Inspection on 12/09/06 for Milbury 694 Pinner Road

This inspection was carried out on 12th September 2006.

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 694 Pinner Road 19/07/07

Milbury 694 Pinner Road 27/01/06

Milbury 694 Pinner Road 18/06/05

Milbury 694 Pinner Road 05/08/04

Milbury 694 Pinner Road 27/04/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

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

CARE HOME ADULTS 18-65 Milbury 694 Pinner Road 694 Pinner Road Harrow Middlesex HA5 5QY Lead Inspector Clive Heidrich Key Unannounced Inspection 12 and 20 September 2006 8:00 th th Milbury 694 Pinner Road DS0000017553.V310865.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 694 Pinner Road DS0000017553.V310865.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 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milbury 694 Pinner Road Address 694 Pinner Road Harrow Middlesex HA5 5QY 020 8868 1894 F/P 020 8868 1894 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.milburycare.com Milbury Care Services Limited Miss Marisa Mwape Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: 694 Pinner Road is a care home providing personal care and accommodation for eight people who have learning disabilities. There were no vacancies at the time of the inspection. The home is owned by Milbury Care Services, which is a national, privately-run, care organisation operating in excess of 200 care services across the country. The London regional office, based in Henley, South London, provides senior management support to the staff and manager of the home. The home is located within a residential area of North Harrow. It is within walking distance of shops and rail links. It is on the main bus route between Pinner and Harrow. There is parking available at the front of the house. The home was opened in 1995. It is a spacious two-storey building that was not originally used for residential care but has been adapted. All the homes bedrooms are single rooms. They are all fully furnished. Most have built-in sinks. The home has two bathrooms, a shower room, and one other separate toilet. Access to the first floor is by stairs only. The home has a good-sized garden that is accessible and maintained. The fee range currently in use at the home is £3610 to £4486 per month. The home’s Service User Guide is available from the home on request. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across two days in September. It lasted twelve hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with the few service users who could provide some degree of verbal feedback. The inspection process also involved observations of how staff provided support to service users, discussions with staff about the work, checks of the environment, and the viewing of a number of records. Feedback from a health & social care professional was also obtained. The manager was present during most of the inspection. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? There was a clear focus on supporting service users to uphold good standards of appearance. Clothing was well-fitting and suited to each service user. One service user had highlighted hair, and another was reported to have visited the hairdresser successfully for the first time in a long while. There was now a day service program for all service users. This means that a couple of service users have been successfully supported to return to programs that they enjoy. There are also implemented plans in place for service users on days off from day services. There was some evidence that service users are communicating more. The commitment and capability shown by staff was seen to support service users well. There is improving focus on service users’ skills development. There are good standards of teamwork within the staff team. Care plans and risk assessments are now up-to-date. There were no concerns with the standard of recording in the home. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There have been no admissions to the home since the last inspection. The admissions process was previously seen to be suitable. Most information required about the home for prospective service users is available in writing and partially in pictures. Minor improvements are needed for clarification purposes. EVIDENCE: A Statement of Purpose, dating from April 2006, was supplied to the CSCI following the inspection. It provides some detailed information on the services to be provided in the home. It has an up-to-date staff list and states their qualifications. It also has shortfalls that need to be addressed. Primarily, the document needs to be checked through to ensure that it fully relates to this home. For instance, the facilities available list five not eight bedrooms, and there is no activity room at the back of the garden as described in the document. The home does not have two vacancies as described in the document. This could all lead a reader of the document to be confused as to the services and facilities provided in the home. The Service User Guide dates from November 2004. It is a standard Milbury guide with specific details added about this home where applicable. It covers all topics expected of such a guide. It includes a number of ‘Change Picture Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 9 Bank’ pictures to assist with the understanding of the written text. It also explains key policies such as for protection from abuse and for equal opportunities. It needs improvement in a few specific areas. These are that the address and phone number of the CSCI are incorrect, the fees payable are not stated, and one service user is referred to by name. These need to be addressed to ensure accuracy of the document and to uphold confidentiality. There have been no new service users admitted since the previous inspection. The home’s admissions process was previously judged as suitable. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with good support, where needed, to make decisions about their lives. There is reasonable support for service users to take risks as part of their lifestyles. Service users hold care plans to identify their needs, wishes, and how the home will provide support to address these. EVIDENCE: Most service users store their PCP file in their room. Checks were made of the care files and Person-Centred Plans (PCPs) of three of the service users. It was evident that since the last inspection, care plans have been updated. They generally show what the specific, individual needs of each service user are, and provide good details about how support is to be provided. They are backed by assessments that have generally also been reviewed and updated in early 2006. The care plans additionally have brief monthly updates that review how the plan is progressing. The manager pointed out that a number of icons or pictures have been added to the PCPs, to help some service users to better understand them. She noted Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 11 that this process had specifically involved a couple of service users making suggestions about icons that had meaning to them. There was written and verbal evidence to show that service users have received formal review meetings about their care since the last inspection. In some cases, two reviews have been held, with one involving the local council’s reviewing officer. The manager confirmed that, where appropriate, family and day services had been invited to the review. There was evidence of service users being able to make decisions about their lives, with support where needed. One independent person noted that service users are increasingly supported to make choices, and have hence become more assertive. Records, feedback and observations showed that, for instance, some service users sometimes refuse requests for such things as attending day centres or taking medications. Where appropriate, staff make reasonable efforts to persuade the service user, through such methods as a different staff member making the request, or helping to reassure certain service users through helping them to first find a favoured object to hold. However, ongoing refusals are respected. Records showed that one service user additionally has the ongoing support of an advocate. It was evident that the staff team as a whole have good individual knowledge of each service user. Consequently they provide support based on the service user’s individual needs. For instance, one service user who could verbalise clearly was asked directly about what they would like for breakfast. For some other service users, a planned breakfast is provided, with a suitable alternative then being provided if the first option is refused. There is also an up-to-date photo-roster of staff by the front door, which one service user showed the inspector that they could use. There were no concerns about service users being enabled to take reasonable risks as part of an independent lifestyle. Service users have the freedom of the communal areas of the home, including the kitchen. The front door has an alarm to prevent dependent service users from leaving the house unattended. Feedback found that individual support is generally provided to service users where their behaviours challenge the service, rather than providing restrictions. For instance, a new style of bin is now being successfully used in the kitchen, after many previous bins have been broken through one service user’s use of them. Records showed that some staff have been on a risk management course in recent months. There generally were individual and up-to-date risk assessments in place that informed of how to manage potential risks to service users. Independent feedback generally confirmed this. The manager stated that the last formal Milbury audit of service users’ finances was in 2004. Records showed that a number of checks of each service user’s money is made, by the manager and then by the service manager. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 12 Checks by the inspector of spending, receipts, and bank-books, for two service users, raised no concerns about accuracy and appropriateness. The system seems to work well. The manager also noted that service users have to attend the bank with appropriate people, to withdraw money from their individual accounts. It is recommended only for there to be a professional audit of service users’ finances, as none has taken place since 2004. This would further reduce risks of mistakes and theft. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are able to pursue leisure opportunities, both in the home and in the community, to an excellent standard. They are all involved in day services, and are supported with activities on days off from these services. There is a strong focus on providing nutritious food that service users enjoy. Service users’ rights are suitably respected, and there is improving focus on skills development. EVIDENCE: Four service users went on a holiday to Tenerife during the summer. One kindly showed the inspector their photo album of the holiday. There was some excitement that it had been discovered that one service user could swim well during this trip. Consequently plans were in place to enable them to swim locally. Feedback found that holidays are being planned for other service users based on individual needs. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 14 The manager explained that brochures had been supplied to the service users to help them to make choices about their holiday. For example, one service user had pointed to a picture of a swimming pool to show that this was a facility that they wanted within the holiday. Records showed that all service users have weekly occupation plans. All attend local day services for all or part of the week. The home provides transportation support for this. This improves on the previous inspection where a few service users were choosing not to attend such services but lacked suitable occupational support at home. The manager also noted that a work placement is now being sought for one service user based on their abilities and interests. Records and feedback showed that service users have reasonable community support. Service users communicated that they attend day services, evening clubs, go for walks, and go shopping, all of which they spoke positively about. There was also feedback that, for instance, great effort had been made to successfully support one service user to their first hairdressing visit for a long time, that a theatre trip was due to shortly take place, and that some service users continue to attend church regularly. Records generally supported this. There was some feedback about service users not being able to attend to community goals as much as expectations from their care plans. This is referred to further under standard 33. There were clear plans on the development of service users’ individual skills. Feedback and observations found that support with this is provided, for such things as setting the meal table, undertaking exercise, and managing the cleaning of parts of the home. Some service users were also seen to be encouraged to take clean laundry to their rooms. There were now records of what skills had been supported with, however these tended to be limited in range and detail, which should be considered further in terms of their consequent usefulness. Service users as a group continue to have two musicians visit them weekly. One service user spoke fondly of this. Recent photos showed that staff support service users to dance and join in with the music. There were good records of planning to support service users to stay in touch with families. Some service users receive regular visits and phone calls. It was clear that family viewpoints are taken on board in terms of the individual services provided to service users. Service users were generally seen to be treated respectfully by staff. For instance, staff generally spoke kindly with service users and listened to responses. Staff also knocked on bedroom doors. One staff member was seen to sit with a service user and discuss the drawing that she was undertaking. The service user appeared to much appreciate this. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 15 Those service users spoken with commented positively on the food provided. One said that the food is good and that they get enough. The breakfast seen was generally eaten by service users, with alternatives being provided where the main course was refused. There was a suitable supply of food available during the inspection. There are no restrictions on service users obtaining the food for themselves. A range of fruit was available in the dining area from the start of the inspection. The availability of fruit at all times was independently confirmed. There is a 6-weekly rolling menu system in the home. It was last updated in January 2006. It contains a large variety of meals, including for breakfast. Feedback found that the menus are based on a combination of nutrition and service users’ known preferences. Records confirmed this. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users receive excellent support with upholding personal care and appearance. They can make choices within this. There are also good standards of healthcare and medication provision, including through good access to healthcare professionals. EVIDENCE: From the start of the visit, service users were seen to be well-dressed in individual, well-fitted, co-ordinated and appropriate clothing. Records and feedback confirmed that service users are supported to shop for new clothing regularly, and to make choices within this process. Observations and feedback also showed that a number of service users had recently attended hairdressers or barbers. One service user had highlighted hair that suited them. There was also evidence of appropriate nail care. The expectations around personal support are documented within care plans. Service users were prompted to, and supported to, change dirty clothing where needed. Service users were also able to make ongoing refusals in this respect as is their right. One service user was separately noted by staff to change their clothing of their own volition. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 17 There was independent feedback that service users are generally treated with dignity and respect. This matches observations from the inspection. Records showed that service users generally receive regular health check-ups with such professionals as the dentist, the chiropodist, and the GP. This includes for medication reviews where needed. There was some evidence of specialist input for individual service users. This includes the psychiatrist and the epilepsy nurse. Where needed, individual epilepsy protocols are in place and are followed. The manager noted that most staff have had external training in this respect. The records of epilepsy were checked within their designated file. They were up-to-date and appropriate. It is recommended only that the epilepsy guidance for each service user be contained within the epilepsy file, for ease of reference. Monthly weight records were in place for those service users checked on. Care plans linked to these where needed. Health assessments and plans dated from 2004 in two of the three cases checked on. Whilst care plans do address pertinent health issues, if these health systems are to be used, they should be kept up-to-date. There were no concerns about how service users are supported to handle their medications. There have been no reports to the CSCI of medication errors. No service users self-medicate. A blister-pack system is used, and medications are stored securely. Two staff are involved in administering the medications, to help ensure that medications are distributed correctly. Staff spoke of receiving training and having to be shadowed by the manager before they are considered suitable to undertake medication distribution unsupervised. The manager noted that she undertakes further checks of staff ability at least annually, and that Milbury have now started their own internal medication training. Staff also spoke of the individual needs of service users around taking medications, which shows appropriate knowledge. Checks of the medication records and the medications found that, except for one isolated case, all medication records were up-to-date. Medication is signed-in fully, and there are records of any tablets refused and returned to the pharmacist. Medication cupboard temperatures had recently begun to be taken, on the visiting pharmacist’s advice after their own checks. There were PRN (as-needed) medicine guidelines in place. Good practice here would be to ensure that these guidelines have all been reviewed and updated in line with care plans, as many dated from 2004, and to attempt to more clearly identify how each service user expresses pain. Liquid medications had a date of opening, as was required at the last inspection. It is felt overall that service users receive appropriate support to handle their medications. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 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): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a reasonable complaints process. Consideration of how to better recognise complaints by service users is recommended. Suitable staff training, recruitment, and written procedures help ensure that there are generally good standards of protection of service users from abuse. However staff have not generally had formal training in working appropriately with any behaviours of service users that challenge, which must be addressed. EVIDENCE: The home has a complaints procedure in place that complies with these standards. A picture-based complaints process is on display in the hallway. There is now a bound complaints book in place within which to receive and record about any complaints, investigations and outcomes. The manager stated that there have been no complaints since the last inspection. The CSCI has similarly received none about this service. It was recommended to the manager to consider how to enable the service users to become further involved in using the complaints process. It was agreed that there is difficulty in recognising complaints from service users due to communication barriers between staff and service users. Recognition and support of how each service user would potentially communicate dissatisfaction with the service should now be pursued. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 19 Records showed that most staff have now attended a Milbury course on the protection of service users from abuse. There was evidence that staff have to fully pass a written assessment at the end of this course, which is good demonstration of knowledge. Plans are in place to ensure remaining staff attend the course. Staff were able to feedback about appropriate responses to allegations or observations of abuse. All staff additionally have Criminal Record Bureau (CRB) disclosures in place through Milbury’s personnel department before working in the home. There has been one allegation of abuse made since the last inspection. Harrow Council’s procedures for the Protection of Vulnerable Adults was used, which the home complied with. The allegation was found to be historic and was hence not investigated further. There are procedures in place to ensure that any known behaviour by a service user, which puts themselves or others at risk, is suitably responded to. This included within individual care plans and risk assessments. The manager noted that the local behaviour therapist visits the home to provide support with these. Checks of training records found that no staff have attended training in the understanding of challenging behaviours, with none currently planned for. This puts service users at risk of staff lacking a suitable awareness of appropriate responses to behaviours that challenge the service, which in turn puts service users at some risk of potential abuse. The registered provider and manager must address this. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 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, 26, 27, 28, and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Improvements have been made to the safety and homeliness of the home since the last visit. However some other issues have arisen, and the unsightly staining to some walls on one side of the house remains to be addressed. Service users are provided with generally suitable and homely communal areas and bedrooms. The home is also kept suitably clean. Only one improvement to the hygiene of the home is needed, to the area of the home that has a lingering odour. EVIDENCE: The home is a residential setting that has been adapted for residential care use. It is quite homely, particularly in that much of the furnishings and décor match well. The home was seen to be reasonably clean from the start of the visit. Staff attended to the majority of cleaning issues after service users had left for their day services. However, according to feedback and records, service users are at other times expected to undertake some cleaning tasks depending on ability. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 21 The standards of décor and furnishings in bathrooms and toilets, and in the lounge and dining room, were generally seen to be suitable. Improvements include that the lounge has been pleasantly repainted since the last inspection, and that the upstairs shower now has a shower radio. There are some concerns with décor in two areas of hallway. Refurbishment has not yet taken place to address an old leak on the outer-right wall of the home. Consequently there remain water stains on one wall in the kitchen, and on walls both on and under the stairs. It was reported that staff have to clean mould from this under-stair area, which connects the kitchen to the lounge, weekly. This is an outstanding issue from previous inspections, and is additionally an action point from the home’s 2005 annual development plan. For appearance purposes, and health and safety, the area must be promptly and properly rectified. The other area of concern is with the inner wall that connects the laundry area to one service user’s bedroom. A number of small but significant cracks in the wall have appeared in these areas, including from the window to the floor within the service user’s bedroom. There are also bulging areas of wallpaper. These areas must also be promptly and properly rectified. Other maintenance issues from the last inspection report have been addressed. There are now curtains in the downstairs lounge. The garden shed is now kept locked for safety reasons. The garden itself was seen to have suitable upkeep, and is reported to be regularly used by one service user. The manager reported that the wobbly toilet seat in the downstairs shower room has been replaced many times, but that it is not possible to keep the seat secure after regular use by one service user. Instead a replacement seat is kept in the home for when the seat gets broken. The tiling issues in this bathroom were also seen to have been addressed. The damaged step on the stairs from the last inspection, was found to have been fixed by attaching a number of small metal brackets to most stairs in the home. Whilst this fixes the safety issue, it compromises the homeliness of the stairs. A longer-term solution must be found. There was offensive odour emanating from one bedroom in the home. The manager explained how they have tried to address the cause of this, but without success so far. Every effort must be made to fully address the issue, including carpet replacement if necessary. The home has a washing machine and a tumble drier enclosed in a separate room. They were working at the time of the visit. There was soap and handdrying paper-towels available at all sinks used for hand-washing during the visit. Taps in the home are thermostatically controlled. Covered radiators are provided to heat the home. The manager stated that the heating issue arising Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 22 from the last inspection had been addressed. Disposable gloves for infection control purposes were seen to be readily available and used. The manager noted that there are now further fire-safety devices fitted to communal doors, to allow the doors to stay open but automatically close if the fire alarm goes off. The kitchen door was seen to be additionally wedged with a door-stop. This was found to be due to the fire device batteries being flat. This could cause unnecessary additional danger should a fire occur. The manager must implement a system to ensure that the devices are kept fullyfunctional. One further improvement is needed in the downstairs bathroom, where the extractor fan makes a significant amount of unnecessary noise. It must be addressed. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 23 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 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are supported by a committed and capable staff team who are generally well-trained. NVQ targets are close to being achieved. Staff received appropriate supervision. Service users are suitably protected by the recruitment practices being used for the home. Appropriate staffing levels are not being maintained. This puts pressure on the staff team with upholding suitable standards, and prevents service users from having all their needs effectively met. Improvements to staffing levels must be promptly made. EVIDENCE: Those service users able to all fedback positively about staff. Interactions between staff and service users were generally positive. Staff were seen to address service users respectfully, and to generally ask them before providing support. Feedback from staff and the manager showed that staff generally have a good understanding of service users’ individual needs. Staff were able to provide examples of how they have improved their practice to service users’ benefits. Staff noted that they attend training to broaden the understanding of how to Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 24 provide appropriate support. They also receive regular team meetings and supervision sessions. These have for instance enabled staff to feel more confident in encouraging a service user to ride longer on their exercise bike. The manager explained that two staff have achieved the National Vocational Qualification (NVQ) in care qualification at level 2 or above. Three more are progressing with the award, including one awaiting certification. Newer staff are working towards the completion of the Learning Disability Awards Framework (LDAF) award before being considered for support for the NVQ. The manager is aware of her responsibility to have a staff team of whom at least 50 have the NVQ award. There was feedback that there are not enough staff working in the home at all times. The expected minimum staffing for the home, based on the significant support needs of the eight service users, is for four staff to be rostered to work. The home’s Statement of Purpose also states this. Only three staff were present throughout the course of the first day of inspection. The use of a student nurse to assist with breakfast and cleaning, and the manager to drive people around and provide evening support when one service user had to be checked at a hospital, enabled service users’ needs to remain broadly met. However some care plan needs of individual service users, such as with going for a walk in the early evening, were generally not happening. Analysis of two weeks’ roster, from 21st August, found that there were eleven from a possible fourteen occasions when only three staff worked the late shift, with more staff working on the other three occasions. Four staff worked the morning shift on nine from fourteen occasions, with three working on the other occasions. Within this, the manager worked some of these shifts including sleep-overs, and there were some occasions when staff worked both shifts of the day, taking an hour’s break between the shifts. Nine bank staff were used during these weeks, supporting the three permanent staff who were on leave. The home has a team of eight permanent staff. Despite the committed care being provided to service users, the evidence is that there is often insufficient staffing numbers in the home. The registered people must address this, to ensure that the agreed staffing levels of four staff in the mornings and evenings, relative to when service users are present in the home, is provided at all times. This is additionally a requirement from the previous inspection that is yet to be addressed. In terms of recruitment, checks were made of the personnel files of three newer staff members. It was found that all three staff have suitable and timely Criminal Record Bureau (CRB) disclosures, written references, identification checks, and work permit information where necessary. The manager stated that a designated person in the organisation’s Personnel Department undertakes these checks. Records showed that the manager and another senior person undertake interviews, and that application forms including Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 25 employment histories are acquired. A suggested improvement is to ensure that a reference from an overseas employer be additionally obtained where there are no British employers. The manager keeps a record of each staff member’s training courses. Certificates are also kept. Training plans are kept within supervision and appraisal records. Training records showed only significant shortfalls for challenging behaviour training (see standard 23) and for autism training. The manager noted that autism training has recently begun being provided by Milbury, and that all staff are scheduled to attend. Staff were generally seen to have had formal training in emergency 1st aid, health & safety, food hygiene, and fire safety. There were also suitable records of induction for new staff within reasonable timescales. The manager is recommended to ensure that such training takes place within 6 weeks of starting for any bank staff. Milbury 694 Pinner Road DS0000017553.V310865.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a manager who runs the service in a manner that focuses primarily on service users but which also supports staff well. The work of the staff team reflects this. There are also good standards of quality auditing in the home. The health & safety of people using the home is generally well-protected. Minor shortfalls in the updating of professional checks in some areas must be addressed. EVIDENCE: The current manager started working in the home in October 2004 following a period of management instability in the home. She was successfully registered with the CSCI in March 2005. The manager noted that it remains for her to complete the Registered Managers’ award and level 4 NVQ in care. She is working towards this through a local training provider. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 27 Feedback and observations confirmed that the manager ensures that the home is suitably run. Staff noted that the manager provides good support, but addresses any poor practices, for instance through calling weekly staff meetings for a while recently. The manager was also seen, and fedback to be, suitably service-user focused. Feedback and observations showed that staff work well together as a team. For instance, whilst work tasks are allocated at the start of shifts, staff communicate well to ensure that they both distribute realistic task schedules and provide cover where needed. Staff in particular commented that they do not leave others to complete their tasks when they have finished their own; rather they work together to get all tasks completed. A service review meeting took place in-between the two inspection days. Three feedback forms had been received for this, from relatives and social work departments. The forms were seen to ask a number of pertinent questions. People were also invited to the meeting. The manager noted that the meeting focused on the ongoing development of the service, and would include the production of a report, as with the previous year. The whole process is seen to help to ensure better quality services for the service users. The CSCI continues to receive monthly reports from the operations manager about her findings from visits to the home. The visits help to uphold suitably quality within the service. Professional checks of equipment in the home were seen to be in place for the gas system, the fire system, and the fire extinguishers. No current electrical wiring certificate could be found during the visit, and although the inspector received assurances that a suitable test has taken place, a copy of the inspection records were not provided as requested. The legionella testing was also out of date. This partial lack of testing could put service users at risk of an accident. The manager agreed to address the issues. There was a fire-safety risk-assessment dating from March 2006 in place using Milbury’s standard form. The manager said that it is checked by a local health safety rep, and that it raised no concerns. The home was also visited by the local fire authority in January 2006, and was seen to have addressed their minor recommendations. There were suitable records of internal health and safety checks from those records checked. These included for fridge and water temperatures, and fire systems and drills. Suitable risk assessments were also in place. Milbury 694 Pinner Road DS0000017553.V310865.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 2 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 2 ENVIRONMENT Standard No Score 24 1 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 4 3 X X 2 X Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement The home’s Statement of Purpose needs to be checked through to ensure that it fully relates to this home. See standard 1 for further details. The home’s Service User Guide needs some minor alterations as stated within the details of standard 1. The registered people must ensure that formal training is provided to all staff, in respect of working appropriately with any service users whose behaviour challenges the service. The staining from a leak in the hall needs renovating. Previous timescales of 30/11/05 and 1/5/06 not met. This must address the stains in the kitchen, under the stairs, and on the wall in the stair area. The cracks and bulging within the wall that connects the laundry area to one service user’s bedroom, and within the DS0000017553.V310865.R01.S.doc Timescale for action 1 YA1 4, 5 15/02/07 2 YA23 18(1)(c) 15/02/07 3 YA24 23(2)(b, d) 01/12/06 4 YA24 23(2)(b, d) 01/12/06 Milbury 694 Pinner Road Version 5.2 Page 30 5 YA24 23(2)(b, d) 6 YA24 23(2)(c) 7 YA24 23(2)(c), 23(4) 8 YA30 16(2)(k) 9 YA33 18(1)(a) service user’s bedroom walls, must be promptly and properly rectified. A longer-term solution for upholding the safe structure of the stairs, whilst being of a suitably homely appearance, must be found. The extractor fan in the downstairs bathroom, that makes a significant amount of unnecessary noise, must be fixed. The manager must implement a system to ensure that the firesafety devices on doors are kept fully-functional. Every effort must be made to fully address the issue of offensive odour from one bedroom, including carpet replacement if necessary. The manager must ensure that staffing levels are upheld, through the use of agency staffing if necessary. Previous timescale of 15/3/06 not met. The registered people must ensure that a professional legionella test is promptly undertaken. 01/03/07 01/12/06 15/11/06 15/01/07 15/11/06 10 YA42 23(2)(c) A copy of the electrical wiring certificate for the home must also be provided to the CSCI, to confirm that a suitable test has taken place. 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Milbury 694 Pinner Road DS0000017553.V310865.R01.S.doc Version 5.2 Page 31 No. Refer to Standard YA7 Good Practice Recommendations It is recommended for there to be a professional audit of service users’ finances, as none has taken place since 2004. This would further reduce risks of mistakes and theft. The records of those skills that service users have been supported with should be further developed in terms of range and detail. If health assessments and plans are to be used within the home, they should be kept up-to-date. It is recommended that the epilepsy guidance for each service user be contained within the epilepsy file, for ease of reference. The PRN (as-needed) medicine guidelines should be reviewed and updated in line with care plans, as many dated from 2004. They should also more clearly identify how each service user expresses pain. Recognition and support of how each service user would potentially communicate dissatisfaction with the service should be pursued. For prospective employees who used to live overseas, a reference from an overseas employer should additionally be obtained where there are no British employers. 1 2 3 4 YA13 YA19 YA19 5 YA20 6 7 YA22 YA34 Milbury 694 Pinner Road DS0000017553.V310865.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: 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 694 Pinner Road DS0000017553.V310865.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!