Inspection on 25/07/05 for Milbury 3 Barn Rise

This inspection was carried out on 25th July 2005.

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

Other inspections for this house

Milbury 3 Barn Rise 11/01/08

Milbury 3 Barn Rise 30/08/06

Milbury 3 Barn Rise 03/01/06

Milbury 3 Barn Rise 10/02/05

Milbury 3 Barn Rise 16/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 3 Barn Rise Milbury Care Services Ltd 3 Barn Rise Wembley HA9 9NA Lead Inspector Sue Mitchell Unannounced 25 July 2005 14:50 th 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. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 3 Barn Rise Address Milbury Care Services Ltd 3 Barn Rise Wembley HA9 9NA 020 8904 4596 020 8904 4596 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) Milbury Community Services Mr Carl Eastman CRH PC - Care Home Only 6 Category(ies) of LD - Learning Disability registration, with number of places 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10.2.05 Brief Description of the Service: 3 Barn Rise is a residential home providing personal care and accommodation for 6 males with profound learning disabilities and challenging behaviours. The provider is Milbury Care Services, a nationwide organisation. The home aims to provide a normative life for the service users and enable them to enjoy all the facilities and amenities available within the community. The home is situated in a quiet residential area of Wembley and is close to public transport and shops. The ground floor accommodation consists of a lounge, dining room, kitchen, utility room, one bedroom with ensuitreand 2 toilets. The dining room has a patio, which opens on to a large enclosed garden. The first floor accommodation consists of 5 single bedrooms, one of which is ensuite, bathrooms and toilets. Some of the residents are supported to attend local day services and the home also provides day care in house. The home has its own transport which enables the residents to acess the wider community. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out during the late afternoon and early evening when the residents were at home. The manager was on duty along with the three evening shift staff. The inspector spoke to all the staff on duty. The residents have little or no verbal communication skills and use signs, gestures and physical contact to express themselves. The inspector spent time observing staff interacting with the residents. They spoke to them in a caring manner, asking them what they wanted to do or offering them choices of activities. The residents responded to the questions by carrying out the requests or refusing in a non-verbal manner. One person was able to answer the inspector’s simple questions about his day at the day centre by saying he had a good day. The inspection focussed on following up the requirements set at the last inspection as well as care plans, health and safety issues, medication and staff training. What the service does well: What has improved since the last inspection? The home had met all the requirements set at the last inspection. The environment remains clean and well looked after. Work is planned to improve the flooring in the communal areas and new furniture has been purchased. New pictures in the lounge and dining areas have brightened up these areas. An application has been made to convert the garage into a snoozleum for the residents to use. The staff were pleased with the increased opportunities for training on offer. The manager stated that the organisation has started meetings in each region for the care home managers to meet regularly with senior management, which he felt was very supportive for him and the staff team. Two new staff have been recruited and interviews were due to be held. The home will then be fully staffed. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 6 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. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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) 2 Information on how new residents are admitted to the home is in place. All the residents have an individualised service users guide to inform them and their relatives of the homes facilities EVIDENCE: There have been no new admissions to the home for a number of years. There is a comprehensive referral and admission procedure in place. The residents’ have individualised service user’s guides as well as a generic one for the whole home which was seen as good practice 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 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 standard(s) 6,7,9 The residents have detailed care plans to enable their needs and wishes to be carried out. Risk assessments are in place to support them both within the home and out in the community. EVIDENCE: Two care files were assessed. There were two files for each resident; one containing the current health and care plan, the other the risk assessments, old information, health care and other records. The current care plans were not easily accessible to staff being kept upstairs in the office. Key workers review each plan on a monthly basis and carry out a yearly review with key personnel including social workers and family. The residents had their reviews in April and May 2005. The minutes from the reviews and the completed IPP forms were in the office rather than in the care plan files. There was no evidence that the current care plans had been updated from these reviews. The inspector felt that the information was in place but work was needed to review the information held on both files and to archive old material. Staff need to have ready access to the care plans to record information and update them. The above was discussed in some detail with the manager. It was recommended that care plan folders be created, which would contain current working documents such as care plans, the last IPP review, risk assessments, 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 10 behaviour management guidelines, health care records and other charts used in the home. It was also recommended that rather than key workers evaluating each care plan monthly that they wrote monthly summaries of the residents’ activities, relationships, behaviour, health care and medication and progress in relation to care plans. This would also aid the review process. The residents have limited verbal skills and are unable to participate in meetings. Staff were observed to ask individuals their choices about activities during the inspections. The residents mostly responded to the questions nonverbally but one or two did answer the staff. There is only one person who has an advocate/ befriender. The manager stated there is a long waiting list for advocates. The residents are unable to manage their finances. The organisation is the appointee for the residents. Each resident has updated risk assessments and some have behavioural management guidelines for staff to follow. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 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 standard(s) 12,13,15,17 The residents enjoy a range of leisure and social activities both in the home and out in the community. They are offered a range of freshly cooked meals. EVIDENCE: Four of the residents attend local day services three days week. Staff provide in house activities for the two other residents as well as to the other residents when they are not going to the day centre. Details of the resident’s day care activities are recorded on their care plan as well as on the notice board. The manager stated that the home has applied to use the sensory room for one person at the Harrow Resource Centre (run by Milbury). The other person without a day service has a full programme of activities tailored to his likes and needs. He enjoys using the outdoor trampoline in the garden, meals out, walks, drives in the van etc. There are games and garden play equipment for the residents to use when they wish as part of the day care activities. Three of the residents went on holiday with staff to Blackpool for a week. The manager stated that the other three had day trips, as they were unable to travel far or to cope with being away from home. He has worked with the residents for many years and said he has tried to take them away but it was unsuccessful and now they have short trips out instead. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 12 One person visits their family each week. All but one person has some contact with their families through cards, letters, visits and phone calls. The person with out family has a befriender. The residents are unable to participate in the preparation of meals but help to lay and clear the table. On the day of the inspection they had freshly cooked lamb mince, rice and vegetables. The inspector observed that they all seemed to enjoy the meal. There are special plates and cutlery for those who require this. None of the residents requires support to eat their food and there are no special diets although they have food preferences, which are recorded. The residents are weighed monthly. The manager stated that one person is to see the dietician as he has lost weight and staff were concerned. The resident’s come from a range of cultures; Asian, Afro Caribbean and white and black British. The manager said that they had come from long stay hospitals where their cultural heritage was not acknowledged. In terms of meals the menu offered Afro Caribbean and Asian meals as well as traditional meals. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 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 standard(s) 19,20 Residents benefit from regular health care appointments and are supported to access specialist health care professionals. They are protected by the home’s medication policies and procedures. EVIDENCE: There were health action plans on the two care files sampled. These were noted to be out of date and had not been completed in full by the key workers. The manager must review the use of these forms, as there was also health care information in place in other parts of the resident’s files. If the action plans are to be used the manager must ensure that key workers update them regularly particularly if medical information changes. The residents are supported to attend health care appointments. The dentist and optician come to the home to carry out regular checks. There is support from the epilepsy nurse. The psychiatrist is provides support to the home in terms of assisting staff in the management of behaviour and also monitors the residents’ medication. There were records of all appointments in the resident’s files with details of outcomes and follow up visits. The home uses a monitored dosage system (MDS) supplied by Boots. The manager stated that he has requested the pharmacist to come and provide training on the MDS for staff. The medication records and cabinet were checked and found to be in order. There are guidelines for staff for the use of 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 14 PRN rectal diazepam. The epilepsy nurse had requested a record of a resident’s fits for monitoring purposes, which was in place. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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) 22,23 The residents are unable to verbalise their concerns but robust policies are in place to protect them from harm. EVIDENCE: The home had been required to make minor amendments to the complaints and Protection of Vulnerable Adults policies at the last inspection. These had been carried out. There had been no complaints made to or about the home since the last inspection. There is a pictorial complaints procedure for the residents in the service users guide. None of the residents have the ability to voice their concerns verbally. In discussion with staff it was evident that they understood the need to protect the residents from harm. One new staff member stated that she had recently attended abuse awareness training, which she found interesting and helpful. The manager stated that all staff have attended abuse awareness training. There are policies in place on handling residents’ monies and challenging behaviour. The staff code of conduct clearly states staff responsibilities in relation to resident’s possessions and finances. The operations manager audits the resident’s accounts on a monthly basis and signs them off. Milbury Care Services is the appointee for the residents 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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) 24,30 The residents live in a clean and homely environment, which is free from odours EVIDENCE: The inspector did not carry out a full tour of the building, as there had been no changes to the home since the last inspection in terms of furnishing or decoration. The manager had recently purchased some brightly coloured pictures, which had been put up in the communal areas and gave a more homely feel to the home. The manager and staff said that there was to be new flooring for the dining and lounge areas and that new furniture was due to arrive the following day. The manager also stated that an application had been made to convert the garage into a snoozleum for the residents to use. The driveway was also to be resurfaced. The home was clean, tidy and free from odours at the time of the inspection. One person has continence issues, which the home is addressing with advice from the continence advisor. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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) 32,35 The residents are cared for by a well trained and competent staff group. EVIDENCE: The manager stated that there were three vacancies but two posts had been filled and he was waiting for CRB checks to come through. The third post had been advertised and interviews were to be carried out this week. The rota indicated that three staff were on duty on each shift, which was the case at the time of the inspection. The manager was also on duty. Milbury employs its own bank staff that cover for staff vacancies. Staff carry out cleaning and cooking in the home as well as providing care. The residents who have no day care are supported to go into the community or have day care activities within the home. There are sufficient staff available to do this during the day. Milbury has a training coordinator and provides ongoing training for all staff. Staff have had training in core areas such as health and safety, fire safety, and food hygiene. The manager stated that he is in the process of carrying out a training needs assessment with the staff team. The manager has completed his Registered Manager’s Award, two staff have NVQ 3 and one is due to start their NVQ shortly. Three staff have passed their LDAF training and two more are due to start the course. One person is also due to undertake mentoring training. All staff spoken to confirmed that they received good support from the manager and that they enjoyed the training opportunities on offer from the organisation. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 18 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 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) 42 The resident’s health and safety is protected by regular checks of all appliances used in the home. There are robust health and safety policies and procedures in place. EVIDENCE: All certificates relating to equipment and appliances used in the home were made available for inspection. These were seen to be up to date with no outstanding works to be done. A designated member of staff carries out a weekly fire safety audit. Fire drills are held quarterly with the residents. A fire risk assessment is in place. A monthly health and safety check is carried out with a record of any works to be carried out. Hot water checks are also carried out. There were premises risk assessments in place, which had been required from the last inspection. All the residents have risk assessments in place. There are comprehensive health and safety policies in place. Staff have regular health and safety training. 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 20 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 3 Barn Rise Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 21 Yes 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 6 Regulation 15 Requirement The manager must ensure that key workers review the information held on all the care files and archive old material. The manager must review the use of the health care action plans, If the action plans are to be used the manager must ensure that key workers update them regularly, particularly if medical information changes. Timescale for action 30.9.05 2. 19 15 30.9.05 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. Refer to Standard 6 Good Practice Recommendations It is recommended that care plan folders be created which would contain current working documents such as care plans, the last IPP review, risk assessments, behaviour management guidelines, health care records and other charts used in the home. It is recommended that rather than key workers evaluating each care plan monthly that they write monthly summaries of the residents’ activities, relationships, behaviour, health care and medication and progress in relation to care plans. G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 22 2. 6 3 Barn Rise 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow HA1 1BH 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 3 Barn Rise G62-G11 S17428 3 Barn Rise V238254 260705 Stage 4.doc Version 1.30 Page 24 - 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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