Care Home: Milton House

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What the care home does well This random inspection did not focus on all outcome groups. Information can be found in the home`s last key inspection report. What the care home could do better: We have recommended that the home review the length of time people are sat in wheelchairs and of the time people sit at dining tables before lunch is served. Random inspection report Care homes for older people Name: Address: Milton House West Street Bridgwater Somerset TA6 3RH two star good service 14/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: kathy McCluskey Date: 2 6 0 4 2 0 1 0 Information about the care home Name of care home: Address: Milton House West Street Bridgwater Somerset TA6 3RH 01278422235 01278431511 julie.gohot@somersetcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julie Bohot Type of registration: Number of places registered: Conditions of registration: Category(ies) : Somerset Care Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 0 old age, not falling within any other category physical disability Conditions of registration: 0 51 Elderly persons of either sex, not less than 60 years, who require general nursing care Registered for a total of 51 places in Categories OP and PD Staffing levels are monitored on a monthly basis to suit the dependency levels of individual service users. Staffing should not fall below 1 - 10 at night and 1 - 5 during the day. Up to three persons of either sex, between the ages of 50-60 years, who require general nursing care. When the home reaches provision of care for 40 service users requiring nursing care 2 Registered Nurses must be provided at night to comply with the staffing notice in line with Somerset Health Authority. Care Homes for Older People Page 2 of 8 Date of last inspection Brief description of the care home 1 4 1 0 2 0 0 9 Milton House is a purpose built care home situated in the town of Bridgwater and is within walking distance of the town centre. It is owned by Somerset Care Ltd. Accommodation is provided over two floors with a shaft lift giving access to the first floor. Bedrooms are for single occupancy and some are fitted with en-suite facilities. Some bedrooms have limited space. A nurse call system is installed throughout the home and ramps and grab rails are appropriately sited to assist people with mobility difficulties. The home has a very pleasant and well designed garden which is accessible to wheelchair users. Parking at the home is limited although restricted parking is available outside of the home. The home is registered with the Care Quality Commission (CQC) to provide general nursing care to a maximum of 51 older people. It is not registered to accept people whose primary care needs are for their dementia or other mental health needs. Registered general nurses are on duty 24hrs a day. The registered provider is Somerset Care Ltd. The registered manager is Julie Bohot. The comapny area manager is Mrs Sylvia Stowe. We were informed at the key inspection conducted in October 2009, that current fee levels are between £539 and £750 per week for nursing care. Fees are determined on the assessed needs of the individual and of the bedroom to be occupied. The home has a contract with the local authority and will accept people who require assistance with funding. Extra charges include personal items, toiletries, newspapers, hairdressing, chiropody and staff escorts to attend appointments. Information about fees should be obtained directly from the home. Care Homes for Older People Page 3 of 8 What we found: The purpose of this unannounced random inspection was to look at current dependency levels and routines of daily living for people using the service. We were informed that 45 people were currently receiving nursing care at the home. Dependency levels were described as high with 39 people currently requiring the assistance of a hoist and two staff for all transfers. We were also informed that 25 people required staff assistance during meal times. We were told that 4 people were currently being nursed in bed and that 2 people were being treated for a pressure sore. The local authority currently have a contract with the home for 36 beds. We were informed that the home are involved in regular meetings with the local authority regarding current dependency levels of people using the service. We were informed by the registered manager and deputy manager that any referrals are fully assessed by the home and that the dependency levels of referrals and of people already residing at the home are very carefully considered before a placement is offered. As some bedrooms have limited space, the size of the room available is also taken into consideration. We were informed that a placement would not be offered unless the home were satisfied that they could fully meet the individuals assessed needs. We were informed that staffing levels were based on the assessed needs of people using the service. In addition to the registered manager and deputy manager, 2 registered nurses are on duty 24 hours a day. The registered nurses are supported by 10 care staff in the mornings, 9 during the afternoon/evening and 3 over night. During this inspection we were able to meet with a number of people living at the home, we spoke with care staff and spent time observing interactions. During the morning staff were assisting people to get up. They confirmed dependency levels were high but they did not express any concerns about being able to meet peoples needs. They told us that they worked well as a team and that they assisted people in line with their assessed needs and preferences. We were informed that people were assisted to have breakfast, wash and dress following the morning handover at 0730hrs and that this would usually take until 1230hrs. The morning routine appeared unhurried and staff were heard communicating with people in a kind and respectful manner. We heard staff offering people choices about where they wanted to spend their day and additional drinks were offered. During the morning we met with a number of people in their rooms. People were very positive about the kindness of staff and of the assistance they were offered. They told us that the food was very good and that there was plenty to eat and drink. Those who were in bed appeared comfortable and it was apparent that staff had tended to their personal care needs. We were able to see that people had been assisted with diet and fluids. Turn charts were in place for those with an assessed need. We saw that people had access to a call bell and these were noted to be responded to by staff in a timely manner. We noted the standard of cleanliness to be good and there were no malodours. Care Homes for Older People Page 4 of 8 We did observe that the majority of people were assisted into wheelchairs after getting up and that they were not assisted to transfer into a comfortable chair until after lunch. Whilst all were seen to have a pressure relieving cushion in place, we have recommended that this practice is reviewed so that people are not left in standard wheelchairs for long periods. We observed staff bringing people to the dining room from 1220hrs although lunch was not served until 1315hrs. Although some people were seen to be chatting to others, this was not the case for everybody. This routine should be kept under review so that people are not waiting at dining tables for long periods. This was also recommended at the last inspection. We looked at four care plans. These were found to be up to date and reflective of peoples assessed needs. Appropriate wound management plans were in place for the two people being treated for a pressure sore. Care plans contained evidence that people had access to appropriate health care professionals. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 5 of 8 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 8 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 The home should review the length of time people sit in wheelchairs so that the individuals comfort and choice is respected. The home should review the length of time people are sat at dining tables before lunch is served. This was also recommended at the last inspection. 2 15 Care Homes for Older People Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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