Care Home: Milton Grange

What the care home does well The home has a clear, detailed statement of purpose in place; this provides sound and detailed information about the services and facilities that are able to be provided at the home.Admissions to the home are planned and each person has an assessment of their needs and wishes prior to being admitted into the home, this information forms the basis of each individuals care plan. Care planning information is well written and is kept up to date with regular reviews being completed. There is consistency with the management and staff team at the home, all of whom have a sound understanding of the needs of those who live at the home. Staff are recruited appropriately with all required checks being undertaken. Those who live at the home said that staff were "kind to them", that they "enjoyed the meals" provided at the home and that they "enjoyed spending time with their visitors". What has improved since the last inspection? The home has worked diligently in order to meet the two requirements and the three recommendations that were set during our last key visit to the service. When the home carry out a pre admission assessment for privately funded (and local authority funded) individuals their needs are assessed, this is recorded and the information is used in order to guide staff practice and is incorporated within individuals care plans. Where the home have made decisions about when to give prescribed medication to people who live at the home and the circumstances when this should be done this has been documented in care plans. Care plans have also been expanded in the area of diabetes to ensure that all aspects of care in respect of this condition have been covered. Where equipment is in use, such as bed rails, that physically restrains people, clear information has been documented as to their use and the use of this equipment is kept under review. Before allowing a new member of staff to work at the home pre employment checks have been carried out. Information and documents have been obtained to protect people from potentially unsuitable people working at the home. Proof was in place to show that these documents have been obtained prior to the person starting work. Also the home has developed a checklist to evidence that this information had been obtained. The home has a quality assurance system, which gives evidence of the self-auditing undertaken of the different aspects of the running of the home. This would be improved if it including taking into account the views of people who live at Milton Grange. CARE HOMES FOR OLDER PEOPLE Milton Grange 9 Milton Road Charminster Bournemouth Dorset BH8 8LP Lead Inspector Odette Coveney Unannounced Inspection 21st September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Grange Address 9 Milton Road Charminster Bournemouth Dorset BH8 8LP 01202 554351 NO FAX aeliseone@aol.com 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) Mrs Marie Lyzie Ah-Kan Manager post vacant Care Home 16 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0) of places Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental Disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 16. Random Inspection 2. Date of last inspection Brief Description of the Service: Milton Grange is a care home providing personal care and accommodation for 16 older people over the age of 65 with dementia or mental disorder. It is owned and managed by Mr and Mrs Ah-Kan. The home is located in Charminster, a residential area of Bournemouth, close to local amenities such as shops and the post office. The home has been open since 1989 and is a large converted house. Service users live on the ground and 1st floor. Fourteen of the 15 rooms are single with the fifteenth being a double room. Ten single bedrooms have en suite facilities and the double room also has an en suite bathroom. There is a passenger lift. The home has an attractive rear garden that is well maintained and easily accessible. Fees at this home range from £500-£525 per week, this is based upon individuals assessment of need. Milton Grange DS0000003963.V372087.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 2star. This means the people who use this service experience Good Quality outcomes. The focus of this visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for those who live at the home. Prior to this key visit we undertook a random visit to the home on 15th February 2007 in response to an anonymous call to us. The caller raised concerns and we checked these during this visit. Our opinion was that we had previously rated Milton Grange as a good service and this had not changed. This visit was carried out over an 8-hour period. The owner’s Mr and Mrs Ah Kan and the deputy manager were on duty and gave their time to assist with the inspection process. The Annual Quality Assurance Assessment (AQAA) had been completed and was sent to us before the visit. This contained relevant information and assisted us with the pre planning of the visit to the home. A tour of the premises was made and information about this is included within this report. The atmosphere in the home was calm and friendly. People were seen in their rooms and others in the communal rooms. People who live at Milton Grange and staff on duty were spoken with during the day. Records were requested and sampled. These included care and associated records for four of the people who live at the home, fire, maintenance records, recruitment and staff training records and medication records. Feedback was given to Mrs Ah Kan and the Deputy Manger during and at the end of the visit. What the service does well: The home has a clear, detailed statement of purpose in place; this provides sound and detailed information about the services and facilities that are able to be provided at the home. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 6 Admissions to the home are planned and each person has an assessment of their needs and wishes prior to being admitted into the home, this information forms the basis of each individuals care plan. Care planning information is well written and is kept up to date with regular reviews being completed. There is consistency with the management and staff team at the home, all of whom have a sound understanding of the needs of those who live at the home. Staff are recruited appropriately with all required checks being undertaken. Those who live at the home said that staff were “kind to them”, that they “enjoyed the meals” provided at the home and that they “enjoyed spending time with their visitors”. What has improved since the last inspection? The home has worked diligently in order to meet the two requirements and the three recommendations that were set during our last key visit to the service. When the home carry out a pre admission assessment for privately funded (and local authority funded) individuals their needs are assessed, this is recorded and the information is used in order to guide staff practice and is incorporated within individuals care plans. Where the home have made decisions about when to give prescribed medication to people who live at the home and the circumstances when this should be done this has been documented in care plans. Care plans have also been expanded in the area of diabetes to ensure that all aspects of care in respect of this condition have been covered. Where equipment is in use, such as bed rails, that physically restrains people, clear information has been documented as to their use and the use of this equipment is kept under review. Before allowing a new member of staff to work at the home pre employment checks have been carried out. Information and documents have been obtained to protect people from potentially unsuitable people working at the home. Proof was in place to show that these documents have been obtained prior to the person starting work. Also the home has developed a checklist to evidence that this information had been obtained. The home has a quality assurance system, which gives evidence of the self-auditing undertaken of the different aspects of the running of the home. This would be improved if it including taking into account the views of people who live at Milton Grange. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton Grange DS0000003963.V372087.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 Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 4, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Provider takes a lot of care when admitting people into Milton Grange in order to ensure that the home are able to meet the assessed needs of the individual. Clear information is provided about the services and facilities available at the home. EVIDENCE: During this visit we reviewed the homes statement of purpose. This document outlines the admission procedure into the home, the management and staffing arrangements, how to raise a complaint and also provided information about the services and facilities offered at the home. The home informed us that this document had been recently updated they have agreed to forward us an updated version of this in order that we may maintain a copy for our records. During our last key visit to the service undertaken in September 2006 we recommended that pre admission assessments should include documented Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 10 consideration of all areas of their support needs. We saw at this visit that the home has a procedure for admissions, which ensures that people have their needs assessed and have the opportunity to get to know Milton Grange before moving in. Assessments cover areas such as personal care support, communication and individuals likes and dislikes. We saw in records that the home works closely with other agencies and outside professionals to help a new person into the home to settle in as well as possible. We viewed the records for the person most recently admitted into the home and saw all the required documentation in place. Mrs Ah-Kan told us that this person’s relative had visited the home prior to their admission and the person themselves spent some time at the home before being admitted. We spoke with this person who indicated to us that they were settled. Staff spoken with demonstrated a sound understanding of this persons needs. The home has developed comprehensive care plans based on the information provided by care management assessments and from relatives about individuals preferences and choices and also information they had gathered during the assessment process, the trial period and as part of the ongoing placement within the home. The daily records maintained within the home provide clear evidence that individual’s current and changing needs are identified and met. Clear information was in place to show the involvement of specialist services and professionals, ensuring a multi-disciplinary approach. All people who live in a care home, whether they are self-funding or not should have a contract of the terms and conditions in place which outlines their rights and the responsibilities expected of them and of the people who provide the service. At this visit we reviewed the terms and conditions of two of the people who live at Milton Grange, these documents contained all of the required information and had been signed by both a relative of the person who lives at the home and a representative of the home. We noted that two people who have lived at the home for a number of years and who were funded by the local authority did not have in place a contract between themselves and the home. Mr Ah-Kan told us that agreement had been made sometime ago with us that only new people admitted into the home required contracts. We saw that the person most recently admitted into the home had a contract of the terms and conditions of their placement. In respect of the agreement about people who have lived at the home for sometime not needing new contract our views on this are that although this may have been agreed at the time the home should seek to ensure contacts are in place for all in order that all parties involved have clear information about their rights and responsibilities, we will review this at our next visit to the service. Intermediate care is not provided at this home. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who live at the home benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that those living at the home prefer. Individuals have access to healthcare services. Medication practices within the home are good, however improvements are needed in the storage of controlled medication in order that it is held in line with new legislation. EVIDENCE: During this visit we reviewed a number of care documents, these included care plans, risk assessments, daily records, individuals past history and Individual’s care plans. Since our last visit the home have introduced a new care plan format for recording information. We reviewed in full the care and associated records for Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 12 three people and sampled the records of one other. We saw that care plans had been reviewed a minimum of every month, and had been updated sooner when an individuals needs had changed, in line with expected practice. Care plans were well written and contained information in order that individuals are supported appropriately. Many of the people living at this home have a diagnosis of dementia, we saw that care plans covered individual’s mental ability and capacity and further included how individuals would be supported with their communication. Each plan reflected individual’s level of need and ability and provided clear information to guide and inform staff practice. During our last key visit to the service in September 2006 we reported that care plans for people with diabetes must cover all aspects of their health / care needs. And also where bed rails are in use all of the following should be in place - an assessment outlining why the equipment has to be used, how it is to be used and written permissions for its use given by a professional outside the home. And that assessments must be regularly reviewed to make sure that the use of such equipment remains the best option to maintain the safety of individuals and that it is being used safely. We saw care plans we sufficiently detailed about specific needs of individuals. Risk assessments were in place for the use of bed rails, we saw the rails in two peoples rooms and these were being used appropriately and in a safe manner in the best interests of the individuals concerned. When reviewing individual’s records we saw that information was recorded about individual’s manual handling requirements, information included what staff support and equipment was required. Records are reviewed on a regular basis. We also saw that each individual had in place a ‘wandering assessment’ and some discussion took place with Mrs Ah-Kan about the language of ‘wandering’ and that it has been recognised that people with a dementia do not ‘wander’ and that when they walk around the home they have a purpose. We noted that the home has a key pad entry and exit system linked to the front door and discussion took place about individuals restriction to leave, balanced with risk and the providers ‘duty of care’. Mrs Ah-Kan was fully aware of her responsibilities in this area. In order to ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation it is recommended that the home review the ‘wandering’ assessments and the key pad system which are in place for all people who are living at the home. There are good arrangements for access to health services including dental, optician and chiropody. The community district nursing service also provides a service to the home to support those individuals who require regular support with wound dressings. Records were kept of the appointments that people had with their GPs and other healthcare professionals. Records had been completed after each Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 13 appointment, which provided a good report of the outcome and any action that needed to be taken as a result. Those who live at the home told us that they are well cared for, that staff are “kind”, “respectful and polite”. People also told us that they see their doctor when they need to and have access to healthcare support. People told us they are supported to attend hospital appointments. The daily records of people who live at the home confirmed that people access a range of healthcare support. Mrs Ah-Kan told us that there are currently no individuals living at the home who are supported by community psychiatric nurses, however this service would be requested and accessed if required. In talking with individuals who live in the home they all spoke positively of the approach of staff “always speak to me as I would like” “they treat you nice”, “staff here are lovely”. We also noted that when talking about those who live at the home both staff and management were respectful of individual’s privacy. The home has a clear confidentiality policy. During this visit we saw and heard staff talking with people living in the home in a calm, friendly manner, asking them their opinion and offering choices. Privacy is upheld and staff support and manage individual’s personal private space in such a way that will not upset the individual. People are encouraged, where they are able, to be part of the whole lifestyle at Milton Grange by being included and supported in daily life, such as sewing small items of clothing and preparing vegetables During our last key visit to the service undertaken in September 2006 we reported Where there are particular medication issues these should be documented and reviewed in the care plan e.g. the circumstances under which staff make decisions about administering medicines - where they are ‘when required.’ This was reviewed and we noted no concerns in this area. None of the people living in the home look after their own medicines, staff look after and give all the medicines. The pharmacy supplies medicines to the home using a monitored dosage system. We saw that medication is held securely in a locked trolley, which is attached to the wall. Within training records we saw that staff have completed medication competency training. We reviewed records of medication and saw that there is clear administration of medication for regular prescribed medication and records of medication that are returned to the pharmacy because they are no longer required. One person living at the home takes a controlled medication; this is currently being kept in a locked tin in a locked cupboard. The legislation in relation to the storage of controlled medicines in care homes changed in July this year to ensure that all care homes (even those without nursing care) are consistent in this area. In order that the home is storing controlled medication securely it is required that a controlled drugs cabinet is obtained and used for this medication. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home EVIDENCE: During our last key visit to the home undertaken in September 2006 we rated the quality outcome in this area for people living at Milton Grange as being that of excellent. We saw nothing at this visit to indicate that this has changed. Mrs Ah-Kan and deputy manager both said that standards have been maintained in this area. During our last key visit to the service we reported an exercise class is held weekly at the home. A hairdresser visits fortnightly. Entertainers are arranged from time to time. The mobile library service also comes to the home. Both Mrs Ah Kan and some of her staff have attended dementia activity training, which has provided them with specific knowledge and skills. Activities run by Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 15 staff are generally informal and in response to what residents want to do on that day e.g. carpet bowls, massage, crosswords. Consideration is given to keeping people occupied e.g. helping staff fold laundry, and having things that they are interested to hand to keep them stimulated e.g. books, magazines and puzzles. They are also encouraged to move around if they are able. The home told us that a local curate and orthodox priest come to Milton Grange to see residents and help meet their spiritual needs. One resident at the home is a Muslim and the home has worked with their family to ensure that they are respecting her faith in the way that they deliver care. One of the people who live at the home told us that they receive Holy Communion from the priest who visits the home and that this is important to them. In the lounge we noted poems on the wall in poster form, Mrs Ah-Kan told us that one of the people who live in the home reads these and appears to take comfort from the words written. People told us that they enjoyed their meals and their there was always ‘plenty of it’. We saw in records clear information about special dietary requirements. The kitchen was seen to be clean tidy with well-stocked cupboards. Discussion with the provider the deputy manager and evidence from the visitors’ book showed that the people living at Milton Grange maintain good contact with families and representatives. The level of contact varies for each resident living at the home, some receive regular visitors and go out with family, and others do not. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that meets national minimum standards and regulations, the procedure is available with in the home and relatives understand how to make a complaint. Staff demonstrated an awareness of the content of the adult protection policy and know what immediate action to take and when and who to refer the incident on to. EVIDENCE: There had been no safeguarding adults referrals. The home had written policies and procedures which covered safeguarding adults, the prevention of abuse and whistle blowing. There is clear, time limited complaints procedure in the home. Information on how to make a complaint is also detailed in the statement of purpose for the home and this is available to anyone on request. We viewed the complaints logbook held at the home; and saw that a recorded concern had been dealt with promptly and to the satisfaction of those involved. No complaints were raised with us prior to or during our visit to the service. Due many of the people living at the home having a dementia they may not be able to retain the information on how to make a complaint. Through discussion Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 17 with Mrs Ah-Kan it was evident that she knows the individuals who live at the home well and would have no hesitation in dealing with issues that affect the wellbeing of people who live at the home. Mrs Ah-Kan told us that the home has an ‘open door’ approach and welcomes people raising any concerns they may have with her in order that they may be resolved. Recruitment practices carried out in the home protect people who live at Milton Grange from abuse, criminal records bureau and protection of vulnerable adults checks are carried out, and two written references are obtained before staff commence employment. We saw that staff have received training in order that they are aware of their role and responsibility in respect of the protection of vulnerable adults who live at the home, there are also staff that have completed National Vocational Qualification (NVQ) in care and this important area would also be covered within that training. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and accommodation provided meets the needs of individuals living at the home, however, the lift must be repaired urgently in order that the needs of people living at the home are met, furthermore attention must be given to ensure the home is well maintained. EVIDENCE: Milton Grange is a warm and welcoming home. The registered providers Mr and Mrs Ah Kan purchased the home nearly 20 years ago. The home is able to accommodate 16 people who have dementia; there is currently one vacancy in a shared room. The home is set over three floors; with individuals accommodation set over two floors. There is a small passenger lift for those with limited mobility. Upon arrival at the home we were informed that the lift had been out of action since Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 19 25th August 2008. We saw that numerous attempts have been made to rectify the problem and the providers have been dissatisfied with the response from the lift engineers to resolve the issue and have been frustrated at the lack of progress to get the lift in working order. We should have been informed that the lift was not working as this is a situation that affects the wellbeing of individuals living at the home (see the management section of this report). We saw that the home had contacted the placing authority for one of the people who live at the home as this person had on occasion been required to sleep in the lounge in a recliner chair, this is not acceptable on an ongoing basis. We also saw that the home had purchased a fire evacuation sledge and this had been used on three occasions to transfer people down the stairs. We saw that the home had a risk assessment in place in respect of the individuals involved, however a further risk assessments must be completed to ensure the safety of both the individuals and staff when this equipment has been used. It is required that attention to get the lift repaired is dealt with as a matter of priority, the home must keep us informed of the situation and the effects this is having for the people who live and work at the home. We were informed by the home on October 3rd that the lift is now in good working order. We read the food safety report from Bournemouth Borough Council who had visited the home in July 2008. Mrs Ah-Kan confirmed that all of the actions as outlined within the report had been met and that kitchen units would be being replaced in the coming months, we look forward to seeing this at our next visit to the home. During our visit we saw people relaxing in both the lounge and their rooms, all areas are comfortable. The lounge had benefited from a new conservatory being fitted, creating a focal point in this area. This over looks the well-tended rear garden; a permanent ramp has been provided in order for full access to the garden. The garden has well-established planting for people to enjoy and make use of this area. One person told us “I like what they have done, I love getting in the garden”. One of the people who live at the home showed us their room, it was comfortable and ‘homely’, they said ‘I love my room and all my things around me’. The rooms were personalised with photographs, plants, books and ‘nick knacks’. There are two rooms at the home in which two people share. At this visit two people occupy only one of the rooms. Bedrooms are only shared in limited situations and when this happens it is only by agreement with the people concerned. Screens are provided for privacy and the rooms have the personal belongings of both people. The service is open and honest with people when discussing the use of shared rooms and the prospect of having their own room. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 20 Since our last visit a new phone system has been installed at the home, this can be used to speak with staff by other staff working in the home. Staff told us the new system was very effective. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. We noticed in the bathroom on the first floor the light fitting was not hanging correctly and appeared to be coming away from the fitting. To demonstrate that the home is well maintained it is required that attention is given to the light fitting in the first floor bathroom to ensure it is safe. We also noticed that the ceiling fan was dirty and it was recommended that the extractor fan in this same area should be cleaned We saw that in one bathroom open ‘bookshelf’ type storage was in place, on here were many toiletries belonging to a number of different people who live at the home. We were concerned those individuals’ items would be used for communal use or that someone not aware of the hazards could ingest them. The deputy manager assured us that this would not be the case. We recommended that in order to evidence that the home ensures that each person’s toiletries are stored appropriately; consideration should be given to safe storage of personal items left in the communal bathroom. We noted that call bells were in place for people living in the home to summon for staff assistance, during our visit we noted that this call bell was responded to promptly by staff. We also noted that in one toilet area a call bell had been tied up and would have been out of reach of residents. We were told this might have happened as the call bell is occasionally confused for a light pull. The deputy manager untied this during this visit and explained it was an oversight and would not happen again. Generally the home shows a good standard of housekeeping and no offensive odours are apparent. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had sufficient staff on duty and staff are qualified to provide good level of care. Staff are clear regarding their role in what is expected of them. Recruitment practices safeguard the people who live at Milton Grange. EVIDENCE: On the day of the visit, both registered providers were present. Also there was the deputy manager, an ancillary member of staff and two care assistants on duty. There are two staff awake during the night to support people if needed during this time. There are consistently enough staff available to meet the needs of residents; the staffing structure is based around delivering good outcomes for those who using the service, and is not led by staff requirements Comments made by residents during the inspection were; ‘The staff are wonderful and kind, nothing is too much trouble’. The home ensures that all staff receive relevant training that is focussed on delivering improved outcomes for those using the service. The home puts a Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 22 high level of importance on training and staff confirmed that they are supported through training to meet the individual needs of those living at the home; training matrix and certificates seen evidenced that staff have completed core training in areas such as first aid, protection of vulnerable adults training and basic food hygiene, other specialised training is also provided for staff in areas such as dementia awareness, medication competency and infection control. The home has a sound recording matrix in place to evidence staff training. The home are committed to training their staff to achieve a National Vocational Qualification with over 50 having completed the award in NVQ 2 health and social care practices. During our last key visit to the service undertaken in September 2006 we reported All documentation as required by law in respect of employees must be kept on file and be available for inspection at any time. During this visit The recruitment and selection documents for a number of staff were reviewed at this inspection; staff files evidenced that full and robust practices are adhered to at the home to ensure that those appointed have the qualities and skills to work within this care environment. Appropriate adult protection checks are taken to ensure the protection and safety of those who live at the home. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of those who live at the home; there is an open ‘hands on’ management approach at Milton Grange. Health and safety and incidents, which affect the wellbeing of individuals, who live at the home are well managed, however, The Commission must be kept informed of incidents, which affect the wellbeing of individuals who live at the home. EVIDENCE: The Registered Provider and Registered Manager of the home is Mrs Marie Lyzie Ah- Kan who is supported by her husband and a Deputy manager. All of who have a high presence within the home and are involved with the day to Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 24 day activities within Milton Grange. Mrs Ah-Kan has the required qualifications and experience, she is highly competent to run the home and meet its stated aims and objectives, as outlined within the homes statement of purpose. The deputy manager also has a sound understanding of both the needs of those living in the home, staff and legislation relating to managing a care home. Staff are well supported by the management of the home with sound systems in place to support and guide staff practice in order to ensure that all staff are providing a good quality service to those who live at Milton Grange, these include staff supervision and supervision sessions which provide an overall review of staff performances. The atmosphere at the home at the time of the visit was calm and relaxed with individuals looking clearly at ease and ‘at home’. All records seen at this inspection were appropriately and safely stored. Access was appropriately restricted. Accident reports were viewed during the visit; information crossed referenced with care records and were well written and showed that action was taken to support individuals. The home undertakes the appropriate fire safety checks on both a weekly and monthly basis and staff have received sufficient fire safety instruction. Some discussion took place about what the procedure would be in the event of a fire at night. Mrs Ah-Kan was very aware of the homes responsibility and the actions to be taken. To ensure that full risks associated with fire have been considered it is recommended that the home review their fire risk assessment and policy to ensure it covers what the procedure is should a fire occur at night and how individuals will be supported. There are manual handling risk assessments in place for all of the people who live at the home, these record how individuals would be supported safely, identifying potential hazards for both themselves and staff. In order to ensure that safe working practices are in place it is required that a risk assessment is completed in respect of the use of the sledge. See environment section of this report. The home displays a current certificate of Employer’s Liability Insurance. The home has in place clear policies and procedures in areas of staff employment, complaints and health and safety, all of which have been reviewed and updated. This guidance provides clear information to staff to inform and guide their practice. Although historically the home have kept us informed we had not been told that the lift was out of action and what actions were being taken to rectify this. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 25 The home are required to inform the Commission of any incident which affects the wellbeing of individuals living at the home, this must be undertaken in a timely manner as required. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was fully completed and sufficiently detailed. The home has a number of effective quality assurance and quality monitoring systems in place. During our last key visit to the service undertaken in September 2006 we reported that further work must be undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meeting it aims and objectives as detailed in the home’s annual development plan. At this visit we saw that the home have developed an overview of survey results. These measure success in achieving the aims, objectives and statement of purpose of the home. An audit, completed by the home, which undertaken in the form of questionnaires sent to relatives of those who live at the home recorded high levels of satisfaction. One person wrote to the home and said ‘you looked after my relative with great, loving care and attention, the provider and staff are wonderful carers’. The quality assurance audits would be improved if the home sought ways of seeking the views of people who live at the home; we will review this at our next visit to the service. A record of staff supervision sessions was available to see and showed that people receive supervision regularly. Staff confirmed this. We also saw that regular staff meetings are held and these are recorded. Minutes of meetings read by us showed that there is an open management approach at the home; the management wants to hear ideas and suggestions for improvement. Staff spoken with confirmed that they felt supported and able to approach registered provider and the deputy manager should they wish to discuss dayto-day running of the home. One staff said ‘It’s really nice here. I like working here’. Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 26 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 2 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 X 3 3 2 Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP9 Regulation 13 (2) Requirement A controlled drugs cabinet must be obtained to ensure the security of this medication. To demonstrate that the home is well maintained attention must be given to the light fitting in the first floor bathroom The home must inform the Commission of any incidents, which affects the wellbeing of individuals living at the home, this must be undertaken in a timely manner as required. The home must complete a risk assessment in respect of the use of the ‘sledge’ to ensure safe working practices are in place. Timescale for action 21/11/08 2. OP25 23 (2) b 21/10/08 3. OP38 37 21/09/08 4. OP38 13 (4) c 28/09/08 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 Good Practice Recommendations DS0000003963.V372087.R01.S.doc Version 5.2 Page 28 Milton Grange 1. Standard OP7 2. OP21 To ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation. The home should review the ‘wandering’ assessments, which are in place for all people who are living at the home. To evidence that the home ensures that each person’s toiletries are stored appropriately consideration should be given to safe storage of personal items left in the communal bathrooms. The extractor fan identified during this visit to be cleaned To ensure that full risks associated with fire have been considered the home should review their fire risk assessments and procedures to ensure it covers what the policy is should a fire occur at night and how individuals will be supported. 3. 4. OP25 OP38 Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton Grange DS0000003963.V372087.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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