Inspection on 05/11/08 for Millerhouse Residential Home

This is the latest available inspection report for this service, carried out on 5th November 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOME ADULTS 18-65 Millerhouse Residential Home 615 Burnley Road Crawshawbooth Rossendale Lancashire BB4 8AN Lead Inspector Mr Jeff Pearson Unannounced Inspection 5th November 2008 09:45 Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 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 Millerhouse Residential Home DS0000070956.V367062.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 Adults 18-65. 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. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millerhouse Residential Home Address 615 Burnley Road Crawshawbooth Rossendale Lancashire BB4 8AN 01706 220988 01706 220988 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) Mentor Care Ltd Miss Judith Susan Lucas Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC To people of either gender whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability and or dementia Code MD The maximum number of people who can be accommodated is: 6 Date of last inspection First inspection since change of owners Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 5 Brief Description of the Service: Millerhouse is a smaller home registered to provide personal care and accommodation for 6 people, aged 18 to 65 years, with a mental illness. The home is a large cottage type property situated on a busy main road within a village community. Within close walking distance to shops, a pharmacy, pubs and restaurants. Access to public transport is within easy reach, the village is on the main bus route to Burnley and Manchester. Accommodation is provided on two floors. There is a lounge, dining room, bathroom, separate toilet, two single bedrooms and two shared bedrooms. There is an enclosed yard area to the rear of the home. There are steps to the front and back doors, which may make access difficult for people with poor mobility. Staff are on duty to provided support 24 hours per day. Miller House had a Statement of Purpose and Service User Guide providing details of the services available. This information should help people make an informed choice about moving into the home. At the time of this inspection, the range of fees was from £400.00 to £900.00 per week. There were additional charges for – hairdressing, some activities and outings. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people using this service experience Good quality outcomes. An unannounced inspection which included a visit to the service, was conducted at Miller House on the 5th November 2008. The visit took 7 hours and was carried out by one inspector. Residents and staff at the home were invited to complete surveys, to tell the Commission what they think about the care and service provided at Miller House, some were returned to us. Before the visit the owner was required to complete and return to us an annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the home. The files/records of 3 people were examined as part of case tracking, this being a method of focusing upon a representative group of people living in the home. We spoke with people living in the home, the manager, deputy manager and staff. Various documents, including policies, procedures and records were looked at. Most parts of the home were viewed. What the service does well: This home is keen to provide and develop good quality support for people using the service. The home was being well managed by a capable person. The residents said, “Things are fine” and “I like living here”. Staff completing surveys made the following comments about what hey thought the home did well - “ The service does well with every different need of each client” and “Millerhouse creates a secure friendly environment that is conducive to each client” There was a good way of finding out about peoples’ abilities, needs, likes and dislikes before they moved into the home. People living at Millerhouse were being involved with different activities and were getting out into the community. They were being given support to stay in touch with families and friends. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 7 People were being involved as much as they were able, in making decisions about how they spend their time. They were being encouraged to develop skills, by sharing some responsibility for helping with chores in the home. Support with personal and healthcare needs was being given with care and people were being treated with respect. The staff team worked very well with the people living in the home. The residents described staff as “Good” and “Friendly and helpful” To make sure they knew what to do, staff were being given regular training. The accommodation provided a comfortable, clean environment for people living at Millerhouse. The residents were very happy with their bedrooms, which included their own belongings and choice of decoration. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission process ensured peoples’ needs; abilities and preferences were known and planned for before they moved into the home. EVIDENCE: There had not been any new admissions into Millerhouse for some time. However, the admission process was discussed with the deputy manager, who explained that prospective residents would be given a copy of the homes guide and brochure. The person would be visited in their own environment and their needs and abilities considered, with information being obtained from relevant people, such as Social Workers, Community Psychiatric Nurses and families as appropriate. Arrangements, would be made for the person to visit Millerhouse, for tea, overnight and weekend stays and maybe to join in some group outings. Careful consideration would be given to what the home can offer and also compatibility with the existing residents. A plan of care and support would be developed to meet their needs. People would initially move in for a trail period, Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 10 this would enable everyone involved to consider the suitability of the placement. Records seen, showed assessments had been carried out before people had moved into Millerhouse. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Peoples’ needs, abilities and choices were known, but individual plans were not effective in detailing person centred support. EVIDENCE: The residents spoken with had an awareness of their individual plans. Staff completing surveys, indicated they were aware of and understood, peoples’ individual needs. Two care plans and files were looked at as part of case tracking. They included much information; including, initial assessments, plans devised by the care professionals involved with the persons’ care and support, also, records of reviews, one to one meetings and other matters. Some of the information went back over several years. The homes’ care plans were mainly incorporated in the care review records and did not clearly reflect the care and support to be delivered. This meant care plans were difficult to use as a working document and were lacking in specific instructions for staff, on responding to peoples’ needs, abilities and behaviours in a person centred way. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 12 The manager said it was her intention to review and update the care plans, this being included the AQAA (Annual Quality Assurance Assessment) as a matter for future improvement. Systems were in place for people to be consulted individually and in groups. People were being supported to keep a diary of their daily living, planned events and choices. One to one reviews enabled people to say how they felt about the support provided and to be involved with future plans. The deputy manager explained, that people had recently been encouraged to think about any aspirations they may have, so that plans could be made to help them fulfil their ambitions. It was apparent from discussion and observations, people were being supported to be independent as possible. A number of risk assessments and ways of managing risks had been devised in relation to matters such as, accessing the kitchen and accessing the community. Some of risk assessments had been written several years previously and did not show clearly that they had been reviewed. The manager and deputy manager said the risk assessments had been reviewed and were still current. However, to better promote the residents’ safety and good communication, action was needed to show the actual recorded risk assessment had been formally reviewed. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using the service were being offered opportunities to take part in activities, use community resources and continue relationships. EVIDENCE: People living at Millerhouse spoke of the various activities, both in and out of the home they were involved with, including shopping, days out, swimming, pubs, walks, various local initiatives and resource centres. On the day of the inspection visit they had enjoyed a lunch out in a nearby town and were looking forward to attending a local bonfire and firework display. The deputy manager explained the ongoing attention being given, to finding suitable educational and leisure activities for the residents. Millerhouse is situated in the centre of the village and residents are supported to make use of the local shops and community resources. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 14 People spoken with said they were keeping in regular contact with families and friends, visiting them for weekends and social occasions. “I’ve been getting out and about,” explained one person. Independence living skills were being encouraged, people were responsible for tidying their rooms, some made drinks and snacks for themselves and said they were involved with shopping and cooking. Records showed people had agreed to share responsibility with household chores, such as cleaning and washing up. Any restrictions, in the interests of the person concerned had also been agreed with them. Residents said meetings were being held regularly, to discuss matters such as meals, routines and activities. All the residents said they were happy with the food provided at Millerhouse, they said it was, “good”. Individual food likes and dislikes were known and recorded. The menus were being devised each week, based on known preferences and residents’ choices; this was flexible to cater for specific requests and seasonal changes. Information was available on healthy eating, to help promote good diets. Specific dietary needs were being responded to individually, as appropriate. The AQAA (Annual Quality Assurance Assessment) completed by the owner/manager, indicated that involving people with food preparation and cooking as an area for future improvement. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 18,19 and 20 This judgement has been made using available evidence including a visit to this service. Most health and personal care practices and procedures were effective in ensuring people’s needs are properly and sensitively met. EVIDENCE: It was apparent from discussion and observation; people were generally being supported to take an interest in their appearance, hairdressing and clothing. Residents spoken with raised no concerns about the support they received with their personal care needs. The home operates a ‘key worker’ system which involves staff being linked with a particular resident to provide continuity and a more personal service. All interactions observed between the residents and staff appeared sensitive; staff were respectful and genuine in their approaches when providing support and guidance. Care plan reviews and recording systems showed people were getting support with healthcare needs and various appointments. One person spoken with Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 16 explained they were getting medical attention when needed, and that they had recently been to the dentist. To monitor general wellbeing, the owner/manager said arrangements were in place for people to receive annual healthcare checks. Mental health care needs were being monitored and responded to, with the involvement of appropriate professionals such as Community Psychiatric Nurses, Consultants and Social Workers. Medication storage facilities were satisfactory, advice was offered on the safe storage of controlled drugs. Medication policies and procedures were seen to be available. It was advised the revised guidance form the Royal Pharmaceutical Society be obtained to help ensure and promote current good practice. Staff had received medication management training, for some this had been over three years ago, therefore arrangements were being made to access further training, this will ensure they have up to date knowledge and skills. Medication administrations records seen were mostly clear and up to date; dosage instructions on one label stated ‘as directed’ which was not specific, it was advised clearer instructions be requested for the repeat prescription. Another item was prescribed as ‘when necessary’ there were procedures for dealing with this, but staff were not provided with clear instructions on recognising individual triggers, behaviours and symptoms on when to offer the medication. Individual assessments had been carried out on peoples’ ability to manager their own medication; it was advised these be developed to consider all risks, show how decisions are made and why. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Most policies, procedures and practices provided safeguards for people using the service supported the complaints process. EVIDENCE: Resident spoken with indicated they knew how to raise any concerns, saying they would speak to the manager or staff who would “sort it out”. Staff completing surveys indicated they knew how to respond to any concerns raised by people living at Millerhouse or relatives. The manager and deputy manager spoken with, expressed a good awareness of safeguarding matters, including the action to be taken in response to any protection issues. The complaints procedure included instructions on how to make a complaint and how it would be dealt with, along with details of the Commission; it was advised appropriate contact details of the Local Authorities be included in the procedure. Systems were in place for recording and responding to concerns raised. Managing complaints was discussed with the owner/manager, in particular, remaining impartial, devising investigation strategies and ensuring systems make proper provision for recording interviews, outcomes and action taken. One resident commented that they “Feel safe living at the home”. Policies and procedures were available in relation to safeguarding and protection. It was Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 18 advised the reporting of incidents and allegations procedure be clearer in directing people to refer concerns to Social Services, it was suggested telephone numbers also be included, the manager took action in response to this matter during the inspection. The manager said staff had previously received POVA (Protection Of Vulnerable Adults) training and that further appropriate training was to be arranged. The staff ‘whistle blowing’ procedure included some good information; but the procedure needed to include the full contact details of the local Social Services and The Commission for Social Care Inspection, to ensure any unresolved bad practice is appropriately reported. Again the owner/manager took immediate action in response to this matter and said staff would be made aware of the revised procedure. The AQAA (Annual quality Assurance Assessment) showed that POVA training and training on recognising bullying, as plans for improvement at the home. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The accommodation provided a comfortable and clean living environment for people living at Millerhouse. EVIDENCE: Millerhouse blends in well with other residential properties in the area and provides domestic style accommodation. The lounge was seen to provide a homely living environment with sofas, chairs, soft furnishings, pictures and television. The residents spoken with said they liked this room. The kitchen was mainly domestic in style and was used regularly by the residents and staff. Due new regulations residents and staff had to smoke outside, a small shelter had been provided. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 20 The back dining room had recently been redecorated and a laminate floor fitted. This room is also used as the administration office, which the owner/manager said was not ideal. However, lockable storage was provided and it was advised this be used more effectively to better promote confidentiality of personal information. Currently, people living at the home had their own bedrooms due to low occupancy; however, in one double room the furniture had been arranged to promote privacy. People seemed very proud of their rooms and had personalised them with their own belongings, which had helped create a sense of home and ownership. “I like my room” was one comment made. The bedrooms seen were very pleasantly decorated and furnished to a good standard; they had a contemporary look and style; the residents had chosen the colour schemes and furnishings. The home was found to be clean and free from unpleasant odours. The laundry area was small but functional and accessible to people living at the home, the walls and floor were of easily cleaned material, satisfactory laundry equipment and facilities were available. A heated had dryer had been fitted in the ground floor toilet, to promote good hygiene practices. The AQAA (Annual Quality Assurance Assessment) showed further decorating as a plan for ongoing improvement at Millerhouse. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staffing arrangements aimed to provide people using the service with effective and consistent support. EVIDENCE: People living at Millerhouse expressed an appreciation of the support provided by the staff team, “The staff are good,” said one person. Two staff were seen interacting with and supporting the residents, it seemed good relationships had been developed, staff were respectful in their manner and encouraged and consulted with people about daily matters, including the trip to the shops and planned bonfire night celebrations. Staffing rotas were being devised fairly flexibly, to take into account the needs, abilities and routines of the people accommodated, there were usually two people on duty during the week. The rota showed clear on-call arrangements for management support. Staffing levels were discussed with the Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 22 owner/manager and deputy; in terms of providing effective support in response to individual needs and choices, the owner/manager was confident staffing levels were sufficient. There was a low staff turnover at the home, which had provided people living at the home with continuity of support. Staff indicated in surveys that appropriate recruitment practices had been carried out at the home. The recruitment records kept of newest staff indicated appropriate checks and screening had been carried out, references sought and interviews held. It was advised the application form be updated to routinely request dates of education, membership of professional bodies and guidance on suitable referees. Records showed an initial induction training programme for new staff was being carried out. The deputy manager said they were currently reviewing all the staff training programmes. Most staff had attained NVQ (National Vocational Qualifications) level 3 in promoting independence, with the newest staff member having just started NVQ level 2. The mandatory courses for new staff at Millerhouse were defined as mental health, moving and handling, fire safety, food hygiene, medication, risk assessments, first aid. Records and discussion showed training in these subjects had been completed, was ongoing or being planned for. Surveys completed by staff indicated that relevant initial and ongoing training was being provided. The deputy manager had undertaken training in individual staff supervisions and appraisals, records and discussion showed systems were in place to provide this form of individual guidance and development. Staff indicated in surveys that they were well supported by the managers. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Management and administration practices were effective in ensuring the home is run for the benefit of the people using the service. EVIDENCE: The owner/manager was previously the registered manager at Millerhouse and had 15 years experience in the mental health field, with 12 years in management. She had attained the Registered Managers Award, and completed City and Guilds Care management training. She was proposing to update development skills, by accessing Mental Health Capacity Act and Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 24 challenging behaviour training. The value of completing NVQ level 4 in supporting independence was discussed. Consultation surveys had been carried out with residents and others, with the findings being responded to as appropriate, it was advised the results and findings of quality surveys be reflected within the AQAA (annual quality assurance assessment). The AQAA included some relevant information, with several areas for improvement being identified. Effectively completing the AQAA, in particular, ensuring enough details are noted and using the process for ongoing quality assurance and developing the service, was discussed with the owner/manger. The benefit of having Internet access at the home, to provide opportunities for the residents skill development, communication, training and obtaining useful information was discussed with the owner/manager. Arrangements were in place for staff to receive training in safe working practice subjects. The homes AQAA indicated the servicing and checking of equipment and installations, records were seen in support of this. Fire drills were being carried out, fire risk assessments were seen. Health and safety risk assessments had been completed. Health and safety policies and procedures were available; guidance had been obtained in relation to infection control. The owner/manager said portable appliance testing was no longer required to be carried out annually; it was advised this matter be clarified to ensure safe practices. Systems were seen to be in place to identify and respond to general maintenance matters and repairs. Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard YA6 YA9 Good Practice Recommendations To provide people with effective support, care plans should include detailed instructions on responding to individual needs, goals and behaviours. Individual risk assessments should be formally reviewed and updated; this will ensure people using the service are more safely supported to develop their independence skills. To ensure management of medication is safe and appropriate, a regular auditing system should be introduced which covers matters such as records, storage and administration. The assessing of peoples ability to manage, or be involved with their medication. Also, individual protocols for ‘when necessary’ and ‘variable dose’ medication should be given further consideration and attention, this will ensure people are more effectively and safely supported with their medication. 3 YA20 4 YA20 Millerhouse Residential Home DS0000070956.V367062.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection 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. 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