Inspection on 15/08/07 for Milbury 46 Flambard Road

This inspection was carried out on 15th August 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milbury 46 Flambard Road 07/07/08

Milbury 46 Flambard Road 20/03/07

Milbury 46 Flambard Road 20/04/06

Milbury 46 Flambard Road 25/10/05

Milbury 46 Flambard Road 01/06/05

Milbury 46 Flambard Road 11/01/05

Milbury 46 Flambard Road 26/10/04

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 Milbury 46 Flambard Road 46 Flambard Road Harrow Middlesex HA1 2NA Lead Inspector Wendy Heal Key Unannounced Inspection 15th August 2007 09:30 Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milbury 46 Flambard Road Address 46 Flambard Road Harrow Middlesex HA1 2NA 020 8907 5896 F/P 020 8907 5896 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) Milbury Community Services Caroline Elizabeth Hodgson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 19th July 2006, four named service users under the age of 65 years and five named service users who have mental health needs, requiring personal care, can be accommodated. The CSCI must be informed when any of these service users no longer reside at the home. 20th March 2007 Date of last inspection Brief Description of the Service: 46 Flambard Road is registered to provide care and accommodation to a maximum of 8 adults (aged 18-65) who have learning disabilities. The Registered Provider is Milbury Community Services. The care home is located on a suburban road fairly close to central Harrow and Kenton. It is close to a variety of shops, health and social care facilities and services, public transport and other community leisure facilities. The building is on two floors. All bedrooms are single and are located on both floors. The home has a lounge, dining room and conservatory/smoking room. There is a small laundry room and kitchen. There is a large garden to the rear of the property. The home has some parking spaces on the front driveway. Otherwise there are some metered street parking places available. The home usually has its own vehicle that can be used by people living in the home to access the community, providing there is a member of staff on duty who can drive. Fees are approximately £1,100 per week. The home has the purpose and function document and inspection report on the notice board to view. The report is also on the CSCI website. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place as part of the inspection programme. Compliance was checked against key standards and took approximately 8 hours. On my arrival the manager was supporting one of the people living at the home by attending the hospital with them to ensure their health needs were met. Therefore another manager from one of the other organisations homes arrived at the home to offer her support until the manager returned from the hospital. I undertook a tour of the building and spoke with people who live in the home and also with members of the staff team. I gained further information by an inspection of the documentation kept in the home, including care plans and health and safety documentation. The staff on duty assisted me throughout the day. I would like to thank the people who live in the home and the staff on duty for their openness and participation. What the service does well: The home is well maintained well furnished and equipped, which makes it a pleasant place for people to live in. The home is also clean and hygienic which benefits the health of people living and working there. There is a large landscaped garden and conservatory, which provides people with suitable space to relax, which benefits their wellbeing. People make opportunities. use of community activities, which offers them new People are encouraged to be as independent as possible and offered choices, which, makes them, feel valued. Links with people’s relatives are encouraged which benefits their emotional wellbeing. The complaints procedure is displayed in a user- friendly format, which means it is available to all of those people living in the home, which means their rights are respected. The staff are undertaking their NVQ 2 and are receiving adequate training to ensure they have the skills to meet the needs of the people living in the home. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 6 The staffing levels are adequate to ensure that the needs of the people living in the home can be met. There are no staff vacancies which means that the team are able to work more effectively Adequate staff recruitment procedures are in place, which protect people living in the home from potential abuse. Health and safety procedures are recorded and being taken seriously which promotes the health and safety of the people living in the home. An adequate record of fire drills checks on the emergency lighting and smoke detectors were available which, promotes the health and safety of the people living in the home. What has improved since the last inspection? The purpose and function document has been updated along with the service user guide, which also contains a summary of the purpose and function document, which means people, have adequate information to decide if the service is suitable for them. The privacy and dignity of people living in the home has been enhanced, as there are now curtains in all bedrooms. Also the identified person who enters other people’s bedrooms and damages their property now has additional one to one support and a waking night staff has been employed to improve the teams ability to monitor this person’s behaviour. There are sufficient bathrooms and toilets that are in a usable condition and toilet areas had adequate soap and towels, which benefits the health and wellbeing of those living in the home. There is now an up-to date record of the staff signatures to indicate who is qualified to administer medication, which means that professional practice is being followed, which benefits the people living in the home. The home now has a copy of the London Borough of Harrows safeguarding Adults procedure which means staff are being provided with the necessary information to protect people living in the home. Staff are receiving formal supervision, which assists their personal development and improves the quality of care provided to people living in the home. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 7 The home now maintains a register of complaints, which means the recording systems are more effective which benefits the people living and working in the home. The garden shed, which contains the paint, is now locked which promotes the health and safety of the people living in the home. An electrical and gas certificate were inspected and found to be in order. The fridge freezer temperatures were being recorded daily which benefits the health and safety of the people living in the home. What they could do better: The care plans (PCP) which, the new manager is working hard to develop, need to be fully completed and kept up-to-date to ensure that the needs of the people living in the home can be fully met. People’s risk assessments need to be developed further to ensure that any identified risks to those people living and working in the home are minimised. The administration of medication must be improved and staff must sign for the medication administered to ensure that professional practice is followed. There must be documented guidance for all of the PRN medication that is administered to the people living in the home to ensure that effective procedures are in place to safeguard people’s health and safety. People’s health action plans and health assessments must be updated to ensure that accurate information is recorded about people living in the home and available for staff working in the home to ensure that people’s needs can be met. The dinning room flooring must be replaced, as it is looking old and worn. The certificate to prove that the water system has been checked must be sent to the CSCI area local office to evidence that effective health and safety checks are being carried out to protect the wellbeing of the people living in the home. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 9 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 Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, People who use the service receive an adequate outcome. This judgement has been made using available evidence including a visit to this service. People have all of the information they need to make an informed choice about were they want to live. On person is inappropriately placed in the home at present. As no new people have moved into the home it is not possible to determine how satisfactory the assessment process is. EVIDENCE: Since the previous inspection there have been no new admissions to the home. Currently the home has one vacancy. A new manager has been appointed at the home and is undertaking the registration process. The purpose and function document has been updated. The service user guide now has a summary of the purpose and function document included in it. This ensures that people are provided with adequate information to make an informed choice in relation to where they want to live. One person who is still living at the home can exhibit challenging behaviour and he was being assessed on the day of the inspection as a more suitable placement is being identified by the manager to ensure this persons needs are fully met. This will also ensure that his behaviour does not have an adverse impact on the other people living in the home. The manager has agreed to keep me fully informed with regard to this situation. Milbury Community Services have supplied a report to the Commission For Social Care Inspection Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 11 in relation to this matter. The identified person now has one to one support to ensure his needs are met. An additional waking night staff has been appointed to ensure that the person can be supervised at night, which prevents his behaviour effecting the privacy and dignity of other people. Since no new people have moved into the home since the last inspection I was not able to assess National Minimum standard 2. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, People who use the service receive an adequate outcome. This judgement has been made using available evidence including a visit to this service. Not all of the people’s care plans have been completed in the new format which means that not all of the people’s assessed and changing needs are fully documented in their care plans. This means their needs cannot be fully met. There is a lack of evidence to demonstrate that people are fully involved in the completion of their care plans, which does not empower them. The service does assist people fully to make decisions with regard to their daily lives, which benefits their wellbeing. The service is not fully supporting people to take risks as part of an independent lifestyle, which does not ensure their needs are fully met and their wellbeing is safeguarded. EVIDENCE: I examined three peoples care plans, which I choose at random. The management team are in the process of updating people care plans as a new format has been developed based on person centred care planning and this will ensure that care plans are based on the individual persons needs which will make the person feel valued. The new care plan format included information in a range of areas for example home life and refers to the persons privacy, Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 13 dignity, respect, household tasks, relationships, which includes the importance of having discussions with identified people’s family members to discuss their relatives care plan. However there was no evidence to show these discussions had taken place as yet. This also refers to the importance of setting up a form of communication with relatives and the person living in the home to ensure a good rappour exists between them. Personal care is identified, which also includes the person’s care and hygiene needs when staying with a relative. Community presence and participation which, includes a routine in relation to activities and notes the need for staff to accompany the person to the activity until staff are sure the person is happy and comfortable when they are there. Care of clothing is also an area identified to ensure the person always looks presentable which improves their self-esteem. Scrapbooks that contained photographs are also used by the staff to assist the people living in the home to be fully involved in the communication process. The manager recognises that the scrap - books work alongside the person centred friendly person centred planning approach. The care plans have not yet been fully updated and the review of the care plans is not complete. There must be clearly recorded evidence that people living in the home are involved in the care planning process. I examined a number of risk assessments identified for the individual people living in the home and they were not all up-to-date. One identified person’s risk assessment refers to monitoring the person’s mental state and the document states that staff must observe behavioural changes and take action immediately such as PRN medication to be given to calm the person. The risk assessment does not say how long the person is to be observed how information is to be recorded to identify any triggers which may cause the persons distress or at what point the on call manager is to be contacted and any other professional that may need to be consulted in relation to the persons wellbeing. One the day of the inspection there was no written guidance available in relation to how staff are to manage the person if his behaviour deteriorates what may trigger a decline in the person’s behaviour and information that must be recorded to reflect on identified situations. One identified person does not always respond when the fire alarm is activated and the home needs to be evacuated. He does not always leave his room it is noted in the risk assessment that staff are to discuss the importance of him leaving his room. However the risk assessment does not inform staff what the agreed plan of action is if a fire does take place to safeguard the person the manager has agreed to discuss this issue with her fire safety officer and ensure that all agreed action is recorded and all relevant professionals are aware of the agreed plan of action. This identified risk must also be noted in the persons care plan. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 14 The identified person who removes the window restrictor in the bathroom must have the issue assessed as part of his risk assessment to minimise in risks identified to his safety and the safety of any other person living in the home. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17, People who use the service receive a good outcome. This judgement has been made using available evidence including a visit to this service. People are encouraged to take part inside and outside the home to promote their personal development. People are part of the local community. Contact with people’s family is promoted which assists their emotional wellbeing. People rights are recognised a service user meetings are taking place. People are being offered varied meals, which are healthy, which safeguards their health and wellbeing. EVIDENCE: None of the people living at the home attend any form of employment or educational establishment. One person attends the Welldon Centre three days per week. Two people attend the Harrow resource centre. One person attends this centre approximately three times a month and another person attends twice a month, which assists to promote their personal development. A professional person visits the home on a Wednesday afternoon and undertakes a massage session with those people living in the home who are Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 16 interested in taking part, which, assists them to relax, and provides them with a new experience. One the day of the inspection I observed that some of the people living in the home were watching television, and some of the people were relaxing in the conservatory. The manager has developed a new recording sheet, which starts from the time when the person wakes up in the morning. The document covers particular areas like has the person had breakfast did they chose their breakfast and did they appear to enjoy it. The document is used to include activities undertaken, the persons communication skills, interaction with others, daily living skills, the persons mood and behaviour which ensures a record of their whole day is recorded and can be used to recognise their achievements which makes people feel valued. I noted evidence that people are taking part in the local community. One person living in the home had been given the opportunity to go fishing and also attended a jam night at the local pub. One person had gone to a football match, went shopping on separate occasions for food and clothes. People living in the home had also gone for walks and visited the park, had dinner out which allows people to interact outside the home and improve their social skills. Some people travel on public transport with the assistance of staff and have their own freedom passes, which increases their independence. The people living in the home have also obtained their own library cards, which benefits them, as they feel valued. People are supported and encouraged to make their own drinks and assist with cooking and laundry, which further develops their individual skills. I noted from the care plans that some of the people’s relatives took an interest in their care. Some people also have very regular visits to their relative’s homes, which ensures family links are maintained and benefits people’s emotional wellbeing. The inspector noted that staff members knock on people’s bedroom doors, which, assists to ensure people’s privacy is respected. There is also an extra waking night person appointed to support one identified person at night, which, assists to safeguard the privacy of the other people living in the home as more effective monitoring at night can take place. On the day of the inspection all of the bedrooms were inspected with people’s permission and they all had curtains at the windows to ensure people’s dignity and privacy was maintained. . Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 17 One person who may enter people’s bedrooms now has one to one staffing, which, assists to ensure that the privacy of other people living in the home is not compromised. People are taking part in service user meetings, which ensures their rights are respected. On the day of the inspection the kitchen was clean and tidy, which benefits the people living and working in the home. I examined the menu, which has visual pictures of food and ingredients. The pictures can be chosen and velcroed onto the menu to aid communication and assist people to make their own choices. The food identified was varied and nutritious which ensures people’s dietary needs are being met. People are consulted at the weekly meeting about what they would like to eat. People have the choice of a take away and confirmed themselves that they had asked the manager for a Chinese take away on their birthday, which they said they enjoyed. People do go shopping with the manager to buy the food and one identified person discussed with the inspector his choices of roll mops and jellied eels, which he enjoys. One identified person eats the food of others, which does not lead to a pleasant meal -time experience for the other people living in the home. The manager hopes that the additional staffing hours will assist to improve this situation. The fridge and fridge freezer was inspected and all food was within its use by date, which means people are eating food that is not harmful to their health. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, People who use the service receive an adequate outcome. This judgement has been made using available evidence including a visit to this service. People do receive support in a way they prefer and require which benefits their wellbeing. People’s physical and emotional needs are being met. Record keeping in relation to administration of medication is not adequate and does not safeguard and protect people living in the home. EVIDENCE: I examined three care plans and noted guidance in relation to bathing and dressing. The bathroom door must be closed to maintain the person’s dignity. The identified people were female therefore it was noted that female staff assist them with their personal care to further respect their dignity. Staff must ensure the person has put on their bathrobe before leaving the bathroom. The person must be offered a choice of what to wear and the weather conditions must be taken into account. The manager further explained that she is obtaining full-length mirrors to encourage people to take pride in their appearance, which benefits their self-esteem. Each person’s file had a completed document entitled ‘My health assessment’ which are currently being up-dated to ensure that all of the information is accurate and reflects the persons individual needs. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 19 People’s individual files contained Health Action Plans, which need to be reviewed and up-dated to ensure people’s individual needs can be fully met. The manager was in the process of booking dental appointments for several people. People living in the home had accessed their optician, dentist general practioner; psychiatrist and chiropodist, which ensures people’s health care needs, are being monitored. I examined the homes medication administration records, which are meant to be double signed to safeguard people’s health and wellbeing. However medication had not been signed for on four separate occasions on particular shifts, which does not ensure people’s health care needs is protected. This issue was discussed with the manager on the day of the inspection and she will investigate this issue further. The person’s individual picture identified their medication records, which prevents the wrong medication being administered to people. There is a record of staff signatures to identify those staff who are authorised to administer medication. The storage of medication was inspected and found to be in order. One identified person did not have guidelines completed in relation to the use and administration of their PRN medication, which does not promote good practice. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, People who use the service receive an adequate outcome. This judgement has been made using available evidence including a visit to this service. People’s views are listened to and acted upon which makes them feel valued. Systems are in place to protect people from potential abuse. EVIDENCE: I noted that on the wall of the foyer was a service user- friendly version of the homes complaints procedure, which ensures that it is accessible to all who may need to use it. The complaints record was inspected and there had been two complaints made since the previous inspection, which had both been responded to appropriately which means that complaints are taken seriously. I asked to see and was shown the homes policy and procedure on the Protection of Vulnerable Adults (POVA). I was also provided with a copy of The London Borough of Harrow’s procedure on the safeguarding of Adults which means staff have access to sufficient information to protect people from potential abuse. Staff had received training in relation to the protection of vulnerable adults, which ensures staff have the knowledge and skills to protect people from potential abuse. People’s financial records were checked and all of the balances were accurate except one identified person had an additional twenty pence when the money was checked. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 21 Only the manager and deputy manager have access to people’s money and the safe, which further protects people from potential abuse. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30, People who use the service receive a good outcome. This judgement has been made using available evidence including a visit to this service. People are living in a clean homely comfortable safe environment. EVIDENCE: I toured the premises in the company of the manager and entered all but one of the people’s bedrooms with their permission. One person asked that I did not enter his bedroom and I respected this request. The bedrooms were appropriately furnished and were personalised. The bedrooms all had curtains to maximise people’s privacy. There is a large kitchen. The home was appropriately furnished throughout, which makes it a pleasant place for people to live in. The dinning room needs the flooring replaced as it is looking worn which gives it the appearance of being marked. The conservatory is very nice and overlooks a large garden, which has been landscaped and contains two storage sheds and the sheds are kept locked to ensure that people’s health and safety is protected. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 23 I inspected the upstairs bathroom and toilet, which was clean and had a supply of soap and towels. The manager informed me that she has obtained a new paper towel dispenser. I have discussed the importance of obtaining a curtain or divider for the shower to improve the privacy of those people using the walk in shower and she will investigate this. I was assured that the bathroom is available for use at all times as it has been explained that The National Minimum Standards states that bathrooms and toilets must not be shared by more than three people it is therefore essential that the bathroom is available to be used at all times to ensure that people’s personal hygiene needs are fully met. On the day of the inspection one identified person was seen detaching the window restrictor in the upstairs bathroom to look out of the window, which could put this person and other people living in the home at risk. This is further referred to in the section that looks at risk assessments and personal safety. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36, People who use the service receive a good outcome. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the homes recruitment procedure, which is effective. People are supported by appropriately trained staff, which improves the quality of care provided to people living in the home. People living in the home benefit from a well supported and supervised staff team. EVIDENCE: The manager informed me that the deputy manager position was recruited to and this person is a registered mental health nurse. An additional waking night staff has been employed and bank staff are now being used by the home to cover the extra hours that have now been agreed to work with an identified person to ensure his needs are met. The rota was inspected and the staffing identified on the rota was sufficient to ensure that the needs of the people living in the home could be met. I looked at the recruitment documents for staff. Application forms had been completed, references had been obtained, passports and visas had been checked and Criminal record Bureau checks obtained and staff had a record of their terms and conditions, which, means people living in the home are protected from potential abuse. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 25 I examined the homes training records staff had received training in relation to medication, protection of vulnerable adults, autism, supporting people with mental health needs, fire training, first aid, food hygiene, infection control which ensures that staff are being given the opportunity to improve the skills which will improve the quality of care provided in the home. Staff are undertaking their NVQ level 2 and the manager has obtained the NVQ level 3. The staff supervision records were seen and found to be in order which ensures that staff are being supported to work with people in a consistent way which improves the quality of care provided to people living in the home. The deputy manager needs to undertake training in relation to supervision to ensure that the management team can undertake this area of the work. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42, People who use the service receive an adequate outcome. This judgement has been made using available evidence including a visit to this service. The people living in the home are benefiting from the continued improvement being shown with regard to the management of the home. People living in the home can be more confident that their views underpin all self-monitoring and development by the home. The health safety and welfare of people living in the home are better promoted and protected than identified at the previous inspection. EVIDENCE: The new manager has undertaken the registration process and all staff reported that that standard have improved since the manager has been responsible for the home. The manager has the NVQ level 3. The manager is undertaken a quality assurance survey, which ensures that the quality of care provided to people living in the home is being monitored. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 27 The health and safety documentation was inspected and was found to be in order. The gas certificated dated 24/08/06 was seen. The electrical certificate dated 08/05/07 was seen. The portable appliance testing is due on 06/03/08. The fire alarm system was inspected on the 03/05/07 and was found to be in order. Regular fire drills had taken place. The emergency lighting had been tested on the 13/10/06. Water temperatures testing had taken place on the 13/08/07.The record of fridge freezer temperatures are now being recorded. The water certificate, which minimises the risk of legionella being passed onto people living and working in the home, was not available at the time of the inspection. The manager has agreed to forward this onto the inspector. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 28 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 3 2 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15(1) Timescale for action The Registered Manager must 15/11/07 ensure that that care plans accurately reflect people’s needs, aspirations and agreed goals of care and support. This process must include the identified person and their representatives wherever possible. (Previous timescale of 20/07/06 not met). The Registered Manager must 16/11/07 ensure that care plans must be reviewed at least every 6 months and this process must include the identified person and their representatives. Care plans must be subsequently revised as agreed at the review. (Previous timescale of 01/05/07 Not met). The Registered Manager must 10/10/07 ensure that risk assessments in respect of the identified people living at the home are further developed in order to ensure that people can take risks safely as part of an independent lifestyle. These must include the identified person who requires his mental state to be DS0000017532.V343773.R01.S.doc Version 5.2 Page 30 Requirement 2. YA6 15(2) 3. YA9 13(4) Milbury 46 Flambard Road monitored. PRN is administered to assist him to calm down. The risk assessment must include how long the person is to be observed, what action staff must take to minimise the identified risks. How information is to be recorded and when the manager is to be contacted. 4. YA9 13 (4) The Registered Manager must ensure that the identified person who does not evacuate the home when the fire alarm sounds has a risk assessment to minimise any potential risks to the person and staff working with him. The Registered Manager must ensure that the identified person who removes the bathroom window restrictor has this risk assessed to minimise the potential risk to himself or anyone else living in the home. The Registered Manager must ensure that people’s health assessment and health action plan are updated to ensure that their current needs are adequately reflected. The Registered Manager must ensure that when medication is administered it is appropriately signed for on the medication administration record. 11/09/07 5. YA9 13 (4) 05/09/07 6. YA20 13 (2) 20/11/07 7. YA20 13(2) 10/09/07 8. YA20 13 9. YA24 13(4)(a) The Registered manager must 15/09/07 ensure that guidance is available in written form in relation to all PRN medication administered to people living in the home. The Registered Manager must 01/10/07 ensure that the dinning room flooring is replaced. The Registered Manager must ensure that the water certificate to test for legionella is sent to DS0000017532.V343773.R01.S.doc 10. YA42 23(2) 01/10/07 Milbury 46 Flambard Road Version 5.2 Page 31 the CSCI area office. 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 YA36 Good Practice Recommendations The deputy manager should receive supervision training to ensure that all of the management team are able to supervise the staff team. Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milbury 46 Flambard Road DS0000017532.V343773.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!