Inspection on 09/05/05 for 66 Milton Road (Welcome House)

This inspection was carried out on 9th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

66 Milton Road (Welcome House) 20/06/06

66 Milton Road (Welcome House) 13/01/06

66 Milton Road (Welcome House) 14/12/04

66 Milton Road (Welcome House) 10/08/04

66 Milton Road (Welcome House) 08/01/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 66 Milton Road (Welcome House) 66 Milton Road Gillingham Kent ME7 5LW Lead Inspector Sarah Montgomery Unannounced 9 May 2005 09:30 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 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 Stationary 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. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 66 Milton Road (Welcome House) Address 66 Milton Road Gillingham Kent ME7 5LW 01634 574644 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Toqeer Aslam Care Home only 3 Category(ies) of MD Mental Disorder (3) registration, with number of places 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 14 December 2004 Brief Description of the Service: 66 Milton Road is a registered care home 3 for adults with mental health problems. It is one of many homes owned and managed by the Welcome House Group. At present, two service users live at the home. The home offers a support package to two service users. This comprises of 8 hours per day (9am – 5pm) Monday to Friday, and 3 hours per day (10am – 1pm) on Saturday and Sunday. There is no staff on duty during the evening or overnight. Service users have access to an on-call staff member. The house’s accommodation comprises of a lounge, dining room, kitchen and bathroom on the ground floor, and three single bedrooms on the upper floor. There is a large rear garden. The home is situated in a residential are, with easy access to public transport and local shops. Gillingham town centre is approximately one mile away. Service users are actively encouraged to take part in activities and to lead independent fulfilling lives. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.30am and 2.30pm. One service user was spoken with, and her comments on the service provided were a valuable insight into the home. The inspector also spoke with the acting manager, and a manager from another Welcome House home. Judgements made on the quality of life for service users were made following discussion with a service user, conversations with staff, and reading of records. The inspector concluded that the service users are given a good service at Milton Road, but informed staff that there is clear scope for improvements in all areas of record keeping and documents relating to the home. A tour of the home was conducted. Overall, the home is comfortable and well decorated. The bathroom is in urgent need of repair due to damp causing the walls to crumble. What the service does well: What has improved since the last inspection? 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 6 Service users now live in a more comfortable and homely environment since the home has been refurbished and redecorated. 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. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2. Prospective service users do not have the information they need to make an informed choice about the home. Welcome House conducts thorough pre assessments for the benefit of service users. EVIDENCE: Service users are not given good written information about the home. The service user guide and statement of purpose are documents relating to the ‘Gillingham homes’ and are not specific to 66 Milton Road. The home needs to provide service users with a statement of purpose and a service user guide which relates to their home. The statement of purpose and service user guide describes the home as having Three functions: respite, short-term care; and long-term care. This is not acceptable, and the Registered Person must define the home as having one purpose, not three. Some language in the service user guide and statement of purpose is inappropriate and requires changing. For example ‘ Service users may be allowed to help themselves’ (in the kitchen). Staff names and qualifications in these documents are out of date. The statement of purpose and service user guide must remain up to date to ensure 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 9 service users and prospective service users receive correct information about the home. Records relating to an admission contained very good detail of the manner in which the admission had been carried out. There was excellent detail of the needs, history and desired outcomes for the service user, which were well understood by staff on duty. Information available included assessments from professionals who had been working with the service user. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9. Service users’ quality of care is compromised because their changing needs and personal goals are not reflected in their individual plan and service users are not sure that staff are aware of their needs. Service users benefit from being able to make decisions about their lives, and are consulted on aspects of life in the home. Service users are supported to take risks which enable them to enjoy an independent lifestyle. EVIDENCE: Staffing has been inconsistent in the last few months. This has meant care plans have not been updated for service users, and information in care plans is out of date. A resident spoken with confirmed that needs and goals written in her care plan did not relate to current goals and needs. Although care plans were not up to date, conversation with the resident and a member of staff indicated that current needs and goals were being achieved, even though not written down. Staff understand that residents are individuals whose decisions should be respected. This was evident in daily records, speaking with residents and observing the general environment. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 11 A discussion with one service user evidenced the level of supported independence that service users have within a sound risk assessment process. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13 and 14. Service users benefit from having opportunities to engage in a good range of personal, social and leisure activities. EVIDENCE: Service users confirmed during conversation with the inspector that the overriding aim of the home was to enable people living there to become as independent as possible. Service users told the inspector of all the daily tasks they participate in without staff assistance; this ranges from making breakfast and light snacks, to going shopping, to keeping their home clean and tidy. Records read during the inspection, and discussion with the acting manager supported what the service users had told the inspector. The acting manager spoke of teaching residents practical life skills and of encouraging as much independence as possible within a risk assessment framework. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 13 One service user chooses to access the community and its facilities daily – taking college courses, going shopping, and visiting friends. She enjoys these activities, and is pleased at the level of independence she has achieved. Staff recognise that the service users at the home have different needs and require different levels of support. This is evident in care plans, daily records and risk assessments. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. Service users feel looked after and cared for. EVIDENCE: While talking to a service user, it was evident that individual preferences regarding personal care are taken into account whilst encouraging good standards of personal hygiene and self respect. Records and observation of a resident indicated the improvement achieved since moving in to the home. The inspector looked at health care records. Residents confirmed they receive support in attending health care appointments. Health care records indicated regular and appropriate review of health needs. Both service users choose to self medicate. They receive minimal assistance from staff to do this, and told the inspector they prefer to take their own tablets as “I feel more in control of myself”. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. Service users feel their views are listened to and acted on. Service users are at potential risk because of inadeqate staff training and knowledge on matters relating to adult protection. EVIDENCE: The complaints procedure is displayed on the notice board. Service users are aware they can make complaints, and told the inspector they talk to staff every day, and usually little niggles are sorted out. The service users said they felt listened to by the staff and confident that any concerns would be addressed. When questioned about adult protection procedures, the acting manager did not display sufficient knowledge or understanding. This means that, at present, service users are not protected from potential abuse. The acting manager requires training in this area as a matter of urgency. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27 and 30. Whilst service users largely benefit from living in a safe, clean and comfortable environment, the communal bathroom is in urgent need of repair and is not fit for purpose. EVIDENCE: Service users are responsible for cleaning their home with minimal staff support. The home is warm and welcoming with comfortable furniture. The service users told the inspectors they are very happy with their home, and were recently involved in choosing colours and styles for redecoration. The lounge carpet is stained and needs specialised cleaning. One service user showed the inspector her bedroom. It was nicely decorated and was clearly a personal space in which the service user feels comfortable. The bathroom requires urgent maintenance. Walls are crumbling, and unpleasant odours due to rot permeate the room. Apart from the bathroom, the home is clean and hygienic. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 and 36. Service users benefit from being supported by competent staff. The care of service users is compromised by inadequate paperwork and lack of supervision for staff. EVIDENCE: Service users feel that one member of staff on duty between 9am and 5pm weekdays, and 10am to 1pm weekends is sufficient to meet their needs. Service users feel confident that they can contact staff outside these hours should they need to. Staff spoken with on the day of inspection, and observations made by the inspector, evidenced competence, knowledge and skills in working with adults who have mental health problems. Staff files were inspected and were found to be chaotic. They do not have all information as required by Schedule 2. Service users are not currently supported and protected by the homes recruitment practices. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 18 Staff working at the home do not receive formal supervision. All staff work alone. The registered person must ensure that all staff receive regular formal supervision, and that minutes are taken of these meetings. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39. Service users do not benefit from living in a home which is effectively monitored. EVIDENCE: The home could not provide evidence of monthly Regulation 26 visits. Service user meetings are infrequent and only one has been held this year. Staff meetings are not occurring, and the last staff meeting took place in March 2004. Quality assurance questionnaires for service users could not be accessed on the day of inspection. The inspector read the most recent Regulation 26 report. It did not refer to the bathroom, and stated that all areas in the home were fine. The inspector is not convinced that the Regulation 26 report has adequately addressed issues within the home. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 20 Lack staff meetings and service user meetings is unacceptable. The home must ensure that staff meet monthly, and that service users have an opportunity to meet at least 6 times per year. Both these meetings must be recorded and actions identified. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 x x x Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 1 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x 2 3 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 66 Milton Road (Welcome House) Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 1 x x x x H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(c ) 5(1)(a) Requirement The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as the statement of purpose) which shall consist of - a statement as to the matters listed in Schedule 1. In that, the Registered person shall compile a statement of purpose which is specific to 66 Milton Road, and which states the purpose of the home. The registered person shall produce a written guide to the care home (in these Regulations referred to as the service users guide) which shall include a summary of the statement of purpose. The Registered person shall (b) Keep the service users plan under review. The Registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person shall Timescale for action July 31st 2005. 2. 3. YA6 YA23 15(2)(b) 13(6) July 31st 2005. July 31st 2005. 4. YA27 23(2)(b) June 30th Page 23 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 5. YA34 19(1)(b)(i ) 6. YA36 18(2) 7. YA39 24(1)(a) 24(1)(b) having regard to the number and needs of the service users ensure that (b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. In that, the bathroom is repaired and redecorated. The registered person shall not employ a person to work at the care home unless (b) subject to paragraph (6), he has obtained in respect of that person the information and documents as specified in (i) paragraphs 1 to 7 of Schedule 2. the registered person shall ensure that persons working at the care home are appropriately supervised. The registered person shall establish and maintain a system for (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home. 2005. May 30th 2005. June 15th 2005. July 30th 2005. 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 YA1 YA32 Good Practice Recommendations Consideration is given to changing some language in the statement of purpose and service user guide. Staff are trained to NVQ level 3. 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane, Maidstone Kent. ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 66 Milton Road (Welcome House) H56-H06 S29000 66 Milton Road V223515 090505 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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