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Inspection on 20/04/06 for Milbury 46 Flambard Road

Also see our care home review for Milbury 46 Flambard Road for more information

This inspection was carried out on 20th April 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 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 30 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care home`s polices and procedures are in place to ensure that prospective residents` needs and aspirations are assessed before s/he moves into the care home. Residents living in 46 Flambard Road are offered opportunities to access facilities in the community. Some residents let the Inspector know about their social contacts and this was evidenced during the unannounced inspection. Residents are supported by staff to access healthcare services in the community Residents indicated that they would speak to staff about any concerns that they have. There was evidence that residents` concerns/complaints are acted upon where possible. Residents present as being protected from abuse through the care home`s policies and staff training programme.

What has improved since the last inspection?

Substantial work has been done to plan for the updating of the building and this work has commenced.

What the care home could do better:

Residents living in 46 Flambard Road cannot be assured that their changing needs and personal needs are reflected in their care plans. This is an area that requires development in 46 Flambard Road. Residents must be facilitated by staff (through the care home`s care planning arrangements) to make individual choices about their ordinary living. Residents must be supported by staff to take risks through the care home`s risk management arrangements. Residents must be facilitated to take part in their agreed activities. This was not evidenced through the unannounced inspection. Care practice must be reviewed to ensure that there is time and opportunity for staff to interact with residents, in the manner of their choosing. Residents are offered meals in 46 Flambard Road that to some extent accord with their menu choices. Consideration must be given to ensure that the provision and manner in which residents are served meals are in accord with their choices. Residents receive varying levels of assistance with their personal care tasks and there was evidence to indicate that residents` personal choices were observed. Consideration, however, must be given to ensuring that care practice supports residents` right to privacy and dignity at all times. Residents are largely protected by the care home`s policies for dealing with their medication. Attention must be paid to the recording of medication administered to residents. Residents do not live in an environment that is homely and comfortable as it is being extensively refurbished. Residents do not live in an environment that is maintained in a clean and hygienic condition, though this situation is made difficult with the building works that are taking place in the care home. Residents are supported by a staff team that have not as a group completed their statutory NVQ training in care. This must be planned for and completed. Residents are supported by a staff team that on the day of the unannounced inspection did not present as sufficient to meet their full range of needs. Thismust be addressed with a review of residents` care and support needs carried out. Residents are largely protected by the care home`s recruitment procedures, though work needs to be done to ensure that all required checks are carried out and appropriate documentation available for inspection Residents are supported by a staff team that have individually completed most aspects of their required statutory training in care practice etc. It must be ensured that this training is complete, with individual records of completion maintained.

CARE HOME ADULTS 18-65 Milbury 46 Flambard Road 46 Flambard Road Harrow Middlesex HA1 2NA Lead Inspector Ms Sue Barker Key Unannounced Inspection 20th April 2006 11:00 Milbury 46 Flambard Road DS0000017532.V287530.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 Milbury 46 Flambard Road DS0000017532.V287530.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. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milbury 46 Flambard Road Address 46 Flambard Road Harrow Middlesex HA1 2NA 020 8907 5896 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 Nigel McCann Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 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 and the Registered Manager is Mr Nigel McCann. The care home is on 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 residents to access the community, providing there is a member of staff on duty who can drive. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of 46 Flambard Road. It covered all the key inspection standards and was unannounced. There were 7 residents living in the care home at the time of the unannounced inspection. The inspection commenced at 11am and concluded at 9.15pm. The Inspector was pleased to meet/greet residents living in the care home, in addition to the 2 members of staff on duty and the Registered Manager, Mr Nigel McCann. The Inspector spent time observing the pattern of life in 46 Flambard Road. Some residents kindly let the Inspector know what it was like to live in 46 Flambard Road. Some positive opinions were expressed. The behaviours of some residents were observed to have an impact on others. The building and garden are in the process of being updated extensively, as was previously required. The Inspector observed the builders working mostly on the exterior of the building. One resident let the Inspector know that they will be glad when it is all finished. Some residents went out during the unannounced inspection. Most were at home in the evening. Staff kindly let the Inspector know that 5 residents were going on holiday to North Wales with staff support during the following week. One resident let the Inspector know that they were not going away with the group. Mr McCann advised the Inspector in the pre-inspection questionnaire dated 20/2/06 that the weekly residential fee for each resident living in this service is £1097.56. There are additional charges that are paid for by residents. This includes hairdressing, toiletries, holidays, music and private chiropody costs. The Commission for Social Care Inspection received an anonymous complaint regarding 46 Flambard Road. This was referred to the Registered Provider to investigate. Millbury Community Services has updated the Commission for Social Care Inspection on the progress of their investigation. During the unannounced inspection the Inspector spoke with residents, staff and the manager, in addition to observing care practice and life generally in 46 Flambard Road. The Inspector would wish to thank those in 46 Flambard Road for the hospitality and assistance received during the inspection visit. What the service does well: The care home’s polices and procedures are in place to ensure that prospective residents’ needs and aspirations are assessed before s/he moves into the care home. Residents living in 46 Flambard Road are offered opportunities to access facilities in the community. Some residents let the Inspector know about their social contacts and this was evidenced during the unannounced inspection. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 6 Residents are supported by staff to access healthcare services in the community Residents indicated that they would speak to staff about any concerns that they have. There was evidence that residents’ concerns/complaints are acted upon where possible. Residents present as being protected from abuse through the care home’s policies and staff training programme. What has improved since the last inspection? What they could do better: Residents living in 46 Flambard Road cannot be assured that their changing needs and personal needs are reflected in their care plans. This is an area that requires development in 46 Flambard Road. Residents must be facilitated by staff (through the care home’s care planning arrangements) to make individual choices about their ordinary living. Residents must be supported by staff to take risks through the care home’s risk management arrangements. Residents must be facilitated to take part in their agreed activities. This was not evidenced through the unannounced inspection. Care practice must be reviewed to ensure that there is time and opportunity for staff to interact with residents, in the manner of their choosing. Residents are offered meals in 46 Flambard Road that to some extent accord with their menu choices. Consideration must be given to ensure that the provision and manner in which residents are served meals are in accord with their choices. Residents receive varying levels of assistance with their personal care tasks and there was evidence to indicate that residents’ personal choices were observed. Consideration, however, must be given to ensuring that care practice supports residents’ right to privacy and dignity at all times. Residents are largely protected by the care home’s policies for dealing with their medication. Attention must be paid to the recording of medication administered to residents. Residents do not live in an environment that is homely and comfortable as it is being extensively refurbished. Residents do not live in an environment that is maintained in a clean and hygienic condition, though this situation is made difficult with the building works that are taking place in the care home. Residents are supported by a staff team that have not as a group completed their statutory NVQ training in care. This must be planned for and completed. Residents are supported by a staff team that on the day of the unannounced inspection did not present as sufficient to meet their full range of needs. This Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 7 must be addressed with a review of residents’ care and support needs carried out. Residents are largely protected by the care home’s recruitment procedures, though work needs to be done to ensure that all required checks are carried out and appropriate documentation available for inspection Residents are supported by a staff team that have individually completed most aspects of their required statutory training in care practice etc. It must be ensured that this training is complete, with individual records of completion maintained. 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. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 8 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.V287530.R01.S.doc Version 5.1 Page 9 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care home’s polices and procedures are in place to ensure that prospective residents’ needs and aspirations are assessed before s/he moves into the care home. EVIDENCE: Mr McCann advised the Inspector that the Statement Of Purpose for 46 Flambard Road is to be reviewed. In addition consideration is being given to the development of information for residents in DVD format. The Inspector viewed no evidence during the unannounced inspection of any assessment of potential residents having been carried out by 46 Flambard Road since the last unannounced inspection. No new residents have moved into the care home since 2001. Mr McCann advised the Inspector in the preinspection questionnaire that there is a ‘Referral and Admission’ policy for the care home. Mr McCann supplied the Commission for Social Care Inspection with details of residents’ funding authorities and named contacts from within each authority. Care plan documentation was in place for all residents. This is further evaluated in Standard 7. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents living in 46 Flambard Road cannot be assured that their changing needs and personal needs are reflected in their care plans. This is an area that requires development in 46 Flambard Road. Residents must be facilitated by staff (through the care home’s care planning arrangements) to make individual choices about their ordinary living. Residents must be supported by staff to take risks through the care home’s risk management arrangements. EVIDENCE: All residents have named key workers from within the staff team. The Inspector viewed a sample of 2 residents’ care plans during the unannounced inspection. The Inspector discussed with Mr McCann the need to ensure that care plans reflect the current agreed needs and aspirations of residents. Care plans include statements written about residents rather than presenting their views. Mr McCann indicated that he intended to work on care plans after the building works were completed and was aware that they required reviewing and some updating. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 11 Care plans viewed included some objectives of care for each resident that were personalised, with strategies for staff on how to work with the resident. Care plans show evidence of monthly review where it is largely stated that there was “no change”. It was unclear who had contributed to these reviews. One resident let the Inspector know that they had been to a meeting about their care in 46 Flambard Road. The Inspector viewed the notes of earlier reviews that had been conducted by the resident’s funding authorities. It was unclear how agreed goals /objectives from review meetings had been integrated into the care home’s individual care planning. For one resident this included planning for a holiday. It must be ensured that care plans accurately reflect the residents’ needs, aspirations and agreed goals of care and support. This process must include the resident and their representatives wherever possible. Care plans must be reviewed at least every 6 months and this process must include the resident and their representatives. Care plans must subsequently be revised as agreed at the review. Staff maintain daily notes of individual residents’ welfare and well-being. This includes observations of their moods and activities. It was unclear how the achievement of care plan goals was being monitored and this was not evident from the daily reports. It was agreed within a care plan that one resident was to be encouraged to take more exercise. The daily reports gave little insight into how this aim was being achieved. It was additionally recorded by staff that the resident had been on outings 6 times in 2006. The Inspector discussed with Mr McCann this possible development with regard to the daily reports. Within the daily reports the Inspector noted that staff use terms such as ‘good’ and ’bad’ to describe residents’ moods and demeanour. The Inspector discussed with Mr McCann the need to consider the use of non-judgemental and age appropriate terminology to describe how residents are. The Inspector observed one member of staff asking a resident if they wished to go out to the pub that evening. The Inspector observed little other evidence of residents being offered choices during the unannounced inspection. The evening meal for the day of the unannounced inspection was indicated to be steak and kidney pies on the menu. Inspections of the kitchen storage areas indicated that there was a choice of fresh and frozen vegetables. The Inspector observed that the steak and kidney pies were served to residents with salad. The Inspector heard one resident saying that they did not like salad and did not eat it. The Inspector observed that residents were served rice pudding and jam for their dessert. It was unclear where the decision to have this dessert had come from. Mr McCann advised the Inspector that the resident group decides the weekly menus, with main meal options being chosen as a group. There is flexibility for residents to choose accompanying vegetables, pulses etc on the day. Availability of choice to residents must be reviewed within 46 Flambard Road, in order to facilitate the development of staff practice in this area. Residents’ choices and preferences must be agreed, documented and followed up through the care home’s care planning arrangements. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 12 Mr McCann advised the Inspector that risk assessment is an area that he planned to focus on after the building works and updating of the building are completed. The Inspector viewed some risk assessments in respect of the building and supporting one resident in particular. This is an area that requires development to ensure that residents can take risks safely as part of an independent lifestyle. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 13 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): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents must be facilitated to take part in their agreed activities. This was not evidenced through the unannounced inspection. Residents living in 46 Flambard Road are offered opportunities to access facilities in the community. Some residents let the Inspector know about their social contacts and this was evidenced during the unannounced inspection. Care practice must be reviewed to ensure that there is time and opportunity for staff to interact with residents, in the manner of their choosing. Residents are offered meals in 46 Flambard Road that to some extent accord with their menu choices. Consideration must be given to ensure that the provision and manner in which residents are served meals are in accord with their choices. EVIDENCE: Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 14 Mr McCann advised the Inspector in the pre-inspection questionnaire that residents attend local resource centres and a local college. One resident spoke to the Inspector about the centre that they attended. Most residents went out during the unannounced inspection. One resident kindly advised the Inspector where they go shopping. Residents and a member of staff spoke about a recent visit to a local pub that had been enjoyed. During the day of the unannounced inspection there were 2 members of staff on duty in addition to Mr McCann. Mr McCann stated that staffing levels had been affected by a number of staff being on annual leave at the same time. Staffing levels are evaluated later in the report. 5 residents were to go on holiday to North Wales during the week after the unannounced inspection. Residents were observed watching television in the lounge and listening to music in the dining room, though the Inspector did not observe residents doing anything else. There was some recorded evidence of other leisure activities, other than attendance at day placements, being made available to residents with staff support. One resident kindly showed the Inspector a statue that they had recently made. This is an area that remains in need of development. Care plans identified some goals regarding residents’ individual social and recreational choices. It was unclear how these needs were being met. It must be ensured that the agreed social and recreational needs of residents are facilitated where possible both in the community and care home. The Inspector observed verbal interaction between staff and residents, though this was mainly focussed on care practice issues. Residents kindly confirmed to the Inspector that they enjoyed some flexibility with regard to the ordinary living routines in 46 Flambard Road. Inspection of the home’s ‘Visitors Book’ indicated that residents receive a range of visitors to 46 Flambard Road. Residents were observed moving around the building. The Inspector observed a group of residents sitting in the dining room with members of staff when leaving the building at 9.15pm. The Inspector observed staff knocking on resident’s doors before entering. The Inspector acknowledged the difficulties experienced by staff and residents whilst the building was being extensively updated, with the disruption that is inevitably causes. When this is over it is required that care practice in 46 Flambard Road is reviewed to ensure that residents’ assessed need for interaction with staff on matters not just relating to their care and support are included in the shift planning arrangements within 46 Flambard Road. Mr McCann let the Inspector know that residents plan the menu and shopping list on a weekly basis with staff. Staff then do the food shopping in supermarkets with other items being bought locally. There was a range of foodstuffs observed in the kitchen. One resident kindly advised the Inspector that the food in 46 Flambard Road was “alright” and that there was usually “enough to eat”. Another resident advised the Inspector of what they had eaten for lunch. Residents were offered tea and biscuits by staff in the dining room upon their return to the care home in the afternoon. The Inspector observed staff Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 15 supporting residents to make drinks. One resident kindly let the Inspector know that they were doing more household tasks themselves. The evening meal was served to residents by staff in the early evening. Comments about resident food choices are addressed previously. The evening meal presented to the Inspector as being a functional event with residents coming to the table to eat. The table was not laid. It is required that the provision of meals to residents and mealtimes in 46 Flambard Road are reviewed to ensure that it meets and needs and preferences of residents. Residents’ weights had been checked on a monthly basis by staff till 6/3/06 with a record maintained as required. The kitchen is to be extensively updated as part of the refurbishment programme. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 16 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): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents receive varying levels of assistance with their personal care tasks and there was evidence to indicate that residents’ personal choices were observed. Consideration, however, must be given to ensuring that care practice supports residents’ right to privacy and dignity at all times. Residents are supported by staff to access healthcare services in the community Residents are largely protected by the care home’s policies for dealing with their medication. Attention must be paid to the recording of medication administered to resident. EVIDENCE: Residents confirmed to the Inspector that they enjoy some flexibility regarding their times of getting up and going to bed. The Inspector viewed no personal care tasks being carried out in public areas of the building. Residents have designated key workers within the staff team. Resident’s care plans included their individual plans of care and care objectives. The Inspector observed a number of examples of staff practice that indicated an intrusive approach towards residents. This was discussed with Mr McCann at the time. It is required that staff care practice and values in 46 Flambard Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 17 Road is reviewed to ensure that residents’ privacy and dignity are maintained at all times. Staff maintain records of residents’ appointments with various healthcare professionals and any advice received. There were a ‘My Health Action Plan’ within each of the sample of residents’ files viewed. The Inspector viewed the care home’s medication storage and administration systems. Medication is stored in a locked facility within the building. Their contracted pharmacist supplies a blister pack system of medication administration to the care home. A record is maintained of all medication administered to residents. This is signed for by 2 members of staff where possible. This was mostly fully recorded though some signatures were missing on 17/3/06. This was discussed with Mr McCann during the unannounced inspection. Mr McCann indicated that staff are trained to administer medication safely by the contracted pharmacist, as well as being assessed as competent to undertake the task within the care home. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents indicated that they would speak to staff about any concerns that they have. There was evidence that residents’ concerns/complaints are acted upon where possible. Residents present as being protected from abuse through the care home’s policies and staff training programme. EVIDENCE: Mr McCann advised the Inspector that he had not received any complaints since the last unannounced inspection and that none were recorded. Mr McCann indicated that he had been working to encourage residents to speak out when something is bothering them. The Inspector observed one resident vocalising concern to staff during the unannounced inspection. One resident confirmed to the Inspector that they would speak to staff if something were not right. Mr McCann advised the Inspector that some residents have accessed advocacy services. Mr McCann in the pre-inspection questionnaire confirmed that there is a ‘Complaints Procedure’ for the care home. The Inspector did not view the document during the unannounced inspection. Mr McCann confirmed in the pre-inspection questionnaire that staff employed in 46 Flambard Road would have access to training in Protection of Vulnerable Adults. This is required. There is a Protection of Vulnerable Adults from Abuse policy. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 19 Residents’ monies are held securely on their behalf. The Inspector observed staff giving residents their monies. Records and receipts of transactions are maintained. Inspection of the Regulation 26 monthly visit reports carried out on behalf of the Registered Provider, indicated that residents’ money are checked as part of this process. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 20 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents do not live in an environment that is homely and comfortable as it is being extensively refurbished. Residents do not live in an environment that is maintained in a clean and hygienic condition, though this situation is made difficult with the building works that are taking place in the care home. EVIDENCE: The environment in 46 Flambard Road was in the process of being extensively updated as required. When the unannounced inspection took place a new conservatory was in the process of being built, with the old one having been removed. This was to be the new smoking room. Residents were temporarily using the dining room to smoke in at agreed times of the day. Some bedrooms had been redecorated. New double glazed windows had been fitted throughout most of the building. This presented as a positive improvement to the care home. New fencing had been fitted and Mr McCann indicated that work on tidying up the garden was to commence. An alternative space for residents was to be created in the garden. A separate exterior bin area has been created. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 21 New furnishings and carpet was to be purchased for resident’s bedrooms. One resident advised the Inspector that it was ‘difficult’ with builders in the care home. The Inspector was advised that residents had chosen the colours that the building was being decorated in. One resident let the Inspector know about the colour that their bedroom was being decorated in. A new fit for the purpose kitchen was to be fitted in 46 Flambard Road. Work on the inside of the building was to commence when most residents were on holiday. Inspection of the building indicated that there were areas of the building that were in need of deep cleaning. This was discussed with Mr McCann who is to focus on cleaning schedules for the care home when the building work is completed. This is required. Mr McCann spoke to the Inspector about future resident access to the kitchen. Risk assessment indicated due to health and safety considerations it was necessary to lock the kitchen door at times, when staff were not also present. The Inspector discussed the need to consider this decision in the context of those residents who will be restricted from using the kitchen independently and when it is their choice. This will be evaluated at future inspections. The laundry area is to be updated. This is needed as the laundry is in a poor state of repair and in need of refurbishment. Plaster was falling off a wall in one area of the care home. This was made safe during the unannounced inspection. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 22 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): 32, 33, 34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are supported by a staff team that have not as a group completed their statutory NVQ training in care. This must be planned for and completed. Residents are supported by a staff team that on the day of the unannounced inspection did not present as sufficient to meet their full range of needs. This must be addressed with a review of residents’ care and support needs carried out. Residents are largely protected by the care home’s recruitment procedures, though work needs to be done to ensure that all required checks are carried out and appropriate documentation available for inspection Residents are supported by a staff team that have individually completed most aspects of their required statutory training in care practice etc. It must be ensured that this training is complete, with individual records of completion maintained. EVIDENCE: Mr McCann confirmed in the pre-inspection questionnaire that 3 of the 11 support staff employed in the care home have completed a NVQ Level 2 or above in care. It must be ensured that a minimum of 50 care/support staff undertakes and completes a minimum of an NVQ Level 2 in care. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 23 Staff on duty kindly spoke to the Inspector about their work in 46 Flambard Road. They had worked in the care home for some time and were aware of residents’ current care and support issues. The unannounced inspection occurred at a time when extensive work was being done on the building and its fixtures and fittings. The Inspector observed during the unannounced inspection that the builders were working fairly unobtrusively and were not evident much in the building. Staff did, however, present as very busy during the day. When the Inspector arrived there were 2 support staff on duty in the care home. The Registered Manager, Mr McCann returned shortly afterwards. During the day the Inspector observed that staff were supporting residents with practical tasks. The Inspector observed little interaction between staff and residents other on practical issues, for example serving residents food/drink and escorting residents. The Inspector observed Mr McCann sitting with residents in the afternoon discussing the contents of a daily newspaper. The Inspector observed no staff working with residents on a 1:1 uninterrupted basis. Mr McCann advised the Inspector that he would be looking at shift planning arrangements when the building works are completed Residents presented as knowing the staff on duty and addressed them by their first names. The Inspector discussed the staffing situation with Mr McCann. At the time of the unannounced inspection, 4 support staff were on annual leave or not working. Remaining staff were working long hours to cover. Staff on duty kindly advised the Inspector that they were able to work the extra hours. Mr McCann stated that the care home was operating with minimal staffing levels until all staff are back at work. Mr McCann confirmed that he is able to arrange for extra hours to be rota’d as is necessary. Inspection of the recent past rotas did not indicate that any extra staff hours had been rota’d. In the Inspector’s opinion the staffing cover presented as minimal during the unannounced inspection. It must be ensured that there is sufficient staff on duty to ensure the health and welfare of all residents. It is required that the care and support needs of residents are evaluated, in terms of their need for staff support and staff time, with a report of the outcomes to be submitted to the Commission for Social Care Inspection. Mr McCann advised the Inspector in the pre-inspection questionnaire that no staff had left employment in the care home since the last unannounced inspection and indeed two members of staff had been recruited and offers made subject to satisfactory CRB checks having been obtained. The Inspector viewed a sample the staff recruitment records held in the care home. An application form had been obtained from the applicant within each of the sample viewed. It was unclear, however, how any gaps in the applicant’s employment had been evaluated with no documentary evidence viewed. This is required. Two references had been obtained on behalf of each applicant. Copies of satisfactory ‘Enhanced’ CRB checks in respect of newer members of staff were not available for inspection. This is required. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 24 The Inspector viewed some evidence of staff induction having taken place, though not for all the newer staff employed in the care home. This therefore remains a requirement. The Inspector viewed a staff training record that included an update on what statutory training individual staff had undertaken. This included moving and handling, first aid awareness, medication, food hygiene and health and safety. Not all staff had completed the statutory training. This is required. Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 25 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): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents benefit from living in a care home that has a registered manager. A requirement arose regarding the care home’s category of registration. Residents’ opportunities for contributing their views and opinions are being developed in 46 Flambard Road. Requirements arose concerning the review of the quality of care available to residents in 46 Flambard Road and the extent of the consultation. Staff were working to ensure residents’ health and safety during the refurbishment of the building. A number of requirements arose concerning the care home’s health and safety arrangements. EVIDENCE: Mr McCann is the Registered Manager for 46 Flambard Road and has been so since October 2005. Mr McCann spoke to the Inspector about his plans for the management plans for the care home after the refurbishment work has been completed. This is in terms of developing the staff team, staff training, Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 26 developing care planning arrangements in 46 Flambard Road and maximising the opportunities available to residents. Mr McCann spoke to Inspector about recent changes to the care home’s management systems. In addition upon completion of the investigation of the anonymous complaint it is expected that staff team building and evaluation exercises will take place. The Inspector spoke with Mr McCann about the care home’s registration. This increasingly does not reflect the predominant needs of the resident group. It is required that the registration of the care home is reviewed with an appropriate application for registration submitted to the Commission for Social Care Inspection. The management role in 46 Flambard Road presented to the Inspector as difficult during the unannounced inspection, this is in the context of the refurbishment work and staffing situation. This will be reviewed further at future inspections. There are a number of long outstanding requirements, mainly regarding the building. There was evidence that these are being addressed. Mr McCann confirmed in the pre-inspection questionnaire that there is an annual development plan for quality assurance in respect of the care home. The line manager on behalf of the Registered Provider visits the home on a monthly basis; this visit includes discussion with residents. The Inspector viewed a number of reports of these visits. Mr McCann indicated that the focus of the monthly visits is an improvement agenda. This was not particularly evident from the reports viewed by the Inspector. Mr McCann spoke about his plans with regard to consulting with and seeking the views of residents. This involves encouraging, enabling and empowering residents to articulate either verbally or non-verbally any issues that they may have. Mr McCann indicated that a service review is due. Mr McCann indicated that he aims to improve residents’ choice and involvement within 46 Flambard Road. This is required. It must be ensured that a copy of any review of the quality of care in 46 Flambard Road is forwarded to the Commission for Social Care Inspection. In addition that review must include provision for consultation with residents and their representatives. The care home was subject to extensive updating at the time of the unannounced inspection, with the installation of new gas and electrical equipment. Electrical hand dyers had already been fitted into the care home’s toilet facilities. Risk assessments had been produced in respect of the building that were dated 21/2/06. Mr McCann spoke of the health and safety arrangements for the care home whilst the building work was going on. Health and safety training is available to the staff team, with other statutory training. There are lockable places in the building for the storage of chemicals as required. From information supplied to the Commission for Social Care Inspection in the pre-inspection questionnaire, it is unclear whether there are any qualified first Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 27 aiders in the staff team. This is required. further at the next inspection. This standard will be evaluated Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 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 x 2 2 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 1 25 x 26 x 27 x 28 x 29 x 30 1 STAFFING Standard No Score 31 x 32 1 33 1 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 x 2 x 2 x x 2 x Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 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 YA2 Regulation 12 Requirement The Registered Provider must consider the registration of the care home and submit an ‘Application for Variation of Conditions of Registration’ in respect of those residents for whom their need for care and accommodation in 46 Flambard Road falls outside the current registration of the care home. (Previous timescale of 25/01/06 not met) It must be ensured that care plans accurately reflect the residents’ needs, aspirations and agreed goals of care and support. This process must include the resident and their representatives wherever possible. Care plans must be reviewed at least every 6 months and this process must include the resident and their representatives. Care plans must be subsequently be revised as agreed at the review. It is required that the Registered Manager ensures that the staff team considers the use of nonDS0000017532.V287530.R01.S.doc Timescale for action 20/07/06 2 YA6 15 20/07/06 3 YA6 15 20/09/06 4 YA6 12 20/07/06 Milbury 46 Flambard Road Version 5.1 Page 30 5 YA7 12 6 YA7 12 7 YA9 13 8 YA12 12 9 YA16 12 10 YA17 16 11 YA18 12 12. YA20 18 judgemental and age appropriate terminology to describe how residents are. Availability of choice to residents must be reviewed within 46 Flambard Road, in order to facilitate the development of staff practice in this area. Residents’ choices and preferences must be agreed, documented and followed up through the care home’s care planning arrangements. Risk assessments in respect of 46 Flambard Road require development in order to ensure that residents can take risks safely as part of an independent lifestyle. It must be ensured that the agreed social and recreational goals/needs of residents are facilitated where possible. It is required that care practice in 46 Flambard Road is reviewed to ensure that residents’ assessed need for interaction with staff on matters not just relating to their care and support are included in the shift planning arrangements within 46 Flambard Road. It is required that the provision of meals to residents and mealtimes in 46 Flambard Road are reviewed to ensure that it meets and needs and preferences of residents. Review staff care practice and values in 46 Flambard Road to ensure that residents’ privacy and dignity are maintained at all times. It must be ensured that all medication administered to residents by staff is signed for by the member of staff carrying out the task. DS0000017532.V287530.R01.S.doc 20/07/06 20/07/06 20/07/06 20/06/06 20/07/06 20/07/06 20/07/06 20/06/06 Milbury 46 Flambard Road Version 5.1 Page 31 13 YA24 23 14 YA24 23 15 YA24 23 16 YA25 23 17 YA27 23 18 YA29 23 19 YA30 16 Required building works must be completed by 25/12/05. (Previous timescale of 25/12/05 not met) The Registered Provider must ensure that the home is fit for the purpose for which it was intended and that the safety of residents is assured. (Previous timescales of 30/07/05 & 25/12/05 not met) The Registered Provider must ensure outstanding renovation repairs and upgrading work at the home is carried out without further delay. (Previous timescales of 30/07/05 & 25/12/05 not met) The Registered Provider must ensure the residents’ bedrooms are equipped to meet their individual needs and maintained in an acceptable condition. (Previous timescales of 30/07/05 & 25/01/06 not met) The Registered Provider must ensure there are an adequate number of bathrooms and toilets that are appropriately equipped to meet the needs of residents at home. (Previous timescales of 30/07/05 & 25/01/06 not met) The Registered Provider must ensure that the home has the appropriate equipment and mobility aids to meet the needs of residents individually and collectively. (Previous timescale of 30/07/05 & 25/01/06 not met) The Registered Provider must ensure the home is adequately DS0000017532.V287530.R01.S.doc 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/06/06 Milbury 46 Flambard Road Version 5.1 Page 32 20 YA32 18 21 YA33 18 22 YA33 18 23 YA34 19 24 YA34 19 25 YA35 17 26 YA35 18 27 YA37 10 cleaned, including individual rooms and communal areas. (Previous timescales of 30/07/05 & 25/12/05 not met) It must be ensured that a minimum of 50 care/support staff undertakes and completes a minimum of an NVQ Level 2 in care. It must be ensured that there is sufficient staff on duty to ensure the health and welfare of all residents. It is required that the care and support needs of residents are evaluated, in terms of their need for staff support and staff time, with a report of the outcomes to be submitted to the Commission for Social Care Inspection. Where there are gaps in an applicant’s application for employment history, a satisfactory written explanation of the gap must be obtained. Copies of satisfactory ‘Enhanced’ CRB checks for new staff employed in the care home must be available for inspection. It must be ensured that staff complete a structured induction programme within 6 weeks of appointment that is recorded. (Previous timescale of 25/01/06 not met) It must be ensured that all staff complete their statutory training in safe working practice, principles of care etc with an individual profile maintained for each member of staff. This is required. It is required that the registration of the care home is reviewed with an appropriate application for registration submitted to the Commission for DS0000017532.V287530.R01.S.doc 20/10/06 20/06/06 20/07/06 20/06/06 20/06/06 20/08/06 20/07/06 20/07/06 Milbury 46 Flambard Road Version 5.1 Page 33 Social Care Inspection. 28 YA39 24 It must be ensured that a copy 20/08/06 of any review of the quality of care in 46 Flambard Road is forwarded to the Commission for Social Care Inspection. In addition that review must include provision for consultation with residents and their representatives. The Registered Provider must 20/08/06 ensure that all required tests and inspection of equipment at the home are carried out. Certificates must be available at the home for inspection. (Previous timescale of 30/07/05 & 25/12/05 not met) It must be ensured that there 20/07/06 are qualified first aiders within the staff team. This is required. 29. YA42 23 30 YA42 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Harrow Area office Fourth 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 Milbury 46 Flambard Road DS0000017532.V287530.R01.S.doc Version 5.1 Page 35 - 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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