Care Home: Mills Meadow

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What the care home does well Comprehensive assessments are made of the needs of residents, and care plans in place are regularly reviewed to ensure that people’s changing needs are picked up and met. These plans have been changed to give more and better information about residents for the carers. There are several ways in which changes in residents’ needs and care are passed on to staff coming on duty, whether team leaders or care staff. The home provides residents with a homely environment where they are able to carry out social activities that meet their needs and to receive visitors to Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 maintain family and social contacts. Residents told us that staff were all very helpful and encouraged them to do as much as they could for themselves. Our survey told us that residents felt able to talk to staff if there was anything worrying them. The home is purpose built, safe and well maintained with communal areas and access to safe grounds. The home has a programme for continuously refurbishing and redecorating the home to improve the environment for residents. The staff employed by Mills Meadow are appropriately trained and suitable to care for the needs of older people. Over 85% of staff have an NVQ relevant to the role they perform. Some are studying for higher Level NVQs. The home has a well trained catering service, with regular consultation with residents on their likes and dislikes. It ensures that each person’s nutritional and dietary needs are met. What has improved since the last inspection? The manager has implemented many improvements to care practices and records. A greater stability in the senior team has allowed greater clarity of roles and responsibilities. More training has been made available to staff to support the development of better care practices. All team leaders are trained to do moving and handling risk assessments, all staff have been trained on a nutrition screening tool, falls prevention is a key area with the identification of a falls champion to maintain staff awareness and skills. Care plans are more detailed after the introduction of more comprehensive pre-admission assessments. Plans are more person-centred to ensure that the resident’s perspective is not lost. Designated hours have been provided to the special needs unit for activities, with a special activities area. The garden continues to be improved and made more accessible and safe with the help of a local community organisation. Residents’ protection from abuse has been increased with a training programme run by the in-house trainer who is a team leader. All senior staff have been trained on the Mental Capacity Act implementation to protect residents’ rights.Mills MeadowDS0000038816.V377687.R01.S.docVersion 5.2 What the care home could do better: No requirements or recommendations have been made as a result of this inspection. The AQAA listed areas where the home is planning to improve its care. These included improving access for residents to air their views, continuing a rolling training programme for staff, updating the kitchen areas in all units, and replace the flooring of the dining area of the special needs unit, the introduction of life story books to help staff understand the lives and experiences of those with dementia. Key inspection report CARE HOMES FOR OLDER PEOPLE Mills Meadow Fore Street Framlingham Suffolk IP13 9DF Lead Inspector John Goodship Unannounced Inspection 24th August 2009 09:00 DS0000038816.V377687.R01.S.do c Version 5.3 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. Mills Meadow DS0000038816.V377687.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 Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mills Meadow Address Fore Street Framlingham Suffolk IP13 9DF 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) 01728 724580 01728 724959 lucy.roughley@socserv.suffolkcc.gov.uk Suffolk County Council Deborah Willcox Care Home 35 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (35) of places Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user aged over 65 years of age, whose name was given to the Commission on 05/07/06 who requires care by reason of dementia and is living on Rose Hamlet. 16th September 2008 Date of last inspection Brief Description of the Service: Mills Meadow Framlingham is a residential care home for older people, which is owned and managed by Suffolk County Council, Department of Adult Social Care. The home has a total of 35 registered care beds. The home is registered to provide care for older people; up to 16 of these may require dementia care. Included in both categories are short-term care beds. The home is situated in the centre of Framlingham, a small market town in rural Suffolk. As such, the home is close to shops, and other community facilities and resources. It also benefits from having its own transport, used for outings, appointments, and activities. The home is all single storey, divided into a number of Hamlets - selfcontained units providing residential care. Poppy Hamlet accommodates 15 residents with dementia / special needs. Rose, Viola and Iris Hamlets each accommodate 6 residents. One named person with dementia is cared for on the mainstream hamlets. Iris Hamlet is also used to accommodate some respite care residents. There is also a 20 place Day Centre which is not subject to inspection by the Care Quality Commission. The fees for new admissions at the date of the inspection were £709.00 per week. Mills Meadow DS0000038816.V377687.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 two star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection which concentrated on the outcomes for the people using the service. These outcomes were related to the key national minimum standards listed under each Outcome Group in the report. The inspection visit took place on a weekday and lasted seven and a half hours. We toured the building, visiting each hamlet. We spoke to one resident on Viola, two on Rose, and observed residents on Poppy, the special needs unit. We interviewed three care staff as well as the manager, and a visiting relative. We also spoke to other staff as we went round including catering and laundry staff. Before the inspection, a questionnaire survey, called: ‘Have your say about Mills Meadow’, was sent out by the Commission, via the manager, for residents and staff to use to give us their views on aspects of the home. We received back eight survey forms from residents, and six from staff. Their answers to the questions and any additional comments have been included in the appropriate sections of this report. A self-assessment form was required to be completed by the manager, giving us details of how the home believed it met the national minimum standards and its plans for improvements. This form is called the Annual Quality Assurance Assessment and is referred to in the report as the AQAA. What the service does well: Comprehensive assessments are made of the needs of residents, and care plans in place are regularly reviewed to ensure that people’s changing needs are picked up and met. These plans have been changed to give more and better information about residents for the carers. There are several ways in which changes in residents’ needs and care are passed on to staff coming on duty, whether team leaders or care staff. The home provides residents with a homely environment where they are able to carry out social activities that meet their needs and to receive visitors to Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 Page 6 maintain family and social contacts. Residents told us that staff were all very helpful and encouraged them to do as much as they could for themselves. Our survey told us that residents felt able to talk to staff if there was anything worrying them. The home is purpose built, safe and well maintained with communal areas and access to safe grounds. The home has a programme for continuously refurbishing and redecorating the home to improve the environment for residents. The staff employed by Mills Meadow are appropriately trained and suitable to care for the needs of older people. Over 85 of staff have an NVQ relevant to the role they perform. Some are studying for higher Level NVQs. The home has a well trained catering service, with regular consultation with residents on their likes and dislikes. It ensures that each person’s nutritional and dietary needs are met. What has improved since the last inspection? The manager has implemented many improvements to care practices and records. A greater stability in the senior team has allowed greater clarity of roles and responsibilities. More training has been made available to staff to support the development of better care practices. All team leaders are trained to do moving and handling risk assessments, all staff have been trained on a nutrition screening tool, falls prevention is a key area with the identification of a falls champion to maintain staff awareness and skills. Care plans are more detailed after the introduction of more comprehensive pre-admission assessments. Plans are more person-centred to ensure that the resident’s perspective is not lost. Designated hours have been provided to the special needs unit for activities, with a special activities area. The garden continues to be improved and made more accessible and safe with the help of a local community organisation. Residents’ protection from abuse has been increased with a training programme run by the in-house trainer who is a team leader. All senior staff have been trained on the Mental Capacity Act implementation to protect residents’ rights. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 Page 7 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. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.2 Page 8 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 Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 9 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, 2, 3, 5. Standard 6 is not applicable to this home. People using the service experience good quality outcomes in this area. Residents can expect to have sufficient information to decide if the home is where they wish to live. They can be assured that their needs will be fully assessed to make sure that the home can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that the Statement of Purpose and Service Users’ Guide contained all the information required by the regulations to give prospective residents the Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 10 information they would need when selecting the home. This information included the organisation of the home, the qualifications of staff and the range of needs which the home was registered to meet. They had been revised in July 2009. In places there was still reference to the Commission for Social Care Inspection, the previous regulatory body. However the complaints information used the new name and address. All eight residents who replied to our survey said that they had received enough information to help them decide if this home was the right place for them. We noted that a copy of the Service Users Guide was pinned on the notice board in each hamlet. Later we noted that a copy was kept in all bedrooms. We noted that all the residents’ files that we saw had a copy of their contract. Six of the residents who replied to our survey said they had received contracts. The other two could not remember. The AQAA also confirmed that all new admissions were given contracts which they signed at the end of their trial period. The statement of fees was included in the Service Users’ Guide. The AQAA stated that prospective residents were fully assessed prior to moving into the home, had a fully informed choice about where they wished to live, and that no admission took place without the home having received a Community Care Assessment of need and an assessment carried out by the home. Two residents’ files that we saw had pre-admission assessments. These covered a comprehensive range of daily living needs and medical information about each person. The manager told us that the majority of admissions involve residents referred from hospital. It was usually impracticable for them to make a visit to the home. Other prospective admissions were offered a trial day at the home. The AQAA told us that after the first six weeks, a review meeting is held with the resident and their family to review the care plan and confirm that Mills Meadow is the right place for them. We spoke to a visiting relative who told us that they had not been happy with the hospital trying to discharge their family member home, but were very happy with Mills Meadow. “They have blossomed since they have been here”. Places were usually available for short-term respite care. The same assessments were made for these residents. The AQAA told us that the council had produced a revised protocol for all admissions to short-term care to clarify responsibilities and referral routes. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 11 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. Residents can be assured that their health, personal and social care needs will be identified, monitored and reviewed regularly. They can be assured that they are protected by the home’s medication procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We examined the care plans for two residents, both on the special needs unit. One of them had originally come to stay at the home as a short-term care resident but had now become a permanent resident. Both residents had full care plans in place, which covered all aspects of care such as personal care, moving and handling, continence management, nutrition and night care Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 12 arrangements.The plans contained photographs of the residents, and risk assessments covered moving and handling, smoking, nutrition and weight loss as appropriate. These were recorded as being reviewed as needed. The bathing records which included showering showed regular sessions. Any occasions when the resident declined to have a bath or shower were recorded. The staff used the Malnutrition Universal Screening Tool (MUST) to assess and monitor the diet and weight of residents. Nutrition reviews took place monthly. The manager told us that referrals were made to the hospital dietitians who responded very quickly. The daily record completed at the end of each shift contained good information on what had happened to the resident during the shift, including, as appropriate, what personal care had been given, fluid intake, whether they had had any visitors, and the resident’s general demeanour. We saw evidence that these care plans were reviewed regularly, usually monthly. In addition there were annual reviews. The record of these reviews showed that the residents and their relatives, as well as key staff, were present. One of the team leaders was responsible for auditing that these reviews took place. The AQAA told us that one complaint had highlighted the need for further staff training in catheter care and awareness of pressure area care. This had resulted in the manager arranging for some in-house training with a district nurse. We looked in detail at the records of a resident about whom a deprivation of liberty referral had been made. This was because the home had restricted the number of continence pads kept in their room. There were numerous entries in the daily record for this resident warning staff of their tendency to stuff the pads down the WC. It had been decided at some point to leave in their room only the four pads which the Continence adviser had said they should need each day. However there was a note in the daily record that if necessary more pads were available from the team leader. At a team leader/manager meeting in early August where the effectiveness of this policy was discussed, the manager said that she asked one of the team leaders to check with the Deprivation of Liberty team whether this restriction should be referred to them. They confirmed it should be. Two assessors from the Deprivation of Liberty team arrived during our inspection. They agreed afterwards that there was no deprivation of liberty. At lunchtime, we observed this resident having their lunch in the unit dining room. They did not appear to be uncomfortable or worried. The home had been proactive in the prevention of falls. Incidents of falls were analysed by a carer called the falls champion. In addition, the AQAA told us that a theatre group had visited the home to raise awareness among residents Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 13 and staff on how to prevent falls. This had been arranged in conjunction with the NHS fall prevention co-ordinator. We observed the lunchtime medication round in one of the hamlets. The home had recently moved over to the monitored dosage system, which delivers tablets in blister packs. The proper procedure was followed with the record being signed after the medication was administered. We saw no gaps in signatures for previous administrations. A team leader told us that it was the responsibility of team leaders to check the medication records at each handover to identify any gaps. One medication error had been reported to us since the previous inspection. The AQAA told us about the checking and auditing systems in place to ensure the safety of residents. Staff were required to complete a medication error form as well as an incident record. Staff’s competency was assessed by team leaders at six monthly intervals. Records were audited twice a month by the team leaders and the manager said she did unannounced audits. All the staff surveys said there was always or usually enough staff to meet the individual needs of residents. All the eight residents who replied to our survey said staff always or usually listened and acted on what they said. We observed staff treating residents with dignity and respecting their privacy. We heard a cleaner knocking on a bedroom door and ask if it was “OK to clean your bathroom?” The Council’s quality monitoring team on their visit in May 2009 spoke to ten residents. ‘Overall the feedback from residents was overwhelmingly positive’. Comments included: Staff are all very helpful. People feel able to talk to staff if there is anything worrying them. Staff put things right when they are told about problems. We spoke to a visiting relative who told us that “the staff are very good at keeping me informed. Staff always have time to talk to me”. We observed that staff made normal conversation with all residents, mostly as part of their tasks but also as general social talk. Some staff did say that they would like more time just to sit and talk, or reminisce with residents. Some residents said they would like more of that but they acknowledged that the staff ‘have lots to do’. The quality monitoring report said that a partially sighted resident told them that not all staff told them who they were when they approached them and they found it confusing. The manager confirmed to us that the team had passed this comment on as a general reminder to all staff. Our previous inspections had shown that there were several communication methods used to ensure information was passed on from shift to shift, and from team leader to team leader. We saw that on each unit there was a Communication Book to alert incoming staff of eg appointments with the hairdresser, planned visit by a relative. There was a general Communication Book in the handover room, and the team leaders had their own Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 14 Communication Book. The manager explained who should put entries in these books and when they should be read. She did say that she had tightened up the handover procedure to make it more focussed, professional and less time consuming. It had become ‘gossipy and judgemental’. The six staff who replied to our survey said that the ways they shared information with other carers and the home manager always or usually worked well. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Residents can be assured that they can choose how to spend their time, with opportunities for social activities. They can expect to be offered a wholesome diet suited to their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Seven of the eight residents in our survey said that the home always or usually arranged activities that they could take part in. One said that happened only sometimes. The AQAA listed several events which the home had organised over the past year, including seven boat trips, day trips to Felixstowe, a barbecue, theatre trips at Christmas, and visits to supermarkets and garden centres. The home had access to the bus used jointly with the day centre. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 16 There were photos on display in the hall showing residents at the local flower show and the boat trips. The day centre that was part of the building was run separately from the residential home. Residents were not able to use the centre unless there was a member of the care staff with them. However users of the day centre joined up with residents for outings. Although the home was not yet able to fund an activities co-ordinator, steps had been taken to fill this gap. A team leader had set up an activities committee with residents and relatives to get their views and prepare an annual programme of activities. A carer on the special needs unit organised twice weekly sessions on that unit involving baking, arts and crafts, and quizzes. We watched a carer on this unit playing skittles with four residents. In another unit, we saw one carer ask a resident in one of the small lounges if they wanted to watch a DVD. They said they did so it was put on. We watched as some residents took part in making plum jam on Rose unit. Some had come from other units to join in. The carer told us that one of the residents on that unit was able to do some gardening, for example growing tomatoes. This person told us that “I’m glad to be here. I go down the town each day and have a cup of coffee”. We saw activities calendars on the notice boards in each unit. In August, there was Keep Fit on Mondays, quizzes, a boat trip from Beccles, bingo and the weekly church service. On one unit we spoke to a resident who was attempting a jigsaw with the help of a carer. They were pleased to show us that some of their previous work had been framed and was hanging on the walls. Activities were recorded in the daily record sheet for each person. We noted entries such as ‘out with family’, ‘tea in the garden’, ‘attended church service’. Spiritual needs were catered for by the visits of local churches who provided in-house services. The AQAA told us that four residents had been supported to attend the church of their choice. Seven of the residents in our survey said they always liked the meals in the home. One said that they usually did. There was a lunch board on each unit giving the choices for the day. That day it was lasagne or savoury mince, followed by sticky toffee pudding. One resident told us that “I enjoy the meals but I have to be careful what I eat”. We have described in the previous section how the staff monitor the diets and weight of residents using the MUST system. The cooks were included in residents’ meetings and received a monthly Comments sheet where staff recorded comments made by residents about each meal. Comments included praise and criticism, such as the amount of salt used in the cooking, the quality of the meat, and how nice a particular dish was. We were told that action would be taken to correct any shortfalls if possible. The kitchen also supplied lunches for the day centre. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 17 We noted that, throughout the home, residents had easy access to drinks wherever they were sitting. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 18 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. Residents can be assured that their complaints will be properly dealt with, and they will be protected from abuse by appropriate training and procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All but one resident said in the survey that they knew how to make a complaint. The complaints policy was described in the Statement of Purpose and in the Service User Guide. The AQAA told us that there had been nine complaints in the past twelve months. We looked at the complaints record book and saw that of the seven complaints made since January 2009, five had come from the same resident or their family. Eight of the nine complaints had been upheld. We also saw many examples of favourable comments which the home had received from relatives. One person said “staff put things right when they are told about problems”. In addition two safeguarding referrals had been made by the home’s manager, one concerning a short-term resident who did not want to return home, and Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 19 one arising from an allegation of emotional abuse and intimidation by a staff member. These had been reported in the proper way. A whistle blowing complaint had also been received by the Commission. All these had been investigated appropriately by the provider. In addition the provider had asked their Outcomes and Quality Monitoring Team to visit and report on Mills Meadow in the way they would other homes not owned by the Council. This report concluded that the residents were overwhelmingly positive about the home. The provider is the lead agency regarding the County Safeguarding Procedure, and had set up safeguarding training for all staff during the past year together with the home’s in-house trainer. All team leaders and the manager had attended training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff awareness of residents’ rights under this legislation was demonstrated by the referral described under ‘Health and Personal Care’. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 20 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): 19,20,24,25,26. People using the service experience good quality outcomes in this area. Residents can be assured that the home is safe, and that it provides a clean and hygienic environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was a single storey building so all areas were accessible, including the gardens. The home had been helped by the local Rotary Club to reorganise and set out some of the internal gardens to make them more accessible and Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 21 interesting with raised beds. Two areas were completely enclosed to enable people with dementia to walk freely and securely. All bedrooms were for single occupation and had en-suite toilet and washbasin facilities. There was a communal bathroom on each hamlet with some having assisted bathing and/or shower facilities. Bathrooms had liquid soap and paper towels, and supplies of protective clothing. We saw a bar of soap in one bathroom. This was removed immediately by a carer who suggested that a resident had left it there. The carer understood that bars of soap must only be used by one person to reduce the risk of cross-infection. A sample of hot water temperatures showed that all were within the safe range. Antibacterial hand gel was available at the entry to each hamlet. We saw some of the residents’ rooms. All were personalised with their own possessions and in some cases an item of furniture. Most bedrooms had a door sign that included the name of the resident and in many instances a picture of their choice. The AQAA told us that ten bedrooms had been redecorated and four bedroom carpets replaced. We saw that all units had new lounge chairs. The home had a large laundry room with two washing machines each with a sluice cycle, and a recently replaced tumble drier. There was a separate sewing room, used as a store and for ironing, and a linen room used for sorting residents’ clothes. The laundry assistant told us that the home used red alginate bags for soiled items. This enabled the bags to be put directly into the washing machine without staff handling the items. This reduced the risk of cross infection. All the residents who replied to our survey said that the home was always or usually fresh and clean. The AQAA told us that the home had improved the standard of cleaning with the recruitment of a full team of domestic staff. We noted that one room that was not occupied had been prepared for a new resident. There was a notice on the door stating that it was clean and ready to use. We were told that the home had bought specialised waste bins for continence pads disposal which helped to promote infection control. The AQAA told us that all staff had received training in infection control. This was confirmed by two staff we spoke to. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 22 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. Residents can expect to be cared for by well-trained staff, and be protected by the home’s recruitment procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We interviewed a team leader and 2 carers in private. The team leader was clear that the management situation had improved, both in terms of relationships between team leaders and home manager and in terms of the improved care practices which they were implementing, such as structured care plans and residents’ increased choices. They also felt well supported in their role by the manager. The carers considered their team leader to be their manager in the first instance, and this person was the carers’ first point of contact for support, information and supervision. Both carers were content in their work. One said “I really love my job and look forward to going to work.” The other, newly appointed, carer said “The staff always have a smile on their faces when dealing with residents”. The AQAA told us that there had been Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 23 several staff on long term sickness which meant using agency staff. But the team leader told us “now we have more permanent staff, I know the residents are very well cared for”. The staffing rota showed us that the planned staffing level during the daytime was three carers on Poppy hamlet, for fifteen people with special needs, and three carers covering the other eighteen residents in three hamlets. A team leader managed each shift, and during the week, the manager was available. At night there were two carers and a team leader on duty. On the day of our visit, there was an additional carer who had recently started and was shadowing other carers during their induction period. The manager told us that there were normally three staff on at night including a team leader. This could reduce to two staff if the home had more than ten vacancies. All the staff who replied to our survey said that there was usually enough staff to meet the individual needs of all the people who used the service. The AQAA told us that the home had put in place a full-time senior team leader to support the manager in making and implementing improvements to the home. All team leaders had NVQ Level 3 and were undertaking the Institute of Leadership and Management level 2. We examined the recruitment files for two members of staff, who had been appointed since the previous inspection. All contained two references, complete application forms, identification documents and Criminal Records Bureau certificates. These checks helped to protect residents. The files also contained information about the person’s induction training, supervision and further training. These were confirmed in interviews with two staff. We saw the training records for the staff which included all the mandatory courses on for example moving and handling, fire procedures and food hygiene. Other more specialised courses had been held on catheter care, promoting continence, supporting people with dementia and nutrition awareness. Staff told us in their surveys that they were given sufficient and appropriate training to help them support the needs of the residents. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 24 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): 31,32,33,35,36,38, People using the service experience good quality outcomes in this area. Residents can expect the home to be well run, by competent staff. Their safety is assured by the home’s health and safety practices. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents’ views on their care from comments in our survey, and in a recent provider’s survey, were very positive. One resident said: “things were already Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 25 improving with the new manager. I am much happier living here now’. Another said: “I am very happy and pleased to be here. I think the home is well organised”. Another said: “I am proud and happy to be one of the family of residents of Mills Meadow”. The manager came into post in August 2008 and was registered with the Commission in December 2008. She had previous experience of managing care homes in East Anglia and Oxfordshire. She was qualified with NVQ Level 4 in Care and Management, and was currently studying for the Level 5 certificate of the Institute of Leadership and Management. Staff told us that they regularly received support from their manager. The AQAA told us that care staff meetings were held monthly with whole staff team meetings every four months. We saw the minutes of the monthly care staff meeting of 8 July 2009. Agenda topics covered a recruitment update, new residents, ensuring drinks during the heatwave, training planned, being welcoming to visitors, completing body maps on admission, pressure area care, and the results of the provider’s health and safety audit. We also saw the minutes of the quarterly full staff meeting of 10 June 2009. This agenda was more employment focussed but did include confirmation from the head cook that a resident who had some special preferences ‘could have anything they fancied’. At the end of the meeting, a DVD on ‘Dignity and Respect’ had been shown. The home had a monthly visit from a senior officer of the provider who prepared a report about the home after talking to residents and staff, inspecting the environment and checking key records. These included reports of deaths and serious incidents to the Commission, the complaints record and the accident and incident reports. We saw the report for 9 July 2009, which showed that the six residents spoken to were content with their care and happy that they could express their views. They confirmed that there was a monthly residents’ meeting which gave them the opportunity to raise issues. They felt that their ideas and suggestions were respected and acted on. We were shown the results of the annual Customer Satisfaction survey completed in August 2009. All the people who replied said they were satisfied with the home. One wrote: “Mills Meadow is a haven for me”. The survey for relatives had just been sent out, we were told. We saw evidence that staff were properly trained and supervised. Staff confirmed to us that regular supervision meetings were arranged with them. The manager told us that no personal cash was held on behalf of residents. All residents who were supported through Social Care Services had their monies processed by Suffolk County Council’s finance department. Privately funded residents would choose how their finances should be handled, by themselves or through their representatives. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 26 We examined the fire log. All regular checks were up to date on equipment and alarm systems. The Fire Risk Assessment had been reviewed in March 2009. All senior staff had undergone training in the Mental Capacity Act and the Deprivation of Liberty Safeguards, from the provider’s own specialist team. One referral had been made by the home to the team to assess whether that person was being deprived of their liberty because of the care practice being followed. We were present when the assessors visited the home. No deprivation of liberty was found as the care practice was held to be a restriction for the safety of that resident. Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 27 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 X X X 3 3 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 3 3 X 3 3 X 3 Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 28 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 Mills Meadow DS0000038816.V377687.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Citygate 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. 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. 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