss this. we found that these are recorded in the care notes. Relatives spoken with were very pleased with the fact that they are kept informed about changes and feel that they are involved. This was particularly evidenced with one relative who spoke about the care given for his relative who was coming to the end of life. The manager had attended medical reviews with the relative to assist and support. The person concerned was being nursed on a ‘care pathway’ developed so that all appropriate professionals and those concerned with the person can have input. This meant that the resident was comfortable and well supported. The care records contain details of health care input from various professionals. All relatives spoken with reported that staff were very prompt at referring residents if needed and kept them informed about any health care input. Medications are administered safely. Previous recommendations have been acted on. There are some further recommendations that the manager should action: • One resident is on PRN [give when required] medication for agitation. This is not referenced on the care plan so that there can be consistency with respect to why and when the medication should be given. [ this was mentioned on the last report]. The medication records [MAR charts] seen were clear in that any medication administered was recorded. It was not clear however when trying to audit the stock of liquid medicine for one resident how much was actually in stock currently. This was because previous medication received was recorded on a previous MAR chart and nor carried over to the new chart. There was also no clear date on the MAR to record when stock had been received. This can be improved and the manager was helpful and said she would liaise with the pharmacy. Occasionally care staff administer / apply creams to residents instead of the nursing staff. There needs to be a clear record of the person applying the cream so that records can be accurate. This was discussed with the manager. • • Residents were observed to be dressed appropriately and there was good attention paid to cleanliness so that resident’s dignity was protected. One Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 14 relative said: ‘my relative has been very demanding in the past but staff manage the situation well’. Care staff spoken with displayed good background knowledge and experience in care. They gave examples of how to manage various situations and felt supported by their colleges. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social care in the home is provided with emphasis on people’s individuality but this needs to be more consistently maintained in some key areas so that residents can experience increased engagement and improved well-being by the provision of an activities programme. EVIDENCE: The general ambiance of the home is warm and welcoming. Most of the residents were observed to be relaxed and settled. Those that were more agitated have space to wander and are less likely to feel constrained. Relatives are encouraged to visit and those spoken to felt welcome and that staff would spend time talking with them. Staff were observed to be interacting with residents and supporting them appropriately. Staff were warm and positive in their approach. There was little evidence during the inspection of time spent in providing planned stimulus or activities for residents although it is clear from the AQAA submitted prior to the inspection that there have been developments: Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 16 ‘An activity co-ordinator has been employed and is in post five days a week with a full activity schedule which is on display within the home’ We did observe an activities programme and we also spoke to the activities co ordinator. The programme remains in early development however as the person cncerned has only recently been appointed [last one left] and is still in the process of being inducted and getting to know the home and residents. one relative commented that there are some activities for residents but these are not consistent. Another commented that staff are very supportive of residents and interact well but there could be better access to the garden [for example] which remains under used. The care planning also evidenced that there is a marked difference between the recording and assessment of health needs [very good] and the assessment and care planning of social care needs which was not as evident. The manager is aware of the further developments needed and is planning improvments. For example there are plans to develop the garden to that it can be made safer and accessable to residents so that staff support is not always needed. There was also discussion around the need to develop the activities co ordinator role through training so that more diverse programmes can be developed. All relatives and some residents commented on the food and were pleased with this. The dining room is bright and the dinnertime meal seen was well presented and sociable. Staff were seen in attendance with those residents that required more assistance and were appropriately skilled. There was attention paid to nutrition in the care plans seen. Currently there is a lack of any choice displayed on the menu although it was reported that the cook would prepare an alternative meal ‘if requested’. Realistically this does not provide any real choice for residents with dementia who need to be presented with information [choices] in a more appropriate format. A menu board was observed but this was not used and the menus displayed were in small print and could not be seen by any body with site impairment. The manager reported that she was planning on experimenting with picture menus from which some residents could choose. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good complaints process and the home has responded appropriately to concerns raised so that residents are protected. EVIDENCE: The complaints file evidenced two complaints since the last inspection. One was from a relative regarding general care issues. The other complaint was also dealt with by the safeguarding team from social services in liaison with the manager, and concerned the care of a resident who had been admitted to hospital. The family were concerned abut the care leading up to the admission. Both had been investigated by the manager and letters sent within time scales to the complainants. Relatives were aware of the complaints process and this is clearly displayed in the homes information guides, which are readily available. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. Since the last inspection the manager has implemented a staff-training programme around abuse awareness and the reporting processes for any allegations of mistreatment or abuse. This helps ensure that staff are aware and compliant with good practise and that residents are protected. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to e developed with respect to good practice in dementia care so that residents are living in a suitable and homey environment. EVIDENCE: The home offers plenty of day space, which is bright and homely for residents so that those in particular who like to wander can feel comfortable. Many of the bedrooms have ensuite facilities and there are good provision of amenities such as bathrooms and toilets. The bathrooms offer a number of options in terms of bathing so choice is available. The AQAA returned by the manager lists many developments to the home since the last inspection and these take account of residents who have dementia and also those with more physical disabilities. There is, for example, Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 19 a newly developed toilet facility, which is more easily accessible for people with disability. Also the doorways into lounges have been painted in a different colour to the walls to highlight the opening and an activity room is available for clients, to use with the activity co-ordinator. There is access to green space with a garden area accessible from both the conservatory and dining areas. The garden areas have been improved and now contain a water feature, as well as several sitting areas. The garden is still not used as frequently as perhaps it could be. This is linked to anxiety around residents falling and without staff continually being present this is judged to be a high risk. The garden is therefore only accessible when staff have the time to supervise the area. This was commented on by a relative who said that it was shame such a useful facility could not be better used. The manager is aware of this and is trying to arrange funding to develop the garden further so that it will be accessible at all times. This is good practice and should be actioned. The décor is fresh and there are no unpleasant odours. The home was clean and hygienic. Residents able to express an opinion were pleased with the surroundings generally and visitors also commented favourably. There has been some attempt to personalise bedroom areas so that the residents’ individuality was in evidence with photographs and ornaments on display. There was some discussion around the need to continue to develop the environment with respect to dementia care so that residents with confusion can be assisted to be orientated and find their way around and therefore become more independent. To this end the staff have placed signs and orientation boards to designate bathrooms, toilets etc. This work will continue to be developed. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately and there are sufficient numbers so that they are able to carry out care of residents. EVIDENCE: For 40 residents in the home at the time of inspection there was the manager [usually 8 – 5], 2 trained nurses and 6 Care staff. In addition there were two domestic and one chef and one kitchen assistant working in the kitchen. In addition there is laundry cover and also maintenance cover. The activities organiser is also supernummery to these figures. The staffing rota and the comments received from staff evidenced that these staffing numbers are consistent. Relatives commented generally that although there could always be more staff they were satisfied with current levels and felt that staff were very effective at their work. There is a good compliment of trained staff that are very experienced. Some have mental health training and the manager has completed a course in care of the dying and also a dementia care course. Staff reported that the manager is very keen on training and all spoken with had attended various training courses over the past year. For example moving and handling, fire training and management of challenging behaviour. The Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 21 training records available supported this with all ‘statutory’ training up to date. One staff commented that within a sort time of being employed she was now starting an NVQ course. The manager is satisfied that the current induction course for staff covers the common foundation standards for all carers. This evidences that staff are competent to carry out their work. In terms of further developments it would be recommended that more staff attend specialist dementia care training, particularly nursing staff in terms of their professional development. Recruitment files seen for staff were complete and all the necessary pre employment checks had been completed. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards and 37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent and experienced manager and quality systems are in place to ensure that the service continues to be developed in the best interests of the residents. EVIDENCE: The manager of the home is Janet Hunstone who is a nurse and has long experience in running care homes and working at senior management level in the private sector. She has a management qualification at NVQ level 5. She is able to communicate well and displayed evidence of continued training and clinical update. Both relatives and staff were supportive of her approach and felt that she had a good understanding of resident and staff needs. The manager continues to develop quality assurance systems so that resident / relative views are sought and the home can therefore best be run in their Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 23 interests. There is already an external quality audit, which has been carried out which accessed relative views. The manager has introduced care plan reviews and developed various quality audits around care planning and medication for example. There have also been some meetings with relatives and these are well attended. One relative commented that these are very useful and enjoyable and the management are keen to listen to views. The Provider who is regularly onsite supports the manager and carries out the monthly reports to the manager [regulation 26 reports], which provide feedback about the service. Management of resident’s monies were reviewed this is satisfactory with appropriate records maintained. There are now two signatures on records for any transaction. It would be recommended that the signature of relatives is sought whenever possible. The health and safety checks of the environment are carried out and the certificates of maintenance seen were all up to date including fire safety. Staff interviewed had received basic training in these areas. The assessment of residents regarding moving and handling is currently undertaken by nursing staff in the home but none have training to ‘assessor’ level and this would be strongly recommended. Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X 3 3 Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations • One resident is on PRN [give when required] medication for agitation. This is not referenced on the care plan so that there can be consistency with respect to why and when the medication should be given. [This was mentioned on the last report]. It was not clear however when trying to audit the stock of liquid medicine for one resident how much was actually in stock currently. This was because previous medication received was recorded on a previous MAR chart and nor carried over to the new chart. There was also no clear date on the MAR to record when stock had been received. This recording should be improved. Occasionally care staff administer / apply creams to DS0000069263.V370487.R01.S.doc Version 5.2 Page 26 • • Millbrook House residents instead of the nursing staff. There needs to be a clear record of the person applying the cream so that records can be accurate. 2 OP12 The activity programme needs to be further developed so that residents can benefit form more structured and diverse input. The activities coordinator should attend training suitable for her role. 3 OP15 Currently there is a lack of any choice displayed on the menu although it was reported that the cook would prepare an alternative meal ‘if requested’. Realistically this does not provide any real choice for residents with dementia who need to be presented with information [choices] in a more appropriate format. The plans for the garden should be actioned so that residents can have improved access to fresh air and sunlight. There was some discussion around the need to develop the environment with respect to dementia care so that residents with confusion can become more independent. This should continue. The assessment of residents regarding moving and handling is currently undertaken by nursing staff in the home but none have training to ‘assessor’ level and this would be strongly recommended. 4 OP19 5 OP38 Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Regional Contact Office 3rd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millbrook House DS0000069263.V370487.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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