Care Home: Milton House Nursing Home

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What the care home does well People are assessed before they are admitted to check that their needs can be met by the home. This helps to make sure that the home will be appropriate to meet their needs, and will reduce the chance of admissions going wrong. People say they get good care. They like the staff, and are confident that they understand their needs. They made comments like `the care is good and the staff are good`, and the care is `excellent`. One said that Milton House was a `lovely place`. They said they couldn`t do any better, and commented that the care is `lovely`. A health professional comment agreed, saying `this is an excellent care home`.People have the freedom to choose what they do, when they want to do it. This helps to make their lives more interesting, because one day does not have to be the same as the next. They can have their visitors whenever they want. This helps to maintain social and family links that are important to them. The home is set in beautiful surroundings, with a garden area for people to enjoy, and views of the river. People have a range of sitting areas to choose from, or can spend time on their own. Staff respect this right to privacy. People say there are `always` or `usually` sufficient staff to meet their needs. These staff receive training to tell them how this care should be given, to help make sure it is safe and consistent. The registered providers keep the building maintained, so it is a safe place for people to live. What has improved since the last inspection? There were no requirements made at the last inspection of Milton House, which took place in March 2007. Some of the recommendations have been considered. All staff now make a record of their observations of people over the course of their shift. This makes the records more personal. Thermometers have been provided in each bathroom, so staff can check the water temperature before they assist people into their bath. Individual training records are being developed for staff, so the managers can see where they need more training. Some though, need to be updated. What the care home could do better: Staff could make sure that identified or possible risk to people is always assessed, and a care plan developed, so they can be sure that everyone work consistently to keep this risk to a minimum. People could be invited to be more involved in the review of their care plan so they remain fully involved in decisions about their care. People could also be asked more formally regarding their views about the home. This would assure both them, and the management, that it is being run according to their views and best interests. Some improvements could be made to the way staff record what medication has been given to, or is prescribed for people. This helps to keep the records right, and provides better information when reviewed by the person`s doctor. Staff could be given more information about the role of the local authority as lead investigators in any allegations of abuse, and details about how they can be contacted. This would mean that they can be certain about who, other than the management, they are able to report any concerns to which affect the welfare of people living at the home.The registered managers could complete a management qualification. This would underpin the skills they have, and demonstrate to other staff the importance of keeping their ongoing learning and development in care up to date. They could also provide new staff with the Skills for Care induction, and thereafter regular formal supervision. This will help promote and underpin a consistent approach to care. CARE HOMES FOR OLDER PEOPLE Milton House Nursing Home Marton Road Gargrave Skipton North Yorkshire BD23 3NN Lead Inspector Anne Prankitt Key Unannounced Inspection 10th March 2009 10:00 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 House Nursing Home DS0000027942.V374527.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 House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Nursing Home Address Marton Road Gargrave Skipton North Yorkshire BD23 3NN 01756 748141 F/P 01756 748141 milton-house@btconnect.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) Mr Winston Shutt Mrs Carol Shutt Mrs Hilary Ormrod Mrs Patricia Sykes Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 65 years upwards Date of last inspection 27th March 2007 Brief Description of the Service: Milton House is registered to provide personal and nursing care for a maximum of twenty-two older people. The main part Milton House is over 200 years old and this provides the lounges and a small number of bedrooms. There is additional purpose built accommodation providing further bedrooms, dining room and a conservatory lounge. Many areas of the home have beautiful views of the surrounding countryside and the river, which runs alongside the property. It is located a short drive away from the village centre and there is ample parking space for visitors and staff. The registered provider told us on the day of the site visit that the current weekly fees range from £514.50 to £620. People pay extra for newspapers, chiropody and hairdressing. We were told that people thinking of moving into the home are given a copy of the brochure. There is also a service users’ guide, which, along with the inspection report, people are given on request. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered provider and registered managers think outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys completed by nine people living at the home, four staff, and a health professional. A site visit to the home carried out by one inspector lasting for approximately seven hours. • • During the site visit to the home, several people who live there, some staff, both registered managers and one of the registered providers were spoken with. Three people’s care plans were looked at in detail, as well as two staff recruitment files, some staff training records, and some information about health and safety. Care practices were observed where appropriate. Some time was also spent watching the general activity, to get to know what it is like to live at Milton House. The registered managers and a registered provider were available throughout the day, and feedback was given to them at the end. What the service does well: People are assessed before they are admitted to check that their needs can be met by the home. This helps to make sure that the home will be appropriate to meet their needs, and will reduce the chance of admissions going wrong. People say they get good care. They like the staff, and are confident that they understand their needs. They made comments like ‘the care is good and the staff are good’, and the care is ‘excellent’. One said that Milton House was a ‘lovely place’. They said they couldn’t do any better, and commented that the care is ‘lovely’. A health professional comment agreed, saying ‘this is an excellent care home’. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 6 People have the freedom to choose what they do, when they want to do it. This helps to make their lives more interesting, because one day does not have to be the same as the next. They can have their visitors whenever they want. This helps to maintain social and family links that are important to them. The home is set in beautiful surroundings, with a garden area for people to enjoy, and views of the river. People have a range of sitting areas to choose from, or can spend time on their own. Staff respect this right to privacy. People say there are ‘always’ or ‘usually’ sufficient staff to meet their needs. These staff receive training to tell them how this care should be given, to help make sure it is safe and consistent. The registered providers keep the building maintained, so it is a safe place for people to live. What has improved since the last inspection? What they could do better: Staff could make sure that identified or possible risk to people is always assessed, and a care plan developed, so they can be sure that everyone work consistently to keep this risk to a minimum. People could be invited to be more involved in the review of their care plan so they remain fully involved in decisions about their care. People could also be asked more formally regarding their views about the home. This would assure both them, and the management, that it is being run according to their views and best interests. Some improvements could be made to the way staff record what medication has been given to, or is prescribed for people. This helps to keep the records right, and provides better information when reviewed by the person’s doctor. Staff could be given more information about the role of the local authority as lead investigators in any allegations of abuse, and details about how they can be contacted. This would mean that they can be certain about who, other than the management, they are able to report any concerns to which affect the welfare of people living at the home. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 7 The registered managers could complete a management qualification. This would underpin the skills they have, and demonstrate to other staff the importance of keeping their ongoing learning and development in care up to date. They could also provide new staff with the Skills for Care induction, and thereafter regular formal supervision. This will help promote and underpin a consistent approach to care. 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 House Nursing Home DS0000027942.V374527.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 House Nursing Home DS0000027942.V374527.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): 3 and 6 People using this service experience good quality outcomes in this area. People are assessed before being admitted to check their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A senior staff member who works at the home assesses people before they move there. The assessment is simple and straight forward, although staff must make sure that they date it, so it can be of more use if needed to refer back to in the future. The information is used to decide whether the home is able to meet the needs of the person, with the resources available. Staff spoken with said that this information is passed onto them also, so they know what support the person will need before they arrive. People are invited to visit the home before they decide whether it is the right place for them to live. We were told that they are also are given a copy of the home’s brochure before they arrive, so they can see what the home looks like, Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 10 and what it provides. The home also has a service users’ guide, which gives people further details. Staff give this to people on request. Eight out of nine people who returned their surveys said that they got enough information before they moved in. The ninth said that the circumstances of their admission had meant that they were rushed in, but said that it had ‘gone well’. The home does not provide intermediate care. It does however offer short term care for people and their families who may want a break, or for people who want some more recovery time after being in hospital, for instance. Milton House Nursing Home DS0000027942.V374527.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 and 10 People using this service experience good quality outcomes in this area. People get good care. However, this care, and how risk to their wellbeing is managed, is not always reflected in their care plan. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Everyone has a care plan, which is developed from the information collected about the person before they arrive. The plan included details which showed that people have continuing contact with health professionals such as their doctor, the district nurse and the chiropodist, to help maintain their health. Some areas of the plan could have been more individual, although others were very good. Information written by staff in the daily records implied that they know and understand people well. This sort of information could be transferred into the plans to make them more personal. Staff review the plans regularly, although not always with the person to whom they belong. One person commented in their survey ‘Care plans shown to Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 12 family would be useful, and revisited as extra help needed’. Doing this is good practice, as it keeps people involved in decisions about their care. Risk assessments were normally in place where risk had been identified, and equipment provided where necessary. For instance, people with a high risk from pressure damage had special mattresses to help keep their skin in good condition. And people had a moving and handling assessment which showed how staff must move them safely. There were some omissions, which were discussed with the management on the day, and which need to be put into place so the plans give a full picture of people’s needs, and how they can best be met. For instance: • • People should have a falls risk assessment, especially when they have been prone to falls before being admitted. Staff must complete a bed rails assessment before these are fitted to a person’s bed, to check that they are the right choice, and that the person will be safe when they are used. The fact that the rails are checked regularly should be recorded each time this is done, as evidence that they remain safe and properly fitted. Where things have arisen following admission, for example, where people have been identified as being more vulnerable if they go out alone, a risk assessment needs to be done, followed by a care plan, so staff work consistently to support any person in this position, so they remain safe. Lastly, wherever a risk has been identified, this should be followed up with a care plan to show how the risk must be managed in the person’s every day life. • • People spoken with on the day said they were very happy with their care. Staff spoke to them with respect, and their privacy was protected when they were provided with personal care. Of the nine who returned their survey, seven agreed that they always get the care and support they need, with two stating that this was usually the case. One person said ‘The care is good and the staff are good’. Someone else said that the care was ‘excellent’. And another said that Milton House was a ‘lovely place’. They said they couldn’t do any better, and commented that the care is ‘lovely’. A health professional comment agreed, saying ‘this is an excellent care home’. Staff look after people’s medication where necessary. People are not dissuaded from looking after their own medication if it has been deemed safe for them to so. This is good because it helps to keep people independent. But this decision should not be made without first completing a risk assessment to check that they are willing and able to look after this medication safely. Medication is delivered mainly in cassettes, which the pharmacist prepares following the person’s prescription. Staff check these when they arrive. There Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 13 are proper systems in place so that any unwanted medication is disposed of safely. The records kept by staff as they administer people’s medication were signed up to date, and a sample audit showed that this medication had been given in the right quantity. Medication is stored in locked cabinets, and any controlled medication is stored in a separate metal cupboard so that access to this is limited. The following matters were discussed: • So that their doctor can see how effective people’s medication has been when they come to review this, staff should record how much medication people have been given when their dose is variable. They should also make sure that the person who has applied them, signs for all prescribed creams. To reduce the risk from human error, hand written entries on the medication administration records should be countersigned. A daily check of the medication fridge must be maintained to make sure that medication, which needs to be kept cold, is stored at the right temperature. • • Milton House Nursing Home DS0000027942.V374527.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 and 15 People using this service experience good quality outcomes in this area. People can maintain social links with people who are important to them, and make decisions in their daily lives. Further attention to their collective views will help to identify where they would like to see improvements to the social activities and menu. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home does not employ an activities organiser. Staff said they spend time socially with people whenever they can, and the registered provider organises for a number of people to visit the home to provide entertainment and social events. These activities are provided every two to three days, and include visits from entertainers, a physiotherapist who does exercises with people, a hairdresser, and a pianist. Some people have enjoyed a recent trip into The Dales, which they said they thoroughly enjoyed. A church service is also held at the home monthly, and the priest visits when required. This helps to meet people’s spiritual needs. And people can have their visitors whenever they please. This helps them to maintain social links with people who are important to them. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 15 People’s views about the activities did not agree. Whilst five of those who returned their surveys said there are always activities for them to join in, and one said this was usually the case, three said this was only sometimes the case. They made comments like ‘Not enough’, and ‘Limited. Need more to do, so activity based.’ Some on the day said they would like to see more going on. However, people were clear that they can make choices in their daily lives. One said there was ‘plenty of flexibility’, and ‘no discipline’. This helps to make life more interesting for people by maintaining their independence, and means that one day does not have to be the same as the next. The atmosphere at the home was happy and friendly, and there was lots of light banter which people enjoyed. People are offered three meals each day, and supper. Breakfast is served in their own room. People can then get up and go to bed at their leisure. The cook explained that they know people’s likes and dislikes, and who has special dietary needs. They work closely with the care staff to make sure that these needs are met. The menu is displayed in the hallway so people can see in advance what they will be served. The main meal is served at lunchtime. There was no advertised choice, although the cook said that an alternative was always available if people wanted one. People spoken with were not aware that this was the case, so it would be good practice to advertise this choice, so people can let the staff know in advance if they did not want the meal on offer. This would mean that the meal could be prepared in advance, so people could enjoy their meal at the same time as others with whom they live. The mealtime was a social occasion. The tables were nicely set out, and people were not rushed between courses. Those needing help were provided with this in a dignified way. And people were offered drinks both before and during the meal. People spoken with on the day had mixed views about the menu. Of the nine who returned their surveys, four said they always liked the meals. One said ‘No complaints’. Although five said they usually liked them, they added comments like ‘Not enough fruit and vegetables’. They said they would prefer fresh rather than tinned fruit. Other comments included ‘Too much stodge – carbohydrate – sandwiches, bread, teacakes, sponge puddings’. However, one person commented that the food had improved since they came to live at the home. They said ‘I enjoy all I have now’. The management said that the activities and the food are areas where in the past people have shown their satisfaction. However, there have been a number of new admissions in the last year. Their views may be different to those who previously lived at Milton House. As such, the management have decided to carry out a survey to seek people’s views in each of these areas to see where they would like improvements to be made. This is good practice, and will help Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 16 to make sure that this part of their care is provided based on their views and comments. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 17 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 and 18 People using this service experience good quality outcomes in this area. People can complain, and these complaints will be taken seriously. Further training will make sure staff know exactly to whom they can pass on concerns about safeguarding people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There have been no complaints about the service made to the home, or to the Commission for Social Care Inspection, in the last year. The complaints procedure is displayed in the home. We were told that it is also included in the service users’ guide, which people get on request, and that it is also explained to people when they move in. People who returned their surveys all agreed that they knew how to complain, and they ‘always’ or ‘usually’ knew who to complain to. They made comments like ‘Small home so easy to state views’, and ‘No complaints’. Those spoken to on the day were confident that if they were to make a complaint to the management, it would be dealt with properly. Staff knew that they must pass on complaints and concerns so they can be looked into. This included if they suspected or witnessed abuse, when they knew they could not keep such information to themselves in any circumstances. They said they would have no hesitation in passing this information on to the management. They also said that they would take the matter further if they thought it had not been dealt with properly. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 18 Staff have had training to help them to understand their responsibilities. Although they were aware of the whistle blowing procedure, they were not sure about the role of social services as lead investigators in abuse investigations. And the abuse policy was contradictory in places. The management are going to amend this so it is clear. In addition, staff need to be reminded that they can contact the local authority should they not wish to go direct to the management, so that such matters can be resolved quickly, and people kept safe from harm. The management have agreed to give staff a training update to include information about their role, and how they can be contacted. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 19 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 and 26 People using this service experience good quality outcomes in this area. People benefit from a pleasant, clean, warm and comfortable environment, which meets their collective needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is set in beautiful surroundings on the outskirts of the village of Gargrave. There is a garden area, which people said they enjoy in warmer weather. There is a sitting room with a large screen television. There is also a conservatory, which is well used by people, and which provides views of the river. There is a dining area, a library, and a number of smaller sitting areas. This means that people can sit out of their room if they wish and enjoy a variety of places to spend their day. Lift facilities allow easier access to each floor of the home. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 20 There is one assisted bath, and a walk in shower room. Some people have baths in their en suites, although these are not normally used, because they are not assisted, so more difficult to get in and out of. The majority of rooms provide en suite facilities, and are mainly single. Those seen reflected people’s individual tastes, as they had been able to bring in with them their own belongings. The laundry room is separated from the kitchen area by a door, which is not used. Staff access the room by another entrance, which means that they do not have to transport soiled items through any area where food is prepared. The laundry provides a washer with a sluice facility, and a drier. Staff make sure that soiled linen is transported to the laundry, and washed, separately. Protective clothing is provided for use when they are handling this. This reduces the risk from cross infection. Everyone has their own clothes, which looked well laundered and pressed by the care staff. Everyone who returned their surveys agreed that the home is always fresh and clean. One person added ‘No smells!’. Milton House Nursing Home DS0000027942.V374527.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 and 30 People using this service experience good quality outcomes in this area. People are cared for by staff who get training so they know what good care is, and how it should be provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Many of the staff have worked at the home for some time. This helps provide people with consistent care by staff they know. The registered provider lives nearby, and spends a lot of time at the home, although is not included in the staff numbers. People who returned their surveys said that staff were ‘always’ or ‘usually’ available when they needed them. Those on the day raised no concerns. A staff member commented ‘Every effort is made to make sure we are fully staffed at all times’. A number of staff have completed a National Vocational Qualification at Level 2 in Care, and the management said that they always try to encourage staff to enrol on this training. By doing so, people can be assured that they are being cared for by a well qualified workforce who know what good care, and which meets current standards, is. The recruitment files showed that the right steps are taken to make sure that staff are safely recruited to minimise the risk of people being cared for by Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 22 unsuitable workers. And the four staff who returned their surveys agreed that the right checks were carried out before they were recruited. The registered provider explained that staff are not allowed into the home until it has been confirmed that they have not been barred from providing care. Should they be needed to work before the full police check is returned, we were told that another staff member always supervises them, until all the information about them has been seen to confirm that they are a suitable employee. In one of the files looked at, there had been a misunderstanding about the references, as one referee had responded twice to the reference request. This meant that only one reference was obtained. The registered provider is going to ask for this retrospectively, so she can see the reason why the staff member concerned left their previous employment, and the employer’s views of how they worked. Staff get an in house induction when they first start to work at the home. The length of this induction very much depends upon their previous experience. The registered provider said that she has obtained information about the Skills for Care induction, which should be introduced as it will provide a good grounding for staff about current nationally agreed national minimum standards about care. The management have set up individual staff training files since the last key inspection in February 2007. The records were not up to date, however, and did not reflect the range of training that staff have attended. It is good practice to keep these files. It is also helpful however to have a matrix so the management can see at a glance which staff need updating. This will make sure that compulsory training, as well as training to update general caring skills, does not fall behind. Staff made comments like ‘I feel well supported and staff are very approachable and helpful to enable me to do my job well’. They have received some training to help them understand the needs of people in their care. Recent training for nursing staff to help them maintain their skills includes planning the care of the dying, management of special feeding regimes to keep people well nourished, and pain relief. Milton House Nursing Home DS0000027942.V374527.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, 33, 35, 36 and 38 People using this service experience good quality outcomes in this area. The home is managed by staff who take their role seriously. Recognised shortfalls are addressed by the registered providers to keep people safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Two managers run the home. They are registered with the Commission for Social Care Inspection, and are both qualified nurses. They said that this sharing arrangement works well, and that they give each other advice and support whenever this is needed. Neither have a management qualification, and say they have no plans to do so. A suitable qualification should be pursued. Not only does this underpin good management practice, but it also sets an example for less senior staff to follow, who may be reluctant to Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 24 undertake further training, by showing their commitment as managers to continuous learning and development. The staff say that the management are approachable, and that the management arrangements work satisfactorily. They say that although they do not get regular formal supervision, they can go to the management at any time, and would do so if they had any concerns, so they could be dealt with straight away. They said that the management in turn come to them if they have anything they want to discuss about their work. It would be good practice to introduce regular formal supervision meetings, as they give the opportunity to focus on staff practice, raise awareness of training needs, and the responsibility of each staff member to attend this training. In the absence of current staff meetings, supervision also provides the opportunity to tell staff what they are doing well, and where the management would like to see improvements made generally. There are currently no meetings held for people living at the home to be able to express their views as a group. The registered providers said that these have been held in the past, but were not successful, as they only captured the views of the minority who wanted to speak out. As such, it is recommended that, to understand people’s collective views about the way the home is run, that people, their families, and professionals who visit the service to support them, are provided with periodic surveys which they can, if they wish, respond to anonymously. The registered provider agreed that this would be useful. As stated previously, she intends to begin by carrying out a survey to collect people’s views about the activities and the menu, publish the collective results, and tell people what the management are doing in response to their comments. This will encourage people that the home is acting according to their views. The home has no responsibility for handling people’s monies. This is managed by the people themselves, or their family. Staff have received some compulsory training to help them work in a safe way. Fire training is updated regularly, a number of staff have attended health and safety and infection control training, and the kitchen staff complete training in food hygiene. It has been decided it is not necessary for care staff to do so. These staff complete training in infection control. There are qualified nurses available at all times to provide first aid treatment if required. This is an acceptable arrangement so long as they are confident and competent to take on this responsibility. This should be discussed with them during supervision to check that this is the case. However, some of the care staff have completed First Aid training, which, we were told, is refreshed as required. Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 25 The information provided before the inspection showed that the home is kept maintained so it remains a safe place for people to live. The sample of documents seen on the day confirmed that this was the case. The registered provider checks hot water sink outlets every six months to make sure that the fail safe valves still work. Thermometers are provided for staff to check the temperature of hot water where full immersion takes place. For instance when using the bath or shower. Staff do not currently record this temperature reading. The registered manager has agreed that from now on she will ask staff to do so, so she can check that the valves remain in working order to ensure that people are bathed at a safe temperature. The Environmental Health Officer recently visited, and was satisfied with the systems in place in the kitchen area. The Fire Officer has also visited, and asked for some changes to be made to the fire safety risk assessment, and some work to be carried out to the premises. The registered provider has taken this seriously, and we were told the work, for which no timescales were given, is ongoing. It would be wise to contact the Fire Officer on completion, to check that they are satisfied with the work carried out. Milton House Nursing Home DS0000027942.V374527.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Milton House Nursing Home DS0000027942.V374527.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 OP7 Regulation 13 Requirement An assessment must always be completed to try to minimise risk to people where this has been identified. For instance from falls, specific behaviour which affects people’s safety, where people choose to manage their own medication, or where a decision is being considered to use equipment such as bed rails. This will ensure that the risk to people is kept under review and included in their care plan so staff work in a safe, consistent way. Timescale for action 30/04/09 Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations People and/or their family should be invited to be involved in the review of their care plan wherever possible so they have the opportunity to be formally involved in decisions about their care, and how it is provided. So that their doctor can see how effective people’s medication has been when they come to review this, staff should record how much medication people have been given when their dose is variable. They should also make sure that the person who applies the cream signs the medication record. To reduce the risk from human error, hand written entries on the medication administration records should be countersigned. A daily check of the medication fridge should be maintained to make sure that medication, which needs to be kept cold, is stored at the right temperature. It would be good practice to advertise the daily alternative to the menu so people are able to choose in advance what they would like to eat. So that any safeguarding referral is made speedily, staff should be given sufficient information so that they understand the role of the local authority who lead on all safeguarding investigations. This should include contact details, so that they can go to the local authority directly with their concerns if they so wish. The Skills for Care induction and foundation training should be provided for new care staff so that their induction is in line with current nationally agreed national minimum standards about care. So that it is easier to track when staff need further training in their work, their individual staff training files should be kept up to date. It is recommended that the registered managers DS0000027942.V374527.R01.S.doc Version 5.2 Page 29 2 OP9 3 4 OP15 OP18 5 OP30 6 OP31 Milton House Nursing Home undertake management training. By doing so, they will underpin the management skills they have, and will demonstrate to their staff the importance of continuous learning in the provision of care. Staff should be provided with regular, formal supervision. This should cover all aspects of practice, the philosophy of the care home and their personal career development needs. This will assist the management in ensuring that the home is run in the best interests of those people living there. Ways of formally seeking the views of people living at the home, their families, and the professionals who support them, should be introduced, and carried out on a periodic basis. The planned action following the results should be fed back to people. This will help to confirm that the home is running in people’s best interests, and will allow people to see how the home is considering their views. 7 OP33 Milton House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 House Nursing Home DS0000027942.V374527.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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