Inspection on 08/03/06 for Baxter Close (1)

This inspection was carried out on 8th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Baxter Close (1) 07/11/08

Baxter Close (1) 22/11/07

Baxter Close (1) 18/01/07

Baxter Close (1) 23/06/06

Baxter Close (1) 19/12/05

Baxter Close (1) 03/02/05

Baxter Close (1) 18/10/04

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

CARE HOME ADULTS 18-65 Baxter Close (1) 1 Baxter Close Crownhill Milton Keynes Bucks MK8 OBE Lead Inspector Mr Rob Smith Unannounced Inspection 8th March 2006 12:00 Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Baxter Close (1) Address 1 Baxter Close Crownhill Milton Keynes Bucks MK8 OBE 01908 262835 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) www.macintyrecharity.org MacIntyre Care Miss Amanda Parker Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 2 people with a learning disability. Date of last inspection 19th December 2005 Brief Description of the Service: Numbers 1 and 15, Baxter Close and 6, Marley Grove are three separately registered services located in Crownhill, Milton Keynes. They form a small service group providing accommodation and support to nine adult service users with learning disability. The homes are located within a short walking distance of each other in a small close in an area with reasonably good public transport to the city centre. The service is part of the MacIntyre Care organisation, an established provider of care for people with learning disabilities. At the time of the inspection the residents of Baxter Close included two married couples. The group of homes is managed from Marley Grove, which also provides accommodation for three service users requiring higher levels of support. The staff team works as one group, flexibly covering the needs of service users in all the three settings, rather than being specifically allocated to one or another. Together, Marley Grove and Baxter Close aim to enable people with learning disabilities to live as independent lives as possible. At the time of this inspection staff at the home were also supplying outreach support to two service users in another area of Milton Keynes. It was envisaged that responsibility for this support would shortly be transferred to another part of the MacIntyre organisation. Please note that although the three units are currently separately registered they are all included in the scope of this one inspection report, which has been replicated for each of the three separate services. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection to the three services operated at Marley Grove and Baxter Close. The visit lasted from 12.00 until 3 p.m and comprised discussion with the acting manager and two other staff on duty, examination of key records, a tour of the communal areas of the Marley Grove property and a brief visit to one of the Baxter Close flats. One service user was spoken with in Marley Close and one in the Baxter Close flat. Other service users were either out or engaged in activities. This unannounced inspection took place fairly shortly after the announced inspection of December 2005. Consequently the timescales for addressing the majority of the numerous requirements made at that inspection had not yet expired. For the purposes of clarity those original requirements, if not yet assessed as met, are restated at the end of this report. They will be subject to additional specific CSCI follow-up in the near future. No clear decision had yet been notified to CSCI about possible changes to the structure of services at the units. What the service does well: What has improved since the last inspection? The staffing situation had improved with recruitment to almost all vacant staff posts, enabling better, planned individual input for service users in the three units. Better arrangements for support from the local pharmacy had been introduced in terms of staff training, medication management and recording systems. Better attention was being paid to hygiene and cleanliness standards in the properties visited. Carpets had been cleaned and new furniture bought for Marley Grove and plans were in hand for significant decorative improvements in this unit. Staff responsibilities for reporting concerns to CSCI had been clarified. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 6 Copies of monitoring visit reports under Regulation 26 were being supplied to CSCI. 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. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: As no new service users had been admitted to any of the three units and no new admissions were anticipated it was not deemed relevant to inspect against this set of standards on this occasion. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6&7 Concerns about Individual care planning had not yet been fully addressed following the last inspection. Service users continued to have an appropriate level of direct decision-making influence about the organisation of their lives in the home. EVIDENCE: The last inspection had identified significant concerns about the lack of detailed and up to date personal information and care planning for service users in all three units. Discussion with the acting manager indicated that the intention was to re-establish baseline assessments of need and personal care information on which to develop up to date person-centred plans, although this work was still its early stages. The acting manager also indicated there would be input and mentoring for staff on developing such plans. The original requirement timescale for completion of this work had not yet been reached at the time of this inspection so progress in this area will be specifically reassessed at a later date. Discussion with service users and staff and scrutiny of daily records confirmed that service users were able to exercise a large degree of personal choice Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 10 around how their work and leisure time was spent, and how the day to day planning of their lives was managed and prioritised. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 11, 12 & 15 Improved opportunities were being offered to service users for more focused individual time spent with staff to develop personal skills and opportunities for leisure activities. (Stds 11& 12) Appropriate support was being offered to service users in areas of personal relationships and behaviour. EVIDENCE: At the last inspection concern was raised about the limited time staff had to offer focused individual input to service users, particularly those in the Baxter Close units. The acting manager confirmed that, due to recent staff recruitment, a better provision of individual time was now possible. Examples were evidenced of trips to the gym with staff for one service user, guitar lessons for another and, on the day of the inspection, one Baxter Close service user was getting a personal ‘pampering’ session from a member of staff. The acting manager anticipated the situation would improve further once responsibility for support of service users in Stony Stratford was transferred elsewhere within MacIntyre. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 12 A range of small or larger group holidays were being planned for service users for the coming main holiday periods. This inspection confirmed that good support and input was being provided for one service user to ensure appropriate boundaries of behaviour were maintained in both public settings and when in the home itself. Concerns about the impact of this behaviour on members of staff in the home were seen by the acting manager to have receded since the last inspection. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19 & 20 Service user health care needs were being met. Improvements had been made in the management of medication to ensure service users were kept safe, whilst still exercising appropriate levels of control over their medication. EVIDENCE: Evidence in service user individual log books indicated prompt attention was paid to ongoing and emerging health care needs and on the day on the inspection staff were seen to be offering appropriate and sympathetic support to a service user who was unwell and off work. The progress on more proactive health care plans, as part of improved person centred planning will be assessed at subsequent regulatory visits. The acting manager indicated that individual health action plans will be put in place to address this need. Since the last inspection the acting manager had successfully negotiated improvements in the support given to the home by the local pharmacy. As a result pre-printed medication administration records were being supplied to the home and the dispensing of smaller quantities of medication was allowing safer management of one service user’s self-medication process in Baxter Close. Training for staff on safe management of medication was also now planned. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 14 Records of medication administered seen during this inspection were being appropriately completed. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23 Service users had ready access to complaints processes and continued to be encouraged to express their views on life at the home. Appropriate procedures were in place for the protection of service users from exploitation or abuse. EVIDENCE: MacIntyre had clear complaints processes in place presented in ways intended to be accessible to service users. This was supplemented by an apparently open relationship between staff and service users which enabled them to raise day to day niggles and concerns immediately. No formal complaints had been recorded as made since the last inspection. At the last inspection concern had been raised about the lack of reporting of concerns about staff conduct in one instance. This had been partially resolved in separate discussion with external MacIntyre managers. In the meantime clearer instructions had been provided for staff on reporting requirements under care homes regulations, a copy of which was seen on the staff room notice board. Concerns had also been highlighted at the last inspection around aspects of the management of service users’ money. Some of the specific queries relating to unbanked cheques were satisfactorily explained by the acting manager during this visit and he also indicated new systems for documenting the spending of cash were now in place. These will continue to be closely monitored in subsequent inspections. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30 The units seen during this visit were generally clean and tidy and suitably equipped and plans were in place for improvements to decor and equipment for Marley Grove. EVIDENCE: The communal areas of Marley Grove were seen on this occasion, as was one of the flats at 15 Baxter Close. The Marley Grove environment was seen to be clean and tidy with improvement to the state of the lounge carpet. New lounge furniture had been purchased and plans were in place to replace the carpet and to redecorate a number of the communal areas. Refurbishment of the kitchen was also imminent. Toilet and bathroom areas in Marley Grove were seen to be clean, although provision of more hygienic hand washing and drying facilities, and resealing of floor coverings, had not yet been addressed. The timescale for these requirements from the last inspection had however not yet expired. The environment in the Baxter Close property was seen to be satisfactory, allowing for the responsibility that service users’ themselves carried for day-today cleanliness standards. The acting manager indicated that clearer arrangements were now in place for staff and service users in some of the Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 17 flats, to support the promotion of good standards of cleanliness with agreed regular staff input for those service users who needed help in this area. A new bed had also recently been purchased for one of the flats. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 Staffing arrangements were adequately meeting the needs of service users. The training needs of staff appeared well supported. EVIDENCE: Since the last inspection there had been some further staff changes and additions meaning that the home was now almost fully staffed, with the minor shortfall in hours being covered primarily by small amounts of overtime being worked by existing staff. An acting manager was still covering management responsibilities in the home pending the anticipated return of the registered manager, currently on maternity leave. The increase in staffing had, as already noted, led to some improvement in the provision of targeted individual time for those service users who needed it. Overall staffing numbers therefore appeared adequate at the present time. Longer-term staffing arrangements however remained dependent on decisions around realigning support for service users based in Stony Stratford and resolution of the future structure of the service at Marley Grove and Baxter Close. These issues will be pursued by CSCI with MacIntyre senior managers separately. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 19 Feedback from staff and the acting manager confirmed that a good range of training opportunities was on offer from MacIntyre and that some specific elements related to shortfalls noted at the last inspection were planned, for example around medication and person centred planning. One very new member of staff was spoken with. He was currently undergoing induction training which he found useful and stimulating and felt his introduction into work at the home was being planned appropriately, taking into account his lack of previous relevant experience. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Good attention was paid to maintaining a safe living and working environment. EVIDENCE: Records for fire safety, and the monitoring of temperatures of fridges and freezers in Marley Grove were checked and seen to be in order as were the regular monthly health and safety monitoring records maintained by the acting manager. Health and safety checks were also confirmed in daily records as having been carried out by staff for the Baxter Close properties in concert with the service users living there. No particular health and safety concerns were noted during the course of this visit to Marley Grove and one of the flats in Baxter Close. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 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 2 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X X X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 2 X X X X X X 3 X Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 22 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. 1. Standard YA6 Regulation 15 Requirement That urgent attention is paid to putting into place up to date and comprehensive care plans for all service users and to ensuring reviews both take place and accurate records are maintained of their outcomes. That service user files are audited and updated to ensure they contain relevant and up to date information on service users. That individual risk assessments on service users are reviewed and revised as necessary That as part of the required updating of care plans attention is paid to ensuring clearer indication of service users health and medical care needs. Timescale for action 31/03/06 2. YA41 17(1) 31/03/06 3. YA9 13(4) 31/03/06 4. YA19 13 31/03/06 5. YA24 23(2)(a) That in conjunction with the 30/04/06 property owners the planned redevelopment of the garden area of 1 Baxter Close is completed as quickly as possible. Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 23 6. YA27 16(2)(j) That repairs are undertaken to the corner flooring seals in the bathroom and toilet of Marley Grove and that the area around the specialist bath is thoroughly cleaned. That more hygienic arrangements for hand washing and drying in kitchen, bathroom and toilet areas are put in place in Marley Grove That MacIntyre care undertakes a formal review of the staffing levels required to adequately meet the needs of service users in the three separate units and provides a copy of the findings and intended actions in response to CSCI. 31/03/06 7. YA30 16(2)(j) 31/03/06 8. YA33 18(1)(a) 30/04/06 No. Refer to Standard Good Practice Recommendations Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Baxter Close (1) DS0000015080.V286148.R01.S.doc Version 5.1 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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