Inspection on 20/07/09 for Milton House

This is the latest available inspection report for this service, carried out on 20th July 2009.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milton House 20/07/07

Milton House 23/02/07

Milton House 30/11/05

Milton House 14/06/05

Milton House 02/11/04

Milton House 05/07/04

Milton House 30/05/02

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Milton House 39/41 Spencer Road Bedford Bedfordshire MK40 2BE     The quality rating for this care home is:   two star good 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: Katrina Derbyshire     Date: 2 0 0 7 2 0 0 9 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 Adults (18-65 years) Page 2 of 27 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 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 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Milton House 39/41 Spencer Road Bedford Bedfordshire MK40 2BE 01234216460 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: premilab@hotmail.co.uk Mr Hurry Bhautoo,Mrs Premila Bhautoo care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Change to categories - LD (13), and LD (E) (13) - No service users under the age of 35 will be admitted. The home is also to be registered to provide care to ONE (1) service user with a mental health disorder (MD) (1). This condition applies only to the service user who has been identified to the National Care Standards Commission. At such time as this identified service user ceases to live at the home, the NCSC must be informed immediately and this condition of Registration will be adjusted to reflect this fact. Date of last inspection Brief description of the care home Milton house is a residential care home and offers support to 13 people with learning disabilities. Community facilities and shops are a short distance from the home, which is also within walking distance of Bedford town centre, and the bus and train stations. The building consists of two attached houses linked by access doors on both ground and first floors. The accommodation is organised in three sections. One of the original houses is divided into flats, one on each floor, with three bedrooms each, a kitchen, bathroom and living room. The other house has seven bedrooms, distributed Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 13 13 Brief description of the care home between the floors, with the lounge, dining room and kitchen on the ground floor, and bathroom on the first. There is a toilet and shower on the ground floor. The office/sleeping in room and laundry are also situated on the ground floor. There is a small enclosed garden and some off road parking. The fees for this home vary from £363.00 per week, to £690.00 per week, depending on the funding source and assessed need of the person. Additional charges are made for transport, trips, holidays and meals if taken outside of the home. Care Homes for Adults (18-65 years) Page 5 of 27 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: two star good 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit took place on 20th July 2008. During the visit the communal areas of the home were seen alongside some of the individual accommodation. The inspector spent time with some of the people who live at the home in their rooms and the communal areas. Management and staffing records were examined. The care of two people was looked at in detail. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. Care Homes for Adults (18-65 years) Page 6 of 27 Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the managements submission of documentation. Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards, to look into the concerns that had been raised, and to follow up on previous requirements. Care Homes for Adults (18-65 years) Page 7 of 27 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. Care Homes for Adults (18-65 years) Page 8 of 27 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 Adults (18-65 years) Page 9 of 27 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 10 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The system in place for staff to assess the needs of prospective people is not sufficient to ensure that they would have the information to know if they would be able to meet their needs. Evidence: It was raised at an inspection in February 2007 that people living at the home did not have pre admission assessment information within their care records. As many of the people living at the home had lived there for several years, the senior management had undertaken another assessment of needs. The Deputy manager confirmed at the visit in July 2007 that it would be this template that would be used for assessing the needs of people who may move into the home in the future. However the documents seen at that time did not provide sufficient guidance to make clear all of the needs of each person and how they should be supported. This was seen to have improved at this visit. However no new admissions to the home had taken place since the inspection in 2007; therefore this requirement could not be assessed for compliance and will be looked at next time. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The judgement within this section is based upon the information gained through the inspection in 2007. As no new admissions have taken place to be able to assess full compliance, this judgement has continued. Care Homes for Adults (18-65 years) Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is sufficient to give the guidance needed to staff on how a person should be supported. Evidence: Care plans were seen within the individual folders of people living at the home. Further work had been undertaken since the last inspection to improve the standard of these documents. All care plans seen gave clear guidance to staff in how they should support the person, an example was the level of support that a person needed to maintain their personal hygiene. An issue detailed at the last inspection when clear guidance had not been in place relating to the behaviour of one person had been addressed. Meetings with social services had taken place and a detailed plan was seen. Reviews carried out by social services during the past 12 months showed that there were several people who still wished to move out of the home, this was reported at the previous inspection. The reasons for this varied, from some wishing to move to Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: supported housing and others wishing to move back with relatives. These views were acknowledged by the management of the service and acceptance that people wished to move on. Observation showed that people moved around the home freely with no restriction in place. One person returned from town and they had been accompanied by a member of staff. They stated that they had been out for a cup of coffee and the walk into town and had been good exercise. The needs of people living in the home have changed over time and several now feel that the service no longer fulfils their needs. We reported at the previous inspection that due to limited staff numbers being on duty from Pm the opportunity to go out in the evening was limited for some people, this had now been increased. Risk assessments were in place within the individual care files examined. Risks that had been assessed included leaving the home and health matters. Staff through questioning confirmed that they had received training in the area of risk assessment; in addition they demonstrated a sufficient level of understanding in the possible risks to people living at the home. Care Homes for Adults (18-65 years) Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home do have some access to local facilities so benefit from being part of the community and are supported in maintaining personal relationships. Evidence: Records and through discussion showed that alongside the provision of meals supplied at the home people also have opportunities to eat out in one of the local eateries in the Bedford area. The meals supplied by the home offer basic protein, carbohydrates and vegetables. Stocks of food are now stored appropriately and labelled. Feedback from Bedfordshire Social Services remains that some people feel that there were sufficient choices and activities whilst others do not. Written records show that people do have opportunities to attend day centres and also when staying at the home during the week, being supported to go into town during the day. More staff were now on duty after 8pm so people were also able to go out in the evening. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: Everyone if they so wish are able to maintain personal relationships and maintain contact with family and friends. Entries seen showed several people received visitors weekly and/or went to visit family members. There was evidence that some people would like more freedom in being able to invite other people back to the home, this was not possible due to the communal living and the impact that this would have on the other people at the home. As described within the previous section, there are some people who now wish to move from the home as they feel it does not fully meet their needs. Care Homes for Adults (18-65 years) Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are good at supporting people to access health care support so that their health needs are met. Evidence: Through observation of the people living at the home it was noted that their clothes, hairstyle and makeup reflected their individual personalities. Guidance and support regarding personal hygiene was offered and the level offered by staff was reflected in the care plans tracked on this inspection. One person has seen a decline in their health over the past two years and has needed a significant amount of support from staff and health proffessionals. The person was seen to be supported by staff in the home in a supportive manner. Records showed that staff had atteneded appointments with the person and carried out the actions made following thoes appointments. Within the individual care records examined it was noted that there were documents from a variety of medical specialists as assessed at the previous inspection. These documents showed that people received regular support from Doctors and Nurses. Staff confirmed that they assisted people to attend hospital appointments and the outcome of any medical intervention and subsequent guidance was recorded. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct, the amount of stock was also correct. The storage of medicines were seen to be in a locked facility. Records were seen to show returns of unused medication. Staff receive regular updates in the administration of medicines and observations were made of medication and noted to be appropriate and follow safe practice guidelines. Care Homes for Adults (18-65 years) Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure in the home is satisfactory and results in people being listened to and their concerns acted upon. Evidence: A requirement was made at the previous inspection in relation to safeguarding as the home had not made the Regulator at that time aware of an incident, in addition the updated protocols were not in place at the home. This requirement had now been met. Staff had received training in safeguarding and management and staff had followed through on the recommendations of the safeguarding team to protect people living at the home. As reported at the previous inspection, all care files had a copy of the complaints procedure within them. These were presented in picture format to aid in the understanding of the document; in addition all had been signed and dated by the person to show that they had been shown this document. Feedback from speaking to people living at the home confirmed that people were comfortable in complaining in they wanted to and knew that they had the right to do so. Care Homes for Adults (18-65 years) Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to some of the decor and fittings to create a homely environment throughout the home for people to live in. Evidence: All areas in the home that were seen were clean and tidy. Efforts had been made to replace dining room furniture. The overall decor and furnishing and fittings in the home are not based on modern designs, some decor and carpeting is highly patterned. Within the communal areas of the home there was minimal evidence of service user involvement or influence, there were no items to suggest that anyone had been given the opportunity to have any personal items in these rooms. The overall cleanliness was noted to be satisfactory. Stocks of cleaning materials were seen to be in place and staff confirmed that there were cleaning schedules in places Care Homes for Adults (18-65 years) Page 20 of 27 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. Recruitment systems are good and help protect the people living at the home. Evidence: We reported at the previous inspection concerns on the number of staff on duty being insufficient at times to fully meet the needs of the people living at the home. This was specifically in the evenings. On examination of the staff rota, this showed that this had now been increased from one staff member between 8 pm and 10 pm, to two. Training records showed that staff had undertaken training in the statutory areas including fire safety and medication. A requirement was made at the previous inspection as staff had not undertaken training in the specific needs of the people who live at the home including challenging behaviours, only 3 of the 11 staff employed at that time had undertaken this. Records supplied by the home now showed that this had been met. The homes recruitment policy and procedures was clear. References are taken prior to staffs commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Certificates of qualifications are present within staff files. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Feedback from social services and some of the people living at the home was varied. Some people find the management and staff at the home are able to meet their needs in full, others are still of the view that the home has not kept up to date with the changes needed. One person said,it hasnt moved with the times. Care Homes for Adults (18-65 years) Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are sufficient to reduce the risks associated with this area for the people living at the home. Evidence: As previously reported staff and training records showed that heath and safety training had taken place including fire safety and food hygiene. The most recent inspection by the Fire Service showed that the home met the required standards. As assessed previously the policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Approved contractors had undertaken servicing of equipment and site visit paperwork to evidence that theses had been carried out were seen. Regular checks relating to water temperature for example had been recorded on charts. Stocks of aprons and gloves were noted to be available for staff to use, in relation to infection control. No staff at this visit were seen to use these items inappropriately. The home carries out consultation with the people in different forms. Management Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: confirmed that on a day-to-day basis people are asked for their views and these decisions are then integrated into the care plans. More formal methods such as residents meetings had taken place in the past and minutes were available for inspection, but the home recognised that the views of all residents could not be sought in this way and many did not wish to be involved. Everyone spoken with reported that they found the manager to be a very good listener and all felt that she was very easy to talk to and that they trusted her. Staff said that they found the manager to be both organised and approachable. At the last inspection we reported that it was not clear the hours that she worked in the home as she was not part of the staff rota that was viewed. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 2 14(1) Further development must 04/07/2008 be made to ensure all people have been fully assessed prior to moving into the home, so there is sufficient information to know if the staff at the home have the skills to meet the persons needs. (Previous requirement with a timescale of 30/09/07, not able to be assessed at this inspection) Care Homes for Adults (18-65 years) Page 25 of 27 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 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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