Care Home: Pilgrim Homes Milward House

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What the care home does well New residents are helped to settle into the home through good admission processes and they receive a thorough assessment of their needs by senior members of staff. The health and personal care needs of residents are well managed and clearly documented. The spiritual needs of residents are very well met, and the social needs and interests of residents are catered for. Residents are confident any complaint they have will be listened to, taken seriously and acted upon. Milward House provides a comfortable, homely and clean environment, which is maintained to a good standard. Residents benefit from being cared for by a caring, well trained, skilled staff group, who in turn feel supported by their manager. Residents are fully involved in the running of the home and their opinions and needs are central to how the home is run. What has improved since the last inspection? Additional storage space has been found for storing equipment such as wheelchairs and hoists. A review of the number of hoists has taken place and there is now a hoist on each floor. What the care home could do better: The laundry does not have a designated hand washing sink to help minimise the risk of cross infection. The quality assurance systems could be integrated to include the surveys, audits, meeting minutes, complaints, accidents, etc. this could then enable the manager to produce an annual development plan. Key inspection report Care homes for older people Name: Address: Pilgrim Homes Milward House 6 Madeira Park Tunbridge Wells Kent TN2 5SZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Justine Williams     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Pilgrim Homes Milward House 6 Madeira Park Tunbridge Wells Kent TN2 5SZ 01892528115 01892518802 milward@pilgrimhomes.org.uk www.pilgrimhomes.org.uk Pilgrim Homes care home 28 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Milward House is owned and operated by Pilgrim Homes. It provides personal and nursing care and accommodation for older people with Christian beliefs. Consequently, the Home has a strong Christian emphasis and regular prayer meetings and devotional services are a feature of life within the Home. Milward House is located in a residential area of Tunbridge Wells. Accommodation is over three-storeys, with a passenger lift. Milward House has twenty-four single rooms and two shared rooms. The home employs care staff, working a roster, which gives 24-hour cover. The home Care Homes for Older People Page 4 of 24 28 0 Over 65 0 28 Brief description of the care home also employs other staff for maintenance, catering and domestic duties. The home is adjacent to sheltered housing accommodation that is also provided by Pilgrim Homes. Current fees range from £551 to £904 per week. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection was carried out on 6th April 2010 between 10 am and 1.15 pm. During that time the inspector spoke with residents, staff members, and the deputy manager. Feedback was given during and at the end of the inspection. This report contains assessments made from observation, conversation and records, as well as case tracking and a tour of the premises. The manager returned the Annual Quality Assurance assessment AQAA, on time, and the information provided has been used in the report. As part of the inspection process surveys were sent to service users and to GPs, health care professionals and care managers information from the surveys was also used in the report. People who use the service are referred to as residents throughout the report as this is what they prefer. Care Homes for Older People Page 6 of 24 The quality rating for this service is 3* star. This means the people who use this service experience excellent quality outcomes. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the information they need to help them make an informed decision to move into the home. Residents are confident the home can meet their needs through good admission procedures. Evidence: The homes statement of purpose and service users guides are reviewed and updated regularly and people enquiring about a place at the home are sent or given copies. A resident who had moved into the home recently was spoken with, the resident said she was made to feel very welcome and was assured that her needs could be met. Prospective residents have their needs fully assessed by a senior member of staff to ensure the home can meet their needs, prior to being offered a place. For individuals assessed through care management a copy of their assessment is requested. Care Homes for Older People Page 10 of 24 Evidence: Intermediate care is not offered at Milward House. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well managed. Staff treat residents with respect and maintain their privacy and dignity. Evidence: Each resident has a care plan developed with their involvement. 4 care plans were inspected, each contained a good level of detail to enable staff to meet the residents needs. The care plans included all aspects of health, personal and social care needs. Residents files contained risk assessments for falls, and any actions to be taken to reduce risk was clearly documented. Other risk assessments were seen in the files these were also comprehensive and clear. The care plans had been reviewed on a monthly basis and any changes were written in. The health needs of residents are understood and met. For those residents who are at the home on a residential basis their nursing needs are met by the district nursing service, for those who are placed for nursing care the homes registered nurses carry out this care. All the residents are assessed by the homes registered nurses for pressure area risk, continence assessments, nutrition etc. Residents may keep their Care Homes for Older People Page 12 of 24 Evidence: own GP if local and the GP is in agreement. Staff assist residents to access medical, nursing, dental, and other health services as needed. Visits by health professionals are clearly documented. The nursing staff administer medication at the home and the medicines are stored and managed in accordance with good practise guidelines and legislation. The home has a clear medication policy. The nursing staff undergo training regularly to update their knowledge. Residents spoken with said they were very happy with the home and liked the staff. They said that staff treat them well and are very caring. Interactions seen between staff and residents confirmed this. Residents privacy and dignity are respected , specific comments made in the surveys included we are treated as individuals and they are very attentive to our needs. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents find the lifestyle at the home matches their expectations and they have as much choice and control over their lives as their abilities allow. Residents enjoy a healthy and varied diet which suits their taste. Evidence: Residents said that the activities and routines at the home suit them and they can choose what they wish to participate in. In accordance with its Christian ethos, prayer meetings and devotional services are pivotal to the routine of the home and are provided every day. Most residents attend the services held in the lounge every morning, and many attend the afternoon activities held from Monday to Saturday inclusive from 3.00pm. Information about the activities are displayed in the hall. Residents are able to have visitors at any reasonable time and are encouraged to maintain links with the community through visits out and by inviting local groups into the home. Residents are encouraged to make decisions and exercise personal choice for as long as they are able. Residents spoke very positively about the food at Milward house. All those spoken with said the food was very good. They confirmed that there is plenty of choice and that Care Homes for Older People Page 14 of 24 Evidence: their individual likes and dislikes are noted. The meal times are set but are flexible and 2 residents were seen finishing breakfast at 10.15 in the dining room as they had not wished to get up earlier. Meals are well presented and fresh fruit and vegetables are available daily. The chef has worked at the home for around 20 years and now enjoys working from a kitchen where he can see and talk to the residents in the dining room. Special diets are catered for and the chef and other kitchen staff regularly update their training and skills. Menus are displayed in the dining room and the chef writes up the daily menu in the morning. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that any complaint they had would be listened to and dealt with appropriately. There are systems in place to protect the resdinets from abuse. Evidence: The complaints procedure is given to residents when they move in and is readily available in the home, residents spoken with new who they should speak to if they had a concern or complaint and said they felt comfortable to do this and confident any issue would be dealt with. One resident said I have nothing to complaint about but if I did I know it would be sorted out another said if I have any problems I speak to the staff and they deal with it. A log is kept of all complaints made including very minor expressions of dissatisfaction, and the actions taken to address complaints is also documented. The complaints are dealt with according to the homes timescales and all have been resolved. The home has an policy in place for the protection of vulnerable adults and this informs staff how to deal with suspicions or allegations of abuse. Staff also receive training at induction and further training to ensure they have a good understanding of adult protection. There are no adult protection allegations at the home at this time. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residients have a pleasant, homely and clean environment in which to live. Evidence: The home is situated in a quiet residential area of Tunbridge Wells. It provides spacious accommodation over 3 floors with a passenger lift, to each floor. The home is light homely and decorated and maintained to a good standard. Residents spoken with said its a lovely place to live and we are very grateful to be here. Only 1 resident was not completely happy with her room, but was placed urgently and is waiting for a more suitable room to become available. The home was clean and there were no offensive odours. There is a programme of redecoration and refurbishment in place. Bathrooms and toilets all had pedal bins, liquid soap and paper hand towels in line with good practise guide lines. The laundry is in the basement away from food preparation areas and is a good size with all necessary washing and drying equipment. There is not a designated hand washing sink at present, and the deputy manager agreed to review this urgently. Laundry staff are employed to look after residents clothing and residents said they had not experienced any problems with laundry. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from being cared for by a safely recruited, trained group of staff. Residents needs are met by the number and skills of the staff. Evidence: The home continues to have a relatively low turnover of staff, and the staffing levels are good. A trained nurse is on duty 24 hours a day, supported by care staff. Additional staff are on duty at peak times in order to meet residents needs. The staff rota shows clearly who is on duty and in what capacity. 9 of the 20 care staff have attained NVQ, the home has difficulty in reaching 50 of staff to have NVQs due to the staff employed. Many of the staff are medical or nursing students working at the home part time, others already have degrees. All new staff have an induction which is skills for care compliant. The home has a robust recruitment procedure that it adheres to. All staff complete an application form, have an interview, and transcripts of the interview are kept. Staff provide 2 written references which are verified by the manager, and all staff have CRB checks prior to starting employment. A training matrix is kept to track what training staff have had and when they are due updates. These are arranged by the senior staff. Staff are up to date in core and Care Homes for Older People Page 18 of 24 Evidence: mandatory training and other specialist training is sought, according to complexity of residents needs and the interests of the staff. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefit from the effective management and leadership at the home. Evidence: The manager is a registered nurse and has a post graduate qualification, and NVQ 4 and Registered Managers Award. She has many years experience in the care of older people in a senior capacity. Residents staff and relatives benefit from the open inclusive atmosphere at the home, and the manager communicates clear leadership. Staff and residents are fully involved in the running of the home and there are formal strategies for allowing this to happen as well as informal ones, they include residents and staff meetings. The home has robust quality assurance systems in place, which includes monitoring of complaints and accidents, auditing of documentation as well as surveys sent out annually. The quality assurance system would be improved further by bringing these together to form an annual development plan for the home, which would identify Care Homes for Older People Page 20 of 24 Evidence: areas of strength and weakness and help the manager determine areas for development. The processes for managing service users money are unchanged. The home looks after small amounts of money where residents lack capacity or do not wish to look after it themselves. Recording systems are clear. According to the AQAA all necessary checks, servicing and maintenance of equipment and systems is up to date and the home has a maintenance person to help ensure health and safety is maintained. Staff receive training in first aid, COSHH, food hygiene,health and safety and infection control. Care Homes for Older People Page 21 of 24 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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, Care Homes 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 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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