Inspection on 15/01/09 for Milestone House

This is the latest available inspection report for this service, carried out on 15th January 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milestone House 15/08/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Milestone House Eastgate Seamer Scarborough North Yorkshire YO12 4RB     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline ORourke     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Milestone House Eastgate Seamer Scarborough North Yorkshire YO12 4RB 01723864528 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) : North Yorkshire County Council care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 7 Milestone House is a respite centre registered by North Yorkshire County Council to provide short stays for up to 7 younger adults with a learning disability. Mrs Ruth Collin is the Registered Manager. The home is a large detached building situated on the outskirts of Scarborough. It has been adapted to provide accommodation for service users who may have a physical disability as well as a learning disability. Each of the bedrooms is for single use and 4 of them have ensuite facilities whilst 3 of them are on the ground floor. The home is set in a well-maintained and mature garden that is accessible to all service users. Care Homes for Adults (18-65 years) Page 4 of 25 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Commission for Social Care Inspection inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk The key inspection has used information from different sources to provide evidence for this report. These sources include: - Reviewing information that has been received about the service since the last inspection. Care Homes for Adults (18-65 years) Page 5 of 25 - Information provided by the registered person on an Annual Quality Assurance Assessment - Comment cards returned from people using the service, health and social care professionals and staff. - A visit to the service by one inspector that lasted five hours. During the inspection three people who use the service and three staff were spoken with. Care records relating to four people who use the service, four staff members and the management activities of the service were inspected. Information about the service is available on request and is also available in different formats. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully involved in the assessment process through their preferred method of communication and can be assured their needs can be met at Milestone House. Evidence: People who use the services at Milestone House already have a comprehensive and detailed person centered care plan of which respite care forms a part. The case files seen during the visit contained multidisciplinary assessments. Records were also seen detailing the process of short visits, teatime visits and overnight stays that enabled people looking to use the service and staff to get to know each other. This trial process allows people the opportunity to express their opinion of the service. A link worker is also provided and it is their responsibility to help the induction process within the home. The manager of the service, the care manager, autism worker and the link worker, the individual and their carer all plan and agree the induction period with clear timelines and expectations. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: Information is provided to people in a variety of formats including widget, I speak, and plain English alternatively people can bring with them their preferred form of communication. Discussions with the manager and staff highlighted their awareness of ensuring the balance of care and social needs within the home was appropriate and that peoples needs could be properly met. This decision making process includes the social needs of a person because people using the service can become fixated on each other and this needs to be managed sensitively. The assessment process also allows the manager to ensure the staff have the necessary skills to meet peoples needs. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. People using the service are as involved as they are able to be in their care planning process and they are supported by the staff in their daily lives when at Milestone House. Evidence: The case files seen during the site visit contained detailed information pertinent to the individual. One plan seen contained specific information about the meal routine they had to go through to ensure their nourishment needs were met. Milestone House specializes in the support of people who have an autistic spectrum condition and have an accreditation from the National Autistic Society.The care plans seen of people who have this condition, included an autistic behavioral profile. This includes an identified link-worker with other services. A daily diary is kept and this identifies activities, important relationships in their life and these help staff communicate effectively with people and gives them a chance to express themselves clearly without verbalising their needs. One case record included evidence of a review. This had been carried out in a Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: group format and issues around the care plan were identified on a flip chart. The person whose care plan it was, was fully involved in this process. During the site visit several people were observed making their own decisions, about how they wanted to spend their time when they came in following day services. Staff were observed facilitating these decisions and used minimal guidance. Peoples files are also contained detailed risk assessments and these are reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People continue to take part in educational, and social activities whilst at Milestone House. They also enjoy a varied and balanced diet. Evidence: People who access services at Milestone House do so as part of a larger more involved care package. Staff support people to continue with their organised activities either at college, a local day service or through social events. However people using the service do have the opportunity to use their break at Milestone House as a complete break from their other activities. People using the service access the local community when they are on a respite stay and records showed that they had been to the local garden centre cafe, community centre for tabletop sales, shops and other available facilities. Information was available in the activity room of local events on during the coming months. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: There is a visitors policy in place and people are given the opportunity to identify anyone they do not want to visit them whilst they are on a respite stay. The daily routines are dictated through the week by other activities attended by people using the service. A persons daily routine is part of their care plan. A 4-week menu is provided in a format that is understandable by the people using the service and takes in to account people who are autistic. The main meal of the day is flexible enough to allow people to go out to the local pub or get fish and chips from the local fish shop. The dietary needs of the people using the service are considered before any decisions about what is for the meal are made. They are encouraged to assist in all aspects of meal preparation from shopping to preparing and helping clear up. However it is not compulsory to help the staff. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to be as independent as possible whilst receiving appropriate support as outlined with their care plan. Evidence: The care plans seen during the site visit contained detailed information about the support required by the individual. A person using the service spoken with during the visit said that staff gave them the support and encouragement they required. People are encouraged to let staff know if there is a member of staff they do not want to assist them and this is done through verbal and non-verbal methods of communication. Where someone has identified a carer they do not want assistance from then this information is recorded in their care plan. People continue to maintain contact with their usual health practitioners whilst they are in for a respite stay. There is an arrangement with the local surgery for emergency cover for people staying who are outside of their usual districts. District nurses also provide support. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: There is a clear medication policy in place and evidence was available to show that staff have completed a learning distance course in The Safe Handling of Medicines. Staff spoken with said that they did not handle the medication if they had not undertaken the training. The storage and administration records for the medication was appropriate. Where possible people are encouraged to be self-medication but where this is not possible the staff support them in the way that enables them to be as independent as possible. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. 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. Concerns and complaints are dealt with positively and used to help develop the services at Milestone House. People are protected from abuse through a stringent selection process and regular training. Evidence: A complaints policy is in place and it is available in several different formats so that people can access it if they need to. A record of complaints is held along with any investigations and outcomes. The manager uses this information to help develop the service provided at Milestone House. People using the service are protected from possible abuse through rigorous employment procedures and through staff training. Staff spoken with during the site visit were clear about their responsibilities in the event of suspected abuse. Information was around the building for an advocacy service and people spoken with were confident they could raise any concerns with their carers or someone within their care package. The care plans contained clear risk assessments in the use of restraint, where necessary and what the procedure was if restraint had to be used. The care plans were pertinent to the individual and very clear in their instruction. Care Homes for Adults (18-65 years) Page 17 of 25 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. People live in a well-decorated homely environment that is accessible to everyone. Evidence: The home is converted building providing 7 bedrooms, 5 of which are ensuite. The rooms are well decorated and are equipped with a bed, bedroom furniture and television. The rooms seen were warm and clean. There are 3 quiet rooms, 1 which is used as a sensory room, 1 is an arts and craft room and the other is a general lounge area with television, DVD/Video player and a music centre. All areas of the home are accessible to people using the service and there is generous outside space for them to use as well. There is a small laundry that can be accessed by people using the service with support or laundry can be completed on the persons behalf. The washer has a specified programme to meet disinfection standards. The washer has a specified programme to meet disinfection standards. Care Homes for Adults (18-65 years) Page 18 of 25 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff that are well trained and supervised support people who use the service. Evidence: North Yorkshire County Council has a rigorous recruitment process and staff files seen contained an application form, two written references and a Criminal Records Bureau disclosure. People who use the service are encouraged to take part in an orientation process for staff as part of the recruitment process and the manager values their input. The files containing details of training they have undertaken and supervision notes is now kept by the member of staff they are pertinent to. Staff spoken with confirmed that they had undertaken the statutory training and were more enthusiastic about the specialist training they undertook. Extra staff can be provided through the community support budget and this is used where someone requires one-to-one support. All care staff are encouraged to do the national vocational qualificiation level 2 in care. Feedback received from staff indicated that they have good information about the people using the service and where necessary extra training is provided to ensure they have the skills needed to provide appropriate support. Feedback received from relatives and other professionals was very positive about the care and attitude of the staff. Care Homes for Adults (18-65 years) Page 19 of 25 Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. People benefit from living in a well-managed and safe environment where their views are regularly sought about the service provided. Evidence: The registered manager currently overseas the service as she has other responsibilities within North Yorkshire. There is a management team that looks after the service on a day-to-day basis. The operations manager leads this team and she has an national vocational qualification level 4 in management and care. As part of their quality assurance programme people are asked to complete questionnaires. These are a pictorial document and they are assisted by their families to fill them in. The home holds a current National Autistic Society accreditation for autism specific services. This accreditation is renewed annually. The assessors, a panel of three independent adjudicators, spend time seeking the views of people using the service, their families and outside professionals. They also scrutinise policies, Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: procedures and working practices. North Yorkshire has a service improvement plan that managers have to complete and these identify areas that the staff are looking to improve. The health and safety records were checked and all were found to be up to date. Risk assessments for fire, the environment, COSHH and people who live in the home. All accidents and incidents are recorded and when necessary they are reported to the Commission of Social Care Inspection. Care Homes for Adults (18-65 years) Page 22 of 25 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 Adults (18-65 years) Page 23 of 25 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 Adults (18-65 years) Page 24 of 25 Helpline: 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 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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