Care Home: Millfield Lodge

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What the care home does well Prospective residents have a good standard of information to help them in their decision where to live and they receive written confirmation, following a full assessment of their needs, to say if the home is a suitable place for them to live.Millfield LodgeDS0000015176.V376108.R01.S.docVersion 5.2Within the home`s `Compliments` folder we read cards and letters from families that had comments such as `Thankfully within a short time your support of (their) health and well-being rapidly improved.` Written comments in the surveys we received from some of the residents included `Very good general care` and `I am very well looked after.` Other comments we received included ... `the Christmas party and the summer bar-be-cu were very enjoyable` and that the 2008 summer bar-be-cu was `extremely enjoyable` and `Anita + her staff made it a very family day`. People live in a clean and comfortable home with a range of places to sit and visit. The approach to the home had pots, containers and hanging baskets with colourful flowers such as fuchsias. One person wrote in their survey `Environment is exceptionally pleasant, safe, well decorated. There (are) very comfortable lounges, there is a pleasant courtyard where one can sit. I find this of great benefit.` People can be confident that they are cared for by well recruited and generally well-trained staff. The staff we spoke with said that they enjoyed working at the home and there was a `Good team spirit.` What has improved since the last inspection? There were eight areas that we identified at our last inspection where the home needed to improve upon and these are as follows:We expected action to be taken to ensure that appropriate action and care is taken for any person found to have unintentional weight loss. A nutritional assessment tool has since been introduced and the home has gained advice from a dietician about how to manage people`s nutrition and monitoring their weight and body mass index. To ensure that the residents were protected from harm due to falls, we made a requirement for the home to take action for the residents to have access to a falls prevention co-ordinator. Following our inspection the home contacted such a person, who visited the home and provided their expert advice: this requirement has therefore been met. We made an immediate requirement that special instructions for the administration of medicines must be followed to protect residents from harm. We saw that the records made when medicines are given to people indicate the correct time the medication is given and it was confirmed by a member of staff that this was the case. We also observed medication being given to residents which was satisfactory and so consider this requirement to have been met. To ensure that the people were protected from the risk of recurring abuse we made a requirement for the home to follow local safeguarding procedures and, Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 based on the information we have received from the home, this requirement has been met. Information provided by the home, within the AQAA, indicated that action has been taken to reduce the risk of infection by making sure flannels, when used to provide personal care, are used in a safe and appropriate way. To ensure that the people were protected from unsuitable staff we expected the home to take action to ensure that full and satisfactory information is obtained about the staff before they started working at the home. We found this action had been taken when we looked at two of the staff files as there was full and satisfactory information about them. To ensure that the people were protected by a well-managed home we made a requirement for information to be sent to us with regards any untoward incident and any other events occurring in the home. We have since received such information and therefore this requirement has been met. To protect the people by ensuring the accuracy of records we expected action to be taken with regards the way any fire drill was recorded. This record has now the names of the staff who have attended a fire drill practice. Outside of these eight areas the home has also improved its auditing and analysis of people`s falls: a falls analysis is carried out each month and areas are identified where any risks may be reduced. Regular checks are also made on the accuracy of medication records to ensure people receive the medicines prescribed for them. What the care home could do better: To ensure that the people are receiving accurate and up to date care, the care plans must be updated and reflect the person`s individual needs. We expect the home to take action rather than we make a requirement on this occasion. To ensure that people are safe and treated with dignity we expect the home to take action to ensure that the people`s standard of personal care improves with particular regard to oral hygiene and the checking and changing of incontinence pads. We expect the home to take action rather than we make a requirement on this occasion. The temperature of the room used for storage of medication has been recorded above the recommended maximum. We expect the home to continue to closely monitor the temperature and, if necessary take steps to reduce it without the need to make a requirement at this stage.Millfield LodgeDS0000015176.V376108.R01.S.docVersion 5.2People who need help to eat should have this done by the staff on a 1:1 basis. This is to ensure that the person is being valued when having this care and support provided. As a mark of respect we expect the home to take action to improve the way people`s personal clothing is washed and ironed. To ensure that all areas of the home are accessible for people who need help with their mobility we recommend that the home reviews all such areas for people needing such assistance. (This does not appear in the recommendation table but appears in the main body of this report. To ensure that people are moved and transferred in a safe way we expect the staff to follow the people`s moving and handling care plan. We also expect all of the staff to have attended up to date moving and handling training. We have made no requirements on this occasion. Key inspection report CARE HOMES FOR OLDER PEOPLE Millfield Lodge Potton Road Gamlingay Bedfordshire SG19 3LW Lead Inspector Elaine Boismier Unannounced Inspection 7th July 2009 10:00 DS0000015176.V376108.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millfield Lodge Address Potton Road Gamlingay Bedfordshire SG19 3LW 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) 01767 650734 01767 651434 anitaram1@aol.com Ms Anita Ram Ms Anita Ram Care Home 31 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (31) of places Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd July 2008 Brief Description of the Service: Millfield Lodge is situated on the edge of the village of Gamlingay in the South Cambridgeshire District. It is located at the end of a short private drive and is within about a mile of the shops, doctors surgery and village centre. Gamlingay is on the Cambridgeshire-Bedfordshire border and is approximately a 30-minute drive from Cambridge city and a 15-minute drive from Sandy. Millfield Lodge is a single storey building. In 2006 the home was extended and the original home altered and refurbished. The home now has thirty-one single bedrooms. The twenty newer rooms each have a large ensuite shower room; seven rooms have an ensuite toilet, and four rooms have a washbasin. There are two lounges. One of the lounges has a large conservatory attached, which has doors to an enclosed patio area. Both lounges have dining areas and there is a large dining room. There are two bathrooms and a shower room, as well as a kitchen, laundry room, offices and staff room. The home has plenty of parking spaces at the front, and large gardens to the rear and side of the building. The current fees range from £365 to £600 with additional costs to include those for chiropody and hairdressing. Further information about the fees can be obtained from the home. CQC reports are available from the home or from our website at www. cqc.org.uk Millfield Lodge DS0000015176.V376108.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 star. This means the people who use this service experience good quality outcomes. We, The Care Quality Commission (CQC), carried out this unannounced key inspection, by three Inspectors, between 10:00 and 16:50 taking just under 7 hours to complete. Before the inspection we received surveys from twelve of the residents and ten from the staff. We looked at information that we have received about the home since our last key unannounced inspection. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Some of the people living at Millfield Lodge are unable to say what it is like living at there so one of the three Inspectors spent sometime observing and recording the experience of some of the people using the service. This activity is called short observational framework for inspection or SOFI. During this inspection we looked around the premises and looked at some of the documentation. We case tracked two of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them and any visitors they may have. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager and some of the visitors to the home. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. What the service does well: Prospective residents have a good standard of information to help them in their decision where to live and they receive written confirmation, following a full assessment of their needs, to say if the home is a suitable place for them to live. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 6 Within the home’s ‘Compliments’ folder we read cards and letters from families that had comments such as ‘Thankfully within a short time your support of (their) health and well-being rapidly improved.’ Written comments in the surveys we received from some of the residents included ‘Very good general care’ and ‘I am very well looked after.’ Other comments we received included … ‘the Christmas party and the summer bar-be-cu were very enjoyable’ and that the 2008 summer bar-be-cu was ‘extremely enjoyable’ and ‘Anita her staff made it a very family day’. People live in a clean and comfortable home with a range of places to sit and visit. The approach to the home had pots, containers and hanging baskets with colourful flowers such as fuchsias. One person wrote in their survey ‘Environment is exceptionally pleasant, safe, well decorated. There (are) very comfortable lounges, there is a pleasant courtyard where one can sit. I find this of great benefit.’ People can be confident that they are cared for by well recruited and generally well-trained staff. The staff we spoke with said that they enjoyed working at the home and there was a ‘Good team spirit.’ What has improved since the last inspection? There were eight areas that we identified at our last inspection where the home needed to improve upon and these are as follows:We expected action to be taken to ensure that appropriate action and care is taken for any person found to have unintentional weight loss. A nutritional assessment tool has since been introduced and the home has gained advice from a dietician about how to manage people’s nutrition and monitoring their weight and body mass index. To ensure that the residents were protected from harm due to falls, we made a requirement for the home to take action for the residents to have access to a falls prevention co-ordinator. Following our inspection the home contacted such a person, who visited the home and provided their expert advice: this requirement has therefore been met. We made an immediate requirement that special instructions for the administration of medicines must be followed to protect residents from harm. We saw that the records made when medicines are given to people indicate the correct time the medication is given and it was confirmed by a member of staff that this was the case. We also observed medication being given to residents which was satisfactory and so consider this requirement to have been met. To ensure that the people were protected from the risk of recurring abuse we made a requirement for the home to follow local safeguarding procedures and, Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 7 based on the information we have received from the home, this requirement has been met. Information provided by the home, within the AQAA, indicated that action has been taken to reduce the risk of infection by making sure flannels, when used to provide personal care, are used in a safe and appropriate way. To ensure that the people were protected from unsuitable staff we expected the home to take action to ensure that full and satisfactory information is obtained about the staff before they started working at the home. We found this action had been taken when we looked at two of the staff files as there was full and satisfactory information about them. To ensure that the people were protected by a well-managed home we made a requirement for information to be sent to us with regards any untoward incident and any other events occurring in the home. We have since received such information and therefore this requirement has been met. To protect the people by ensuring the accuracy of records we expected action to be taken with regards the way any fire drill was recorded. This record has now the names of the staff who have attended a fire drill practice. Outside of these eight areas the home has also improved its auditing and analysis of people’s falls: a falls analysis is carried out each month and areas are identified where any risks may be reduced. Regular checks are also made on the accuracy of medication records to ensure people receive the medicines prescribed for them. What they could do better: To ensure that the people are receiving accurate and up to date care, the care plans must be updated and reflect the person’s individual needs. We expect the home to take action rather than we make a requirement on this occasion. To ensure that people are safe and treated with dignity we expect the home to take action to ensure that the people’s standard of personal care improves with particular regard to oral hygiene and the checking and changing of incontinence pads. We expect the home to take action rather than we make a requirement on this occasion. The temperature of the room used for storage of medication has been recorded above the recommended maximum. We expect the home to continue to closely monitor the temperature and, if necessary take steps to reduce it without the need to make a requirement at this stage. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 8 People who need help to eat should have this done by the staff on a 1:1 basis. This is to ensure that the person is being valued when having this care and support provided. As a mark of respect we expect the home to take action to improve the way people’s personal clothing is washed and ironed. To ensure that all areas of the home are accessible for people who need help with their mobility we recommend that the home reviews all such areas for people needing such assistance. (This does not appear in the recommendation table but appears in the main body of this report. To ensure that people are moved and transferred in a safe way we expect the staff to follow the people’s moving and handling care plan. We also expect all of the staff to have attended up to date moving and handling training. We have made no requirements on this occasion. 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. Millfield Lodge DS0000015176.V376108.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 Millfield Lodge DS0000015176.V376108.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 People using the service experience good quality outcomes in this area. People can be confident that there is a good standard of information about the home to help them in their decision where to live. Full assessments of each new resident’s needs are taken into consideration before the person is admitted so that the person knows the home will be suitable for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We have received from the home a copy of the up to date Statement of Purpose and Service User’s Guide for 2009 and both of these were satisfactory. All of the 12 residents’ surveys said that the person had received enough information to help them in their decision where to live. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 11 During our last key unannounced inspection, in July 2008, we noted that there were some of the residents who had an increase in their needs since arriving at the home. The home considered that they were no longer able to meet these people’s increased needs and we heard during a safeguarding meeting held in December 2008, when the Registered owner/Manager attended that the home had taken action to request the placing authorities to take action to ensure that these people’s needs were being met. The AQAA told us that ‘A comprehensive pre-admission needs assessment of the prospective service user is completed by senior staff either during their visit to the Home (if they choose this) or staff visit their home, hospital or other establishments and make available photos of the Home environment.’ The AQAA also told us that there have been no placement breakdowns and this indicated that the current pre-admission process is satisfactory. Of those care plans we examined we found that there were full and satisfactory assessments of the person’s needs, including those of the home and a letter had been sent to the prospective resident to confirm that the home could meet their assessed needs. Millfield Lodge DS0000015176.V376108.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. The information in care plans needs work to be done to make sure staff know how to fully meet everyone’s needs in a person centred way. Medication practices are generally of a good standard so that medicines are dealt with safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We examined five people’s care records, as part of our case tracking and as part of our SOFI, and found that these contained risk assessments for malnutrition, falls, moving and handling and the development of pressure sores. We found that the care plans were reviewed each month and four of these five care records had life histories about the person, indicating that the person was valued as a unique person. During our SOFI it was evident that the Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 13 staff knew about the people’s life histories and their individual likes and dislikes. We found, however, that the care plans are currently not person centred. For example we read, for a care plan for breathing, ‘(They) will maintain a clear airway and breathe normally’. This does not inform the reader how the person ‘breathes normally’ and if anything, such as a change in air temperature or increase in exercise, might affect the person’s breathing. Another example said, for a person’s activities care plan, that the person would engage in ‘meaningful activities’ although these were not detailed. Person centred care and person centred care planning means that a person is treated as more than a series of tasks to be performed. The individual is seen as a whole person and acknowledges the persons unique humanity. We found, within one person’s pre-admission assessment, that they had a history of physical abuse and aggression directed at other people. Although the care plan told us that the person was ‘agitated’, we could find no triggers to cause such agitation, how this affected the person and any other people; we could find no record of what the staff could do to alleviate the person’s distress and when the staff were to give the person their prescribed medication to alleviate such behaviour. We noted that body maps were completed for any injury sustained by the resident, such as a skin tear, although we found for one person, who had bruising, there was no body map completed to gauge the extent of their bruising and record this as a baseline observation in order to monitor the person’s progress thereafter. The Manager agreed with our findings and stated that care plan records were to be reviewed as part of the home’s quality assurance. Looking at the homes ‘Compliments’ folder we read cards and letters from families that had comments such as ‘Thankfully within a short time your support (their) health and well-being rapidly improved.’ Speaking with visitors to the home we compared with what we saw and heard with a resident’s care plan. We found that the person’s care plan said that they were to be supported to clean their teeth although we saw that their toothbrush had not been used and the tube of toothpaste was almost full. The person’s visitors told us that these toiletries had been bought ‘some time’ ago. Within this person’s care plan we saw that the person needed assistance with going to the toilet during the day and that they wore incontinence pads. The care plan provided no guidance in how often the person’s incontinence pads were to be checked and we found no record of when these were checked or changed. The visitors considered that the checking and changing of these Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 14 incontinence aids could be better as they found their relative needing such care more frequently than what was currently provided. We expected the home to take appropriate action where any person was found to have unintentional weight loss. The AQAA said ‘Records of monthly weights are recorded correctly and in the event of any special dietary needs, we have sought advice from the Dietician who has no concerns about the dietary needs or weights of the service users.’ As part of our case tracking and SOFI we found that the home has implemented the Malnutrition Universal Screening Tool (MUST) and these had been completed each month. Although one of the people’s MUST care plan stated that the person was to be weighed every two weeks, they had been weighed each month; their weight had remained stable. According to the Manager and her Deputy the advice they had been given, by the dietician, was that any person who had a stable weight, could be weighed once a month. The MUST care plan would need to be amended to reflect such advice. We found, within those care files that we examined, no records of unintentional weight loss experienced by any of the people. The Manager agreed with our findings and said that action would be taken to improve such areas of recording and care practices. We made a requirement for people to have access to a falls prevention coordinator. Following this requirement the home consulted the Cambridgeshire falls protection co-ordinator who, with their manager, considered that although the home came under the Bedfordshire Primary Care Trust there were a higher number of people living at the home who were funded by Cambridgeshire. With this information the falls prevention co-ordinator visited the home and offered their expert advice. This requirement has been met. Following on from our inspection in July 2008 we expected the home to take action to reduce the spread of infection when providing personal care to people when using flannels to wash people. The AQAA said ‘Staff use appropriate flannels, towels, incontinent wipes and pads when providing personal hygiene needs of the service users.’ A district nurse visiting the home the day we were inspecting, said that the home is visited at least twice each week by a district nurse and felt that the home had a good relationship with the district nursing service. In addition to the district nurse we saw and briefly met a health care professional who specialised in caring for people with Parkinson’s disease and they had visited one of the people. From our examination of people’s care records we saw that people also have access to opticians, chiropodists and community psychiatric services. Our SOFI was carried out over a period of two hours and we found that the interaction of residents with other residents and staff with residents were, on Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 15 the whole, a positive experience for the residents as they showed positive well-being. A person who was ‘passive’ had less interaction from the staff to engage them, thereby there was a loss of opportunities for the staff to encourage and promote a positive sense of well-being for this person. All of the 12 residents’ surveys said the person always or usually received the care, including medical care, and support that they needed. Some of the surveys added that the home does well as it provides ‘Very good general care’ and ‘I am very well looked after.’ Medicines are stored securely for the protection of residents. The temperature of the room is closely monitored but it has been recorded above the recommended range on several occasions during the previous month, and was above the maximum at the time of the inspection. The failure to stored medicines at the correct temperature could result in people receiving medicines that are ineffective. We expect the close monitoring to continue and, if necessary, steps must be taken to reduce the temperature to acceptable levels, without the need to make a requirement on this occasion. Separate dedicated storage is provided for controlled drugs and for medicines requiring cold storage. These facilities were acceptable. We looked at the medication and medication records for several residents in the home. Records are made when medicines are received into the home, when they are given to people and when they are disposed of. These records were in good order, providing an audit trail of medicines in use and demonstrate that the people receive the medicines prescribed for them. At our last inspection in July 2008 we saw that some people were given medication not taking into account the special instructions for their use. This could put people at risk and we made a requirement about this. During this inspection we noted that the records of such medicines are made correctly and staff told us that the medication is given properly, so this requirement has been met. The Manager undertakes regular checks of the medication and medication records and this is good practice as errors can be picked up and resolved quickly. We watched some medicines being given to people at lunchtime and this was done with due regard to each person’s dignity and personal choice. We heard a staff member ask a person if they were “ready to take” their medicines and the staff member stayed with people while they were supported to take their medicines. Staff training on the safe use of medicines is of a good standard and people are assessed to ensure they are competent to put this knowledge into practice. One person in the home looks after and takes his own medicines and the risks to himself and other people in the home had been assessed and regularly Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 16 reviewed. We were told that his ability to do so safely is now under question but this was not supported by the records made in the care plan. We saw that the staff knocked on people’s bedroom doors before they entered and we heard the staff call the residents by their first names, rather than use endearments such as ‘Love’ or ‘Dear’. During our SOFI we saw that the staff would include the residents in their conversations when speaking with their colleagues. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. People have opportunities to live a good social life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In June 2009 we received the results of the home’s survey: with regards to the standards of activities one of the surveys said that the activities were satisfactory with the remaining surveys saying that the activities were either good (2) or excellent (8). All of the 12 residents’ surveys said that the home always or usually arranged activities that the person could take part in if they wanted to. One of the comments said that …’the Christmas party and the summer bar-be-cu were very enjoyable’. One of the resident’s surveys, completed on their behalf by their family, told us that the 2008 summer bar-be-cu was ‘extremely enjoyable’ and ‘Anita her staff made it a very family day’. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 18 We saw activities such as exercise games taking place and people encouraged to read newspapers and books. The people’s care records indicated that they take part in quizzes and listen to the television and music. A member of the staff told us that there are arrangements in place to take people out of the home to a local garden centre and to go shopping in one of the nearby towns. During our SOFI we noted that the staff were informing people about some of the latest world news. We saw people’s bedrooms had their personal effects such as photographs and pictures. We saw people receiving visitors and the visitors’ record book indicated that the residents’ could receive their guests any time during the day. One of the resident’s surveys, completed on their behalf by a relative, said that the home was ‘very welcoming’. All of the 12 residents’ surveys said that the person always or usually liked their meals. One of the people added ‘Excellent’. Other written comments included ‘The food is excellent and plentiful, well cooked and presented. There is always a choice’ and ‘Catering exelent (sic)’. Two of the Inspectors sampled the main meal of lamb hot pot accompanied with carrots, peas and potatoes and stated that it was ‘tasty.’ We saw the people offered fruit (bananas and orange segments) and biscuits during the mid morning with a drink; and during the day we saw the people were offered, and encouraged to have, a drink. We saw staff helping some of the people with their food on a 1:1 basis although this was not always the case: we saw a member of the staff helping two of the residents with eating, at the same time; another member of the staff was helping one of the residents and at the same time going over to another resident to prompt them to eat. This indicates that these people were not truly valued, at least on this occasion. As part of the home’s quality assurance the Manager stated that the meal time experience for the residents is under a review. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. Generally people can be confident that they will be listened to and they will be safeguarded from the risk of recurring abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In January 2009 we received copies of correspondence to the home, from a complainant who felt that the home had not listened to their concerns. The home investigated the complaint and found some of the allegations were upheld with particular regard to the standards of personal care and action was taken by the home to rectify the issue. Since then we have received no further contact from the complainant. According to the AQAA ‘‘The feedback from service users meetings and relatives meetings is very positive of their relatives, standards of care. They state they always ‘feel reassured and encouraged as the management always listens and takes appropriate actions when issues are raised’.’’ The AQAA told us that within the last 12 months the home has received 3 complaints, all of which had been resolved within the 28-day time period and Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 20 these allegations had been partly upheld. We looked at the record of complaints and this contained detailed accounts of the nature of the complaints. We heard, from visitors their less than positive views about the laundry (clothes not being washed or ironed properly and we saw examples of this): these concerns were raised and addressed at the residents’ and relatives’ meeting in an open manner and had been recorded in the minutes of the meeting held on the 25th May 2009. (The Manager stated that she would take action to improve the standard of how people’s personal clothes are washed and ironed). Visitors told us that although they did not like raising concerns but, when they had, the home had taken action and the visitors were satisfied with the outcome. All of the 12 residents’ surveys said that the person knew who to speak to if they were unhappy about something with one person adding that ‘Anita (the Manager) always listen (sic) to me’. All of these surveys said that person knew how to make a formal complaint with one person adding ‘There is a complaint procedure in my room and in (the) reception area’. Another of these surveys said that ‘I am totally satisfied with everything’. All of the ten surveys from the staff said that the person knew what to do if any one had a concern about the home. A requirement was made to ensure that the people were protected to reduce the risk of abuse. The AQAA said ‘We have been very vigilant in detecting abuse. We have sought advice from the Cambridgeshire and Bedfordshire SOVA Lead and Duty Coordinator…. We have also had open discussions regarding these situations with health and social care professionals and the police.’ We have received information from the home, including copies of referrals to the local safeguarding teams and this information indicated that there has been an improvement in this area with the requirement being met. The staff who we spoke with told us what they would do if they suspected abuse had occurred against any of the residents, including where they would find contact numbers for the safeguarding agencies, such as the local authority. We were satisfied with their responses as these indicated that the people would be protected from abuse by knowledgeable staff. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. People live in a clean and comfortable home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is on one level and a new security system has been provided to ensure that people are safe and any one visiting the home can only do so with the home being aware of them. The approach to the home had pots, containers and hanging baskets with colourful flowers such as fuchsias and the lawns surrounding the home were tidy. A summer house had furniture for people to sit in and there were benches Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 22 around the back garden path. Walking around the premises we noted that some areas may be difficult to access for people who use a wheelchair, such as going into the inner courtyard and we recommend that the home reviews the accessibility of all areas of the home for people needing such assistance. The home’s survey indicated that the respondents were satisfied with the cleanliness and maintenance of the home from being good (2) to excellent (10). All of the residents’ surveys said that he home was always clean and fresh. Comments included ‘The home is clean and tidy’ and ‘Environment is exceptionally pleasant, safe, well decorated. There (are) very comfortable lounges, there is a pleasant courtyard where one can sit. I find this of great benefit.’ Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. People can be confident that they are cared for by well recruited and generally well-trained staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We received positive comments, about the staff, in some of the residents’ surveys to include; ‘Staff are all very kind, very patient, attentive always willing to help if necessary’ and ‘The staff are very friendly and helpful’. We saw that the staff were attentive and caring towards the residents. The staff we spoke with said that they enjoyed working at the home and found that there was a ‘Good team spirit’. Currently the home has one staff vacancy and according to the Manager agency staff are not used. The staff we spoke with said that there was always enough staff on duty. We saw, during our SOFI, that there was always a member of the staff in the lounge area, called ‘Rose Lounge’, and we also saw that this was the case in the other lounge area, called ‘Tulip Lounge’. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 24 All of the ten surveys from the staff said that there was always or usually enough staff on duty to meet the needs of the residents. The surveys indicated that the staff were contented working at the home. Comments to support this included ‘I enjoy working here…My seniors are very supportive and understanding’ and ‘I am very happy with my manger (sic) and all the support I get…’ According to the AQAA ‘Well over 50 of staff have achieved qualifications of NVQ level 2 or above and others are working towards them.’ (NVQ = National Vocational Qualification). We received information, at the time of our inspection, that this percentage is 75 . We found, during our inspection in July 2008, that most of the required information about the staff was available with the exception of an unexplained gap in employment history between November 2007 and March 2008. We expected the home to manage this issue rather than we make a requirement on this occasion. We examined two staff recruitment files and we found that there was all the required information about the staff and this was satisfactory. According to the AQAA 22 of the staff have attended training in the prevention and management of infection with 13 of the care staff having attended training in malnutrition and helping people with their food. All of the ten staff surveys said that the person was satisfied with their induction and ongoing training that prepared the person to be able to carry out their job effectively and to be able to meet the needs of the residents. Comments included in the staff surveys indicated that the staff are encouraged and supported to gain recognised qualifications, ‘The home has given me the opportunity to get my NVQs and to start a new career’ and ‘Working here is (sic) given me a lot of opportuntys (sic) and gain more experience, and provide me to have a higher qualification’. We saw, from our examination of two staff training files, that the home uses the Skills for Care Induction Standards for social care and these were discussed with the member of staff and signed off by their assessor. Other training records, and discussion with the staff, indicated that the staff have had opportunities to attend training in caring for a person with dementia, caring for a person with Parkinson’s disease and caring for people who have difficulties with continence. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. Although there is some risk to people when they need help to move about they can be confident that the home is otherwise managed well. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Registered Manager is also the Registered Provider of the home. She is supported by an Acting Manager, a Deputy Manager and a Team Leader to help in the management of the home. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 26 We made a requirement for the home to notify us of any untoward event and any other events occurring in the home (such as injuries occurring to residents and safeguarding alerts) and we have received such required information. This requirement has been met. We received the results of a survey carried out by the home, dated the 31st May 2009, when 15 questionnaires were circulated and 12 written responses and one verbal response were received. Overall the home received positive views to those questions asked. The AQAA was completed in a detailed and timely manner and it identified areas where the home does well in and areas were identified for the home to improve in, within the next 12 months such as ‘develop care practice forums for care assistants specifically on Mental Capacity Act and Deprivation of Liberty Standards’ and ‘carry out further landscaping of back gardens and tarmac front driveway.’ As part of our case tracking we examined the two people’s personal allowance records and compared these with the amounts of available monies. We also examined one other person’s personal monies and their associated records. Following a discussion with the Deputy Manager we found that the amounts available reconciled with the relevant records. We have received copies of the fire safety officer (FSO) reports of their inspections carried out since our last inspection. The first FSO report, dated the 5th December 2008, identified that some of the fire doors did not meet the fire safety regulations. The second FSO report, dated the 5th January 2009, said that the home had taken appropriate action to meet these fire safety regulations. We expected the home to record the names of any person attending a fire drill and we found action had been taken to improve this method of recording when we examined the relevant documentation. Fire drills had been carried out, including late evening when the night staff were on duty, during the 17th and 18th June 2009 and the names of the staff in attendance were now recorded. The staff told us that they had attended fire safety training and records of this training were seen with 13 of the 23 staff having attended fire safety training on the 29th April 2009. During our SOFI we saw that the staff moved and handled people safely although we saw that, during our case tracking, two members of the staff start to help a resident from sitting to standing by placing their arms under the person’s armpits. The Inspector stopped this unsafe practice by asking the members of staff if the home had moving and handling belts; this question prompted the staff to stop this unsafe moving and handling technique. We later examined the person’s care plan for moving and handling and this indicated that the person needed the assistance with a moving and handling belt. Following on from this we examined the staff training records for safe Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 27 moving and handling and we found some, but not all, of the staff have attended this training within the last twelve months. We discussed our findings with the Manager who told us that arrangements are in place for staff to attend this training on the 15th September 2009. It is our expectation that all of the staff who do not have in date training attend this 15th September 2009 session to ensure that all of the residents are protected from the risk of harm due to unsafe moving and handling techniques. Fire alarms and emergency lights were checked weekly and monthly respectively and records of these were seen. A certificate, dated 6th March 2009, confirmed that the hoists, used to move and handle people, were safe. Temperatures of hot water accessed by the residents in baths were tested each week and records of these indicated that the hot water is delivered at the safe level of 42 to 43 degrees centigrade. A certificate, dated 21st May 2009, indicated that the portable appliance (electrical) equipment had been checked for safety. Following on from our inspection in July 2008, the home has introduced a falls analysis and this takes into account, for example, what medication the person is taking and any environmental issues. The records of this analysis indicated that no one person has had more than two falls. Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 28 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 x 3 x 3 x x 2 Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard Good Practice Recommendations Millfield Lodge DS0000015176.V376108.R01.S.doc Version 5.2 Page 30 Care Quality Commission Eastern City Gate Gallowgate Newcastle-Upon-Tyne NE1 4PA National Enquiry Line: 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. 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