Care Home: Millfield Care Centre

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What the care home does well Millfield continues to provide spacious accommodation which is well maintained and suitably adapted to meet the physical needs of people who live at the home. The home continues to follow a robust recruitment procedures ensuring all relevant checks have been undertaken prior to new staff commencing their employment. This ensures people are kept safe. Care records clearly show peoples preference and how they wish to be supported ensuring their needs are met. Information had been reviewed and updated to reflect their current and changing needs. A programme of staff training and development is provided ensuring staff are appropriately inducted and trained to carry out their duties safely. We received a good response from both staff and residents with regards to the care provided at the home. Comments included; `activities have got a lot better over the last 12 months`, `they work as a team`, `I enjoy watching films and making things`, `they look after me` and `I can always talk to the manager whenever I want, she will always help`. when asked `what they do well`, two people commented `everything` and `activities`. Staff also commented, `I enjoy working at the home`, `Millfield provides a comfortable environment for our residents`, `staff are well trained and caring` and `BUPA provide well structured care plans that cater for each individual`. A further comment was made by one member of staff about recent changes. They said `I feel that over the last 6 months Millfield has undergone a great deal of change, implemented by the new manager and we are now starting to benefit from all the hard work. However I feel that we must continue at the pace so that we can continue to go from strength to strength with commitment and support from all the staff`. What has improved since the last inspection? The manager has now completed her registration for the home and has been approved by the Commission. Most areas of medication handling have improved and residents are now given most of their medication as prescribed. However further improvements must been made in this area to ensure the ongoing safety in residents` health and wellbeing. Previous arrangements in relation to food items being provided throughout the day and night had improved. Provisions were readily available on each of the units for people as and when they requested. Improvements had been made to the monitoring of individuals changing needs ensuring early intervention is made where necessary. Opportunities for social and leisure activities both in and away from the home are more readily available affording people variety in their daily routines. What the care home could do better: Effective use of auditing systems must be made to ensure that medication handling is safe and to confirm that residents are given their medicines properly and that all medication can be accounted for. Records about some aspects of medication handling must be improved so they accurately reflect that treatment is given as prescribed and that those records are accurately dated. Consideration must be given to the systems used to order medication ensuring it does not run out and residents can have continuous treatment as prescribed. Care plans and risk assessments need to clearly detail the agreed protocol when supporting people with `rescue` medication so that staff are able to support them safely ensuring their health and well being is maintained. Care plans and monitoring records need to clearly evidence how and when people receive their prescribed food supplements so that records show these are being given as directed. The manager is asked to confirm with the Commission that a satisfactory electric circuit check has been completed for the home ensuring the system is safe. Key inspection report Care homes for older people Name: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF     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: Lucy Burgess     Date: 0 7 0 6 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: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF 01706621222 01706627688 mcnallyh@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Emma Elizabeth Fitzgerald Type of registration: Number of places registered: care home 92 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: The maximum number of service users who can be accommodated is: 92 The registered person may provide the following category/ies 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: Old age, not falling within any other category - Code OP (maximum number of places: 52) Dementia - Code DE (maximum number of places: 24) Physical disability - Code PD (maximum number of places: 15) Date of last inspection 1 9 1 1 2 0 0 9 24 0 15 Over 65 0 52 0 Care Homes for Older People Page 4 of 30 Brief description of the care home Milfield Care Centre is a two- storey purpose built home situated close to the town centre of Heywood. Access to public transport and the motorway network is good and there is ample parking to the front and rear of the home. The home is registered to provide nursing and personal care in four distinct units up to a total of 92 residents. On the ground floor one unit provides nursing care for residents in the dementia category, and in separate accommodation nursing care is provided for up to 15 Physically Disabled residents (18 - 65 years). The upstairs unit provides nursing and personal care for 52 Older People. The home is suitably adapted for disabled access and the majority of rooms have en suite facilities. The previous Commission for Social Care Inspection report is available on request. The home weekly charges range from 370.00 pounds to 515.00 pounds per week. This is dependant on the individuals assessed needs. 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 a key inspection for Millfield Care Home, which included a site visit and took place over one day by an inspector and a pharmacy inspector. The service did not know that the inspectors were to visit. As part of our inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned as requested. During the visit time was spent looking at records including care files, recruitment and health and safety. We also spent time looking at the environment. A full audit of the medication system was carried out. Due to concerns identified at the key inspection in November 2009, a management review had taken place to discuss what action was needed. An improvement plan was requested and provided. We also served a Statutory Requirement Notice on the 29 Care Homes for Older People Page 6 of 30 December 2009 with regards to poor medication practice. A compliance date was made for 17 January 2010. A random inspection was carried out on the 22 February 2010 by our pharmacy inspector to check that compliance had been made with the Statutory Requirement Notice. Whilst improvements were found further progress was still required to ensure people were kept safe. The home continue to send us their improvement plans detailing what action is being taken to address the outstanding issues. At present the local authority is not making placements at the home due to on-going concerns about the standard of care provided. As part of the inspection process we had sent out feedback surveys to people living at the home and staff. We received comments from 18 people. These have been added to the report along with comments made from people spoken with during the visit. All the key standards were looked at during this inspection visit as well as the action taken to address the requirements and recommendations identified during our last visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The manager has now completed her registration for the home and has been approved by the Commission. Most areas of medication handling have improved and residents are now given most of their medication as prescribed. However further improvements must been made in this area to ensure the ongoing safety in residents health and wellbeing. Previous arrangements in relation to food items being provided throughout the day and night had improved. Provisions were readily available on each of the units for people as and when they requested. Improvements had been made to the monitoring of individuals changing needs ensuring early intervention is made where necessary. Opportunities for social and leisure activities both in and away from the home are more readily available affording people variety in their daily routines. Care Homes for Older People Page 8 of 30 What they could do better: 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. Pre-admission assessment are undertaken to ensure the suitability of placement prior to people being admitted ensuring their needs can be met. Evidence: Since our last visit to the home the Local Authority suspended admissions to the home due to the concerns identified. However those people wanting to move into the home through private arrangement have been able to do so. The management team have ensured that both existing and prospective residents and their families have been informed about the current issues and action being taken to ensure that these are addressed. During this visit we looked at the assessment for one person who was moving into the home that day. Arrangements had been made for staff to meet with the person and their family prior to the admission. Information was gathered in relation to their care and support needs, ensuring suitability of the placement. Care Homes for Older People Page 11 of 30 Evidence: The homes assessment documentation, Quest, had been completed in all areas of personal, health and social care and clearly identified what areas need to be included in the care plan and risk assessments so that staff were clearly directed in how to support the person. Of the 9 people who completed the feedback surveys, all but one confirmed that they had received sufficient information about the service prior to them moving into the home. Standard 6 is not applicable as the home does not provide intermediate care services. 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. Information is detailed within individual care plans telling staff how people want to be supported in meeting their needs. Whislt most areas of medication handling had improved and most residents receive their medication as prescribed. But ongoing shortfalls in the system places some residents health and welfare at potential risk of harm. Evidence: Individual files are in place for each resident. Records explore all aspects of daily living and care, such as day and night routines, personal care needs, moving and handling, mental and physical health, pressure care, behavioural needs, nutrition and diet and medication. Risk assessment are also completed in all areas where risk has been identified. This may vary depending on the individual needs of people. Assessments explored moving and handling, falls, nutrition and pressure care in addition to the generic assessments to address potential risk in the environment, use of wheelchairs and fire safety. Care Homes for Older People Page 13 of 30 Evidence: Additional records are also held in relation weight records, diary sheets, which are completed at each shift as well as visits or appointment made by relevant health and social care professionals such as district nurses, chiropody, optician, dietician, GP, continence nurse, tissue viability nurse and social workers. Due to issues identified during our last inspection arrangements had been made by the manager for GP reviews to be carried out in relation to medication. Care files were looked for those people where specific needs had been identified. Each of the files provided comprehensive information about the person, their care needs and how they were to be support. Information about routines and individual preferences was personalised and provided a good overview about the person and their likes and dislikes. Care plans and risk assessments had been reviewed and updated on a monthly basis or more frequently where there had been changes in need. On examination of records we found that where one person required additional monitoring due to their nutritional needs, this had been acted upon. Records for another resident who had recently been discharged from hospital showed that where further assessment was needed by health professionals promptly action had been taken to ensure their health and well being was not affected. A further file showed that this person was supported by staff with rescue medication and nutritional supplements. However records did not clearly evidence the protocol in place for administering this medication and monitoring charts for prescribed supplements did not show how this was to be prepared and how often it was given. Records should be expanded upon to evidence that this person is being supported safely. We observed interactions between staff and residents. People appeared to be treated with dignity and respect. Staff knocked on doors prior to entering and personal care support was provided in private. Staff were also seen to wear protective clothing. Observations of people showed that people were supported in their appearance and looked well kempt and were appropriately dressed. Comments were received from people with regards to the care provided. People said; they work as a team, they look after me and I can always talk to the manager whenever I want, she will always help. During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. This was because at previous inspections there were concerns that medicines were not always given properly or handled safely. During this part of the inspection we spoke to one of the unit managers, a nurse and a Care Homes for Older People Page 14 of 30 Evidence: senior carer all of whom had responsibility for handling medicines on the day of our visit. We also spoke to the homes Manager, Regional Manager and Quality Manager who conducted a medication audit on the day of our visit. At our last inspection in February we saw improvements had been in the safe handling of medication but not all the requirements had been fully met. At this inspection we found that almost all of the improvements which had been made last time had been sustained and further improvements had been made in other areas of medication handling. We looked at the records about medication together with the stock of medicines held in the home for twelve residents, five of whom had had recent changes to their medication. At the last inspection there had been concerns that when residents had changes to their medication because of a visit by the doctor, consultant or after a stay in hospital they had not received the new medication properly. During this inspection we found that systems had been put in place to make sure that such medicines were obtained in a timely manner and residents were given their medicines as prescribed. We also found that previously residents couldnt be given their medicines properly because staff had not transferred important information from one set of documents to the next. At this inspection we found that this was information was now transferred properly. At the last inspection the manager told us that a formal audit, checking, system had been put place to make sure the managers were confident that medicines were handled safely. At this inspection we saw that the checks had been increased. A system had been introduced which involved daily stock counts for every medicine in the home. We looked at these daily stock checks which were very confusing and they did not always show that medication had been given properly. An audit of some pain relief tablets for one resident showed that he had been given half the dose of one of his pain killers on certain days and three times the prescribed dose of a second pain killer on another day. The information from this audit had not been used, by the managers, to find out if the resident had been given the wrong doses of medication. The stock count for two other residents medication showed that the stock levels were running low and then had run out. It is of concern that the information from the checks was not being used properly to ensure that medication was being handled safely. The regional manager, discussed with us that the stock check figures did not always reflect the actual stock levels and did not always demonstrate that medication had been given properly. We found that little reliance could be placed on the accuracy of the checking system. Care Homes for Older People Page 15 of 30 Evidence: All medication, including controlled drugs were stored safely and securely. The medicines fridge on one unit had broken and staff had made good arrangements to store medication at the correct temperature on another unit. During our visit we noticed that during a medication round some medication was left unattended on the top of the medication trolley on several occasions. It is important that medication is not left unattended to prevent misuse of medication or harm to residents. Some residents had not been given some of their medication properly, one resident was not given their regular prescribed medication when they were away from the home during the medication administration round another resident did not have their full course of antibiotics. Two residents could not have some of their medication because it ran out . One resident was given the required doses of medication from the homes supply of homely remedies (medication which can be bought over the counter in a pharmacy) until the prescribed medication was ordered and arrived in the home. However the other medication was not available in this way and the residents missed several doses of their medication. The area of medication handling which showed the least improvement was that of record keeping. At the last inspection it was noted that when medication arrived outside the normal monthly cycle the quantity of medication received was not always recorded. Improvements had been made in this area and we saw there were fewer instances of this during our inspection. The records of disposal had improved and the records of administration were mainly good. The improvements in record keeping made it possible to see that most medication had been given as prescribed but the records also revealed that some medicine could not be accounted for. It is important that all medication is accounted for to prevent the risk of medication being mishandled and to protect the health and wellbeing of residents. However as at the last inspection the records about food thickeners were not accurate and half the records we saw during our inspection still could not demonstrate that these thickeners were being properly used. At the last inspection we found that records of administration for one resident were so poor that they showed that medication had been given for several days before it had been prescribed. On this visit we found the same errors had been made and that Nurses had signed these records for four days failing to notice the dates were incorrect until we pointed it out during the inspection. We also found that some records about mediation were undated which made it difficult to tell exactly when medication had been given. Records about controlled drugs were accurate and showed they could be accounted for and had been given as prescribed. Care Homes for Older People Page 16 of 30 Evidence: A letter regarding the safe management of medication has been sent to the home asking them to tell us exactly how they will make the remaining improvements to ensure safety of all residents. Care Homes for Older People Page 17 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. Opportunities are provided for people to take part in social and leisure activities providing variety to their day. Evidence: Opportunities for people to take part in social and leisure activities have improved. There are now two activities staff that provide a range of activities throughout the home. They are supported by unit staff that have been identified as activity champions and assist with activities. As identified during our previous visit two rooms on the first floor had been created into activity rooms, one as a cinema room and the second for arts and crafts. A weekly programme is in place for each unit detailing what is available, these include; a regular Tuesday coffee morning, birthday parties, darts and cards, weekly visits from the hairdresser, films in cinema room, armchair exercise, reminiscence, clothes parties, bingo, making food for themed nights such as pizza for an Italian night, cake baking, shopping trips to Heywood and Bury market, Wii games and pub lunches. The home is also actively involved with Community Crop Children who regularly visit the home and spend time with residents creating raised flower beds in the rear garden. Care Homes for Older People Page 18 of 30 Evidence: Display boards have also been placed around the home with photographs of events that have taken place. Outside space around the home had been well maintained. Areas provided a pleasant environment for people to sit and enjoy the recent good weather. Observations confirmed that people receive visitors throughout the day. People are encouraged to maintain relationships with friends and family. Visitors are able to meet with people in the privacy of their own rooms or in the communal should they choose. Interactions with staff were respectful and people appeared to have a good rapport with each other. Comments were received from people about the activities available to them. People said; Activities have got a lot better over the last 12 months and enjoy watching films and making things. When asked what they do well, two people commented everything and activities. One commented when asked what could be done better was, need large screen televisions. We also looked at arrangements with meals. Dining rooms are provided on each of the units. Rooms are spacious and cater for the physical needs of people. Tables were nicely set with cruets, flowers and menus so that people were able look at the choices available to them. The chef speaks with people on a regular basis to ensure people are being offered what they like. Alternative arrangements are made for people who wish to have something other than that available on the menu. During our previous visit we noted that arrangements in relation nite bites as identified on the menus were not readily available. This had been resolved. Sufficient supplies were available on each of the units so that people were able to have snacks such as toast, cereal, crumpets, potatoes cakes, juice, hot chocolate when they wanted to. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure the safety and protection of people. Evidence: Relevant policies and procedures are available covering these standards. As part of the induction process and on-going development of staff, training is provided in the protection of vulnerable adults. Prior to our visit we had received the completed Annual Quality Assurance Assessment (AQAA) for the home. Details were provided in relation to any complaints and safeguarding referrals over the last year. Two issues had been raised directly with the home by the Commission. These were discussed with the manager. During the visit we examined records, which detailed investigations undertaken, action taken and outcomes. The manager ensures that the Commission and Local Authority are kept informed about all events within the home. Of the 9 people who responded to the surveys, 7 acknowledged that they were aware of who to speak with and how to make a complaint should they need to. One person stated A staff member also expressed, that recent changes had improved the quality of service provided for residents. 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. Millfield provides a good standard of accommodations. It is well maintained and meets the physical needs of people who live there. Evidence: Millfield is a large home, which can accommodate up to 92 people. Accommodation is provided on 2 floors. There are 2 units on the ground floor. One supports younger people with physical needs and the second is for people with dementia care needs. On the first floor support is offered to older people requiring nursing or residential care. The home has been adapted throughout to support the physical needs of people. Specialist equipment such as rise and fall beds, hoist, assisted bathing had been provided as well as additional aids such as zimmer frames and wheelchairs. We again spent time looking round the home. Communal areas, bathrooms and some bedrooms were looked at. Accommodation provided is of a good standard. We spoke with the handyman who told us that work was taking place within the home to refurbish some areas. This included; redecoration of the lounge and dining room on the young persons unit, all en-suites were being repainted, new carpeting in approximately 10 bedrooms and new wall lights throughout. Communal living and dining rooms are provided and a kitchenette with a fridge, toaster, kettle and microwave on each of the unit so that snacks and drinks can be Care Homes for Older People Page 21 of 30 Evidence: provided throughout the day. The microwave on the young disabled unit was in a poor condition and needed replacing. Single bedrooms are provided throughout the home with each having en-suite facilities. Rooms seen had been personalised with furniture items from home and photographs. People had been provided with lockable spaces, call bells were accessible and staff hand washing provisions were available in each of the rooms. Hygiene standards throughout the home were good. Domestic staff are rotad to work each day including weekends. Rooms were found to be clean and tidy and there was no malodour. Suitable arrangements were in place with regards to disposing of soiled waste and protective clothing was available and seen to be worn by staff. There were no issues with regards to maintenance. The handyman carries out all general repairs and health and safety checks. Externally the grounds were also well maintained. People commented about the standard of accommodation provided. They said; the home is well maintained and they maintain the home and garden, well kept. 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. Systems in place ensure that staff are robustly recruited, trained and developed ensuring they have the necessary knowledge and skills needed to support people safely. Evidence: There are currently 65 people living at the home. Based on this and on examination of the rotas sufficient staffing levels were in place. Care staff are supported by a large team of ancillary staff that have responsibility for the kitchen, laundry, domestic, activities and maintenance work. Staffing arrangements were discussed with the manager. Recent recruitment had been undertaken to cover the vacancies. Further bank staff were also being sought so that the home could utilise their own staff therefore reducing any reliance on agency staff. The recruitment files were examined for 3 staff recently employed. These included a bank care worker, unit manager and mental health nurse. Files examined evidenced a completed application, written references, criminal record check (CRB), Independent Safeguarding Authority check (ISA, previously known as POVA), interview information, terms and conditions, health declaration and job description. Where necessary documents had been dated and signed by the manager to verify the information. Care Homes for Older People Page 23 of 30 Evidence: Procedures followed were thorough and ensured that only those people suitable to work at the home had been offered employment. In relation to agency staff we have previously been advised that confirmation of relevant recruitment checks are agreed as part of the service agreement. Suitable arrangements are in place with regards to staff training and development. Information seen for the new staff evidenced they had completed the 3 day induction along with relevant training provided by BUPA. This included: personal best, safeguarding, mandatory health and safety courses as well as familiarising themselves with BUPA policies and procedures. A copy of the homes training matrix was received and the training plan. Information showed that since our last visit in December 2009, further updates have been provided for staff including health and safety, coshh, fire safety and infection control, medication, activities and dementia. Where staff have yet to attend these will be scheduled. Staff also continue to be offered training in NVQs. Information provided on the matrix showed that over 50 of the care staff team have achieved NVQ level 2 or above or are working towards the award. Feedback was received from staff during the inspection and within the feedback surveys about the service. Staff expressed; residents are well cared for and staff make sure they fulfill their needs, we put residents first, I enjoy working at the home, the staff are well trained and caring and BUPA provide well structures care plans that cater for individuals. Another staff member stated on their survey, I feel that over the last 6 months Millfield has undergone a great deal of change, implemented by the new manager and we are now starting to benefit from all the hard work, however I feel that we must continue at this pace so that we can continue to go from strength to strength with commitment and support from all the staff. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear management systems are in place to monitor and review the quality of service. This is to make sure peoples rights are protected. Evidence: The manager had recently been approved by the Commission as the registered manager for the service. She has worked at Millfield since January 2009, prior to this had been employed by BUPA at another establishment as a registered nurse before working her way up to this her first home managers post. The manager has experience of working with older people including people with dementia and physical disabilities. She continues to attend relevant training, such as Leadership and Management, Deprivation of Liberty and Mental Capacity Act ensuring she is up to date with current legislation and good practice guidance. At present the clinical service manager is not at work therefore additional management support has been brought in to assist the manager in the day to day running of the home. Care Homes for Older People Page 25 of 30 Evidence: As already stated within the report, a Statutory requirement Notice was served in December 2009 due to unsafe medication practice. Progress has been made however further improvements are still required. Arrangements in relation to residents personal finances were not explored during this visit. However our previous findings found that BUPA do not act as appointee of people living at the home. Where support is required to manage their affairs residents are generally assisted by family members, a representative or the local authority. Any money held by the home is kept in a residents account and interest is accrued. Individual records were maintained with regards to balances and any transactions, along with receipts. People were able to access money when they need. Quality assurance systems are in place. Internal monitoring is undertaken by members of the management team covering care planning, medication, staffing, training, recruitment and health and safety. Whilst in the main this is effective, systems still need to be improved with regards to medication practice. The management team are aware of this and are being proactive in taking the necessary action to address this. Periodic resident and relative meetings are held, as are staff meetings. The Responsible Individual continues to visit the home each week and completes the Regulation 26 monthly monitoring visits. Reports are held on file. Further auditing is also undertaken by BUPAs quality monitoring team ensuring systems in place are in line with organisational policy and procedure and compliance with good practice guidance and legislation. Time was spent speaking with the handyman about his role and work completed within the home. He is responsible for carrying out all in-house safety checks including fire safety, water temperature, maintenance and equipment ensuring people are kept safe. A random check was also carried out with regards to servicing certificate. Records were found to be in order. We found that the 5 year electric circuit check was due to be completed. The handyman confirmed that this had been scheduled to take place the week following our visit. 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 9 13 The provider must ensure that adequate and effective arrangements are made for the recording, handling, safekeeping and safe administration of medicines. To ensure residents health and wellbeing is not placed at potential risk from harm. 08/07/2010 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 7 Care plans and monitoring records need to clearly evidence how and when people receive their prescribed food supplements so that records show these are being given as directed. Care plans and risk assessments need to clearly detail the agreed protocol when supporting people with rescue medication so that staff are able to support them safely ensuring their health and well being is maintained. The manager is asked to confirm with the Commission that a satisfactory electric circuit check has been completed for the home ensuring the system is safe. Page 28 of 30 2 9 3 38 Care Homes for Older People 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. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - 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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