Inspection on 19/07/07 for Milbury 694 Pinner Road

This inspection was carried out on 19th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Milbury 694 Pinner Road 12/09/06

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 19th July 2007 08:15 Milbury 694 Pinner Road DS0000017553.V344021.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.V344021.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.V344021.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) Milbury Care Services Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 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. 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 home’s Service User Guide is available from the home on request. Fees for placement were made available to the CSCI. They are available on request from management at the home. There was one vacancy at the time of the inspection. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the previous inspection in September 2006, the home’s registered manager has left her role there. An acting-manager appointment was made pending recruitment of a new permanent manager. The new permanent manager started work shortly after this inspection. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. It was duly returned to the CSCI in good time. Surveys were sent to the home after receipt of the AQAA, and a few weeks in advance of the inspection. However, the majority had not been distributed by the time of the visit. Ultimately, surveys were received from four relatives/advocates, and from all residents each with staff support. Their views have been incorporated into the report. The unannounced inspection visit took place across one day in mid-July. It lasted eight and a half 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 some residents during the visit, and received feedback where possible. Communication was too difficult with some of the residents as most are not able to communicate verbally. The inspection process within the home also involved case-tracking the support needs of two residents, observations of how staff provided support to residents, discussions with staff, checks of the environment, and the viewing of a number of records. Feedback was provided to the acting-manager at the end of the visit. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: Residents continue to receive appropriate support in the key areas of medication, food, health, and decision-making. There was a clear focus on supporting residents to uphold good standards of appearance. Clothing was well-fitting and suited to each resident. The personal support standard consequently remains at an ‘exceeded’ level. The food provided overall remains at a good and varied standard. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 6 There has been a relatively low turnover of staff since the last inspection. Vacancies have been filled. Staff generally treated residents respectfully and individually. What has improved since the last inspection? What they could do better: The main issue for improvement is to do with providing activities and stimulation for residents, in-house and in the community, consistently. There is no doubt that a range of activities are provided, but especially during some weekends, there has been little provided to residents, which can cause boredom. It is likely that the failure of the home, to raise staffing levels beyond three staff most of the time, is related to the activity shortfall. Consequently, staffing levels require review. The exception is for pre-planned activities, when additional staffing is provided. There is a small shortfall in the number of staff who have NVQ qualifications. There were no clear plans to address this, which allows residents to experience an insufficiently knowledgeable staff team. The lounge had ingrained food stains from a party that took place four days earlier. Deep-cleaning, through the equipment that was readily available, should have taken place promptly, to help uphold a suitably clean and hygienic environment. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 7 A complete list of requirements can be viewed at the end of the report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 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 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has developed the information for prospective residents so as to better help with communicating about the services offered. However some basic information on complaints and fees are missing. The service acquires suitable information about prospective residents so as to decide about whether the home can meet that person’s needs. EVIDENCE: It has been previously established that the company has a suitable admissions policy. There have been no admissions into the home since the last inspection. A vacancy arose early in 2007. The acting-manager explained that Milbury have a designated person who undertakes initial visits to new people, to assess for suitability of placement. Records and feedback showed that this person had also checked on the vacant room, and that social workers were starting to make visits to the home. There had however not been any potential residents visit at the time of the inspection. There were previously requirements made about making sure the Statement of Purpose and Service User Guide for the home are fully accurate about the Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 10 details of the service, as these documents are used by prospective new residents and their representatives before deciding about moving into the home. These requirements have been addressed for the former but not for the latter, as below. The Service User Guide was updated in late April 2007. It is now a seven-page document that has many useful photos that assist with explaining the services on offer. However, whilst informative, it does lack a clear summary of the complaints procedure, contact details of the CSCI, and information about which services are covered by the fees. This must be addressed, to provide sufficient information to any prospective residents and their stakeholders. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each resident has a suitable care pathway that reflects their needs and preferences, and which is documented in a manner that better enables the resident to own and understand it. However, care pathways are not made easily accessible. Staff do follow the care pathways. Residents’ decisions are respected and supported by staff. Staff encourage residents’ independence where not unduly hazardous. EVIDENCE: Feedback and observations showed that staff had a good grasp of respectfully supporting residents to make decisions about their lives. For instance, one resident was seen to refuse their medication by their actions of pushing it away, which staff accepted. Staff reported that in a different environment, the resident had later taken the medication. Similarly, staff used objects and verbal prompts to encourage one resident to go to the day service. This Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 12 person’s care plan documented about how to encourage them to go out despite their occasional reluctance. The plan and staff feedback appropriately also recognized the resident’s right to refuse, which daily records confirmed. Staff could explain how a non-verbal resident attracts staff attention, and how to enable this person to make choices from two items presented to them. It was additionally observed that residents were free to move throughout the communal areas of the home, and that care plans emphasised choice. Within the AQAA, it was stated for instance that residents were involved in choosing décor and furnishings in the home through acquisition of samples and brochures, and that menus and activities reflect resident preferences. It was possible to confirm this to be the case with menus. The AQAA also recognised the need to further develop communication aids, to better enable residents to express their preferences based on their individual abilities. The care files of the two case-tracked residents were checked through. Each had a Personal Planning Book that detailed the person’s individual needs and wishes. These were written in the first person, and contained many photos and pictures to help make the book more understandable to the resident. Key preferences of the person were evident within these. It was discussed with the acting-manager about easier access for residents and staff to the Personal Planning Books, as they were all kept securely in the upstairs office. The acting-manager explained that one resident in particular is liable to take any paperwork left around and rip it up. Nonetheless, other documents such as daily records are stored securely downstairs. If the principle is for residents to own their Personal Planning Books, individual planning should take place to enable them to have these books easily accessible, such as in their rooms, as far as reasonably practical. This was recognised with the AQAA received. There were also care plans dating from January 2007 in place for each resident, albeit that the Personal Planning Books appeared to post-date these. The care plans considered key areas of need for each resident, and recorded in detail about the support needed to address the need. More recently, monthly care plan reviews have taken place, which the acting-manager stated involved the resident as far as possible. There were written risk assessments in place for the case-tracked residents. These were specific to their individual needs, for such things as bathing, being left alone, and ability to handle hot drinks safely. Observations confirmed that such support is provided. The assessments had been reviewed and updated within the last year. Training records showed that eight staff have had training on risk assessment, including two within 2007. The home also benefits from the input of a regional Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 13 health and safety manager, in terms of advice with and checks of risk assessments. Feedback from staff showed reasonable encouragement of residents to be more independent where possible. For instance, for one case-tracked resident, staff explained that they now encourage them to walk alone more where previously they had felt the need to support them in case of falls. The resident is also encouraged to move limbs to assist with getting dressed, and to take their towel to the bathroom themselves, rather than staff doing these things for them. However, some manoeuvres, such as getting into the car, are still assessed as needing staff support as they present greater risks of injury. It is hence overall judged that residents can take risks as part of an independent lifestyle. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents continue to be supported to take part in a wide-range of appropriate activities in the home and the community. There are however times when residents lack sufficient activity and stimulation. Residents are well supported to maintain and develop personal and family relations. Rights and responsibilities are generally recognised, as residents are generally treated respectfully and individually. However, the breakfast observed during the inspection lacked the necessary support to fully meet individual needs. A strong standard of nutritional and enjoyable food is overall provided to residents. EVIDENCE: All residents have placements at local day centres that occupy most of their weekdays. Staff provide support with transportation, either by the house car if Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 15 a driver is present, via taxi, or via public transport. The service currently has one person who drives the house car, with one further being recruited. It is recognised that having further drivers would benefit residents. One resident was additionally noted to be enrolling for college courses. Staff at the home have the use of a digital camera. This has resulted in many pictures of residents’ activities being stored on the office computer, a concept that one resident referred the inspector to. A sample of these pictures were seen, showing for instance a recent day out at Whipsnade Zoo with residents from other local Milbury homes, one resident’s recent trip into London for the day, and numerous parties and recreational clubs attended. The camera is also used to take pictures that assist with communication, for instance of staff members for the pictorial roster at the front door. A picture was taken of the inspector during the visit, to add to complaints procedure. A community activity chart, for planned summer excursions for residents, showed attendance at recreational clubs, days out in London, theatre visits, and cinema trips. The acting-manager also spoke of a recent day trip to Hastings for four residents in the house car. A weekly visit to the home by an aromatherapist had been taking place recently. Five residents were choosing to use this private service. Individual records and feedback about it were very positive. Feedback from residents about activities during the visit established that they can attend church, go out to eat, visit family, and that there was a recent birthday party in the house for one resident. When asked the question about whether there are good activities, the responses were unclear. Feedback from two relatives/advocates noted the need for more stimulation. One record also raised issues about a lack of weekend activity. Staffing levels at the weekend, as per standard 33, were noted to be insufficient to enabling much community presence unless a planned excursion was taking place. So whilst it is clear that the service does provide overall a good range of activities to residents, there is some concern about the consistency of this occurring. A range of appropriate activities must be consistently provided to residents each week. Some residents spoke with enthusiasm about holidays that were being planned for. The acting-manager explained that these were in the process of being booked, one abroad and one local, based on residents’ preferences and review meeting agreements. Feedback from relatives/advocates was generally positive about the support provided to uphold family relationships. The question on whether the service helps the resident to keep in touch was mostly answered ‘usually’. One person noted that the service agrees to provide transport to enable the resident to visit, another that the home does its best. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 16 One case-tracked resident’s recorded goal was for increased family contact. Records and feedback found that this was clearly being addressed by staff, including through phone calls and plans for a visit. The other case-tracked resident had had a planned family visit postponed. Records and staff feedback confirmed that there was an appropriate reason for this, and that a further visit was being actively planned for. The AQAA noted that people can visit residents at any time, which one relative/advocate confirmed. Privacy is provided if needed. It is hence judged that suitable support with relationships is provided. The overall positive and respectful attitude of staff towards residents, including recognising individuality of residents, shows that residents’ rights generally are respected. It was also apparent, for example, that residents had adapted plates, cutlery and cups to enable independence where needed. Responsibilities were encouraged, for instance with helping to clear the breakfast table, and with feedback that some residents are enabled to get involved with cooking. Breakfast was served to residents shortly after the start of the inspection. The main course was cheese-on-toast, however a few residents chose cereals instead. Tea was also provided from a freshly-brewed pot. One relative/advocate noted that care is taken with meal presentation. The inspector discussed afterwards with the acting-manager about residents all having to wait until everyone was ready, before breakfast began. A suitably-individualised service would enable people to have breakfast when they were each ready. The acting-manager agreed with this. It was established that the three staff were however each busy providing support until all residents were at the table. If any of them had provided immediate support, another area of support would have had to wait. Nonetheless, either through organising things differently or through an extra staff member, breakfast must be made available to each resident when that resident is ready. The menu for the previous two weeks was analysed. It showed a strong degree of providing varied and nutritious foods overall, for instance in emphasising the use of different fruits and vegetables. There was evidence of favourite foods of individual residents being included, which one resident was able to confirm. A strength was that breakfasts generally varied each day. There were two days across the two weeks where there was insufficient protein provided across the day. In consultation with the CSCI’s nutritional guidance document, consideration should be given to ensuring that two servings of a protein food are always provided across each day. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive excellent overall standards of personal support based on their individual needs and preferences. There are also strong overall standards of health and medication support that aim to meet individual residents’ needs, with only occasional documentation shortfalls. EVIDENCE: Residents were generally seen to be wearing well-fitting, individual, appropriate and clean clothing from the start of the inspection. One relative/advocate survey noted this as a strength of the service, based on when they visit without notice. There were no visible concerns with any residents’ hair or nail care. Most residents had clearly had recent haircuts or visited a hairdresser. A few had highlighted hair, all of which shows good attention to supporting a dignified appearance. One resident was seen during the inspection to request for help to blow-dry their hair, which the staff member appropriately attended to straight away. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 18 Care plans showed good detail about the individual personal care support that each resident needs and wants. Staff were aware of particular issues relating to personal care for individual residents, such as one resident not liking their teeth being cleaned and that they are currently using additional mouth-wash. Staff also noted that night-staff support one early-rising resident with their personal care, as again documented within their care profile. The AQAA noted that privacy is now provided when relatives visit. No relatives/advocates raised this as a concern from their surveys. Feedback from residents found that they responding positively to the question of whether their privacy is respected. The overall evidence shows excellent standards of appropriate personal support, as at the previous inspection. One resident had speech therapy input early in 2007. A report noted actions to take, to support the resident. The acting-manager explained that this was on hold pending acquisition of a new community speech therapist. It would nonetheless be proactive to acquire the training recommended, on non-verbal communication skills for staff. Routine health checks, for instance with a chiropodist or optician, within the case-tracked residents’ files were generally evident and up-to-date. However, records were occasionally out-of-date. For instance, a postponed dental appointment within one resident’s file had not been updated on, albeit that the communication book established that the resident had since seen the dentist. This could lead to health checks being missed or not re-booked, and so must be addressed. The acting-manager explained the scenario around referring one resident, who complained of pain, to health professionals who had since diagnosed treatment and further investigations. Records and feedback showed that the local GP is willing to visit the home to help with residents’ health care, including for such things as acquiring blood samples which particular residents may not accept at the surgery. One health professional’s letter on file in the home clearly noted that they are very happy with the particular resident’s upkeep. Regular weight checks were being undertaken for the two case-tracked residents. These showed overall stable weights for the resident. The actingmanager explained suitable responses to the weight loss identified for another resident, whilst there was documented evidence of using diet and exercise to aim to prevent weight-gain for some residents. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 19 Epilepsy records for applicable residents continue to be recorded about sufficiently. Concerns are referred to health professionals. Training records showed that six staff have attended epilepsy training within 2006. The actingmanager showed documentation confirming the booking of a further four staff to attend, which should enable there to always be a trained staff member present on shift. There were Health Action Plans in place for both case-tracked residents. However, whilst one person had five areas of action identified, the other had none, which suggests that further work is needed to ensure that the plans are made fully effective for all residents. This repeats a previous recommendation. The CSCI received three notifications since the last inspection about any residents having falls that resulted in them being checked at the local accident and emergency department. Appropriate actions were taken. Medication was seen to be securely and tidily stored in the home on behalf of residents. Medication is supplied by a local pharmacist using the monitoreddosage system. None of the current residents are assessed as able to selfmedicate. The medications of the case-tracked residents were checked. They were all signed for appropriately. A checking system is also used, the acting-manager explained, to ensure that all tablets can be accounted for. A random check of one set of medication found that exactly the right amount of tablets remained, in line with the check sheets used. Two improvements were needed. One as-needed (PRN) medication was found to have a prescription label that contradicted the as-needed nature, which could result in over-medication. The service must make every effort to ensure that prescription labels correspond with prescriptions. One liquid medication lacked a date of opening, hence there being some risk that the medicine may no longer be fully effective if it becomes out-of-date. Checks need to be made of opened medications to ensure that they are within-date in terms of effectiveness. Nine staff were at the time of the inspection assessed as capable of administering medication. Three others had had recent formal training, and were due shortly to be assessed by the acting-manager for suitable capability. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Suitable procedures and regular training are the primary methods by which the home ensures that residents are protected from abuse. There are procedures to ensure that complaints are dealt with appropriately. Some residents and relatives report however not being able to access the complaints procedure. EVIDENCE: It has been previously established that the home has a suitable complaints procedure. A pictorial complaints procedure remains in place in the entrance hall, and within each residents care file. There have been no complaints to the home directly, or to the CSCI about the home, since the last inspection. Minutes from a recent residents’ meeting also highlighted no concerns being raised. The AQAA noted that a small amount of work is needed to ensure that complaints are properly captured, recorded & addressed. The seven residents’ surveys partially reflected this, in that two stated that they only ‘sometimes’ know how to make a complaint, and one ‘hardly ever.’ Similarly, two of the four relatives’/advocates’ surveys stated that they do not know how to make a complaint. The AQAA showed awareness of this latter point, and made Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 21 reference to both the new letting us know what you think policy and “help cards” for residents. It was previously recommended that consideration be given to how each resident would potentially communicate dissatisfaction with the service. The evidence suggests that further work is needed here, to ensure that residents and relatives can generally be confident about raising complaints, and for complaints to be captured. There have been no abuse allegations made about the home to the CSCI since the last inspection. It was previously established that the service has appropriate abuse-prevention and whistleblowing policies. There was feedback from some residents to suggest that they do feel safe in the home. Feedback from staff showed good awareness of appropriate whistle-blowing procedures. Records showed that most staff received training in abuse prevention at latest within 2006, and on challenging behaviour early in 2007. The most recent staff meeting focussed mainly on refresher training about abuse-prevention, through a presentation and quiz by the local operations manager. The AQAA also stated that the induction of new staff includes about abuse-prevention. This all shows suitably robust abuse-prevention procedures. It was previously required for challenging behaviour training to be provided to all staff, in respect of ensuring appropriate support of residents in such scenarios. Records showed that this was achieved early in 2007. Monthly audits of accidents and incidents are undertaken by the local operations manager. Checks of these, and of a sample of accident and incident forms, raised no concerns. Notifications of serious accidents or incidents are supplied to the CSCI promptly. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with an environment that is generally clean, attractive and suitably furnished. There are sufficient and suitable bathrooms, toilets, and communal living areas. There are few maintenance issues, with the majority of previous requirements in this area having been addressed. EVIDENCE: The home is a residential setting that has been adapted for residential care use. It is quite homely and comfortable, particularly in that much of the furnishings and décor continue to be of a good standard and match well. The lounge in particular had a great many photos of residents attractively on display. One resident was able to confirm to the inspector that nothing was broken. There were a number of requirements made about the environment at the last inspection. Most were seen to have been addressed on this visit. This includes: Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 23 • Redecoration in the hallway to address an old leak. • Adjusting part of the stairs to be sufficient robust but suitably homely. • Fixing an extractor fan in one bathroom. • Keeping fire-doors fully functional. Additionally, the AQAA noted that there are new curtains in the lounge area, that kitchen walls are painted, and that a toilet seat has been made secure. The wall outside the laundry area was also previously identified for treatment due to cracks appearing. At the time of the visit, it had been recently replastered and was drying out. It would then be redecorated. As this has taken a year to attend to, the requirement is repeated to ensure that the work is completed promptly. The standards of décor and furnishings in bathrooms and toilets, and in the lounge and dining room, were generally seen to be suitable. The AQAA identified two areas for improvement, for missing tiles in one bathroom to be re-fitted, and for a radiator cover in one bedroom to be replaced due to wear and tear. These issues remained at the time of the inspection visit, but were reported to have been addressed before the drafting of this report. Additionally, marking on the lounge walls, as identified at the inspection, have been redecorated. The AQAA also noted that the environment is reviewed monthly by the operations manager, and yearly within the service’s annual review process. The latter particularly involves residents and their representatives. Surveys from residents found no concerns with the cleanliness of the home. One relative volunteered a comment confirming this within their survey. The home was seen to be reasonably clean from the start of the visit. There were no lingering offensive odours. Staff attended to the majority of cleaning issues after residents had left for their day services. One issue of ingrained food staining on the lounge carpet, which was not immediately noticeable due to the carpet colour, was discussed. It was stated that this was from the previous weekend’s party, in which case, cleaning was not sufficient. The home’s carpet cleaning machine was used to address the issue before residents returned home. The home has a washing machine and a tumble drier enclosed in a separate room. They were working at the time of the visit. Taps in the home are thermostatically controlled. Covered radiators are provided to heat the home. Disposable gloves for infection control purposes were seen to be readily available and used. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported by an established staff team who demonstrate suitable care and ability overall. There are good standards of training in shortcourses and induction of new staff, however the staff team overall are slightly lacking in NVQ-qualified staff. Good efforts are made to uphold staffing levels of at least three people per shift. However, there are seldom four staff working together, which somewhat compromises residents’ activities and stimulation. Residents are protected through suitable recruitment practices and appropriate supervision of staff. EVIDENCE: Staff feedback showed that they spoke respectfully about residents, and that they know residents as individuals. Staff also showed appropriate knowledge about care practices. Observations found that staff spoke appropriately with residents. For instance, requests were made of residents, refusals respected, Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 25 but staff would persist through other options such as waiting or asking different staff to help, where the request was deemed important. Staff were also observant, for instance in noticing that one resident was stirring tea with a knife and so providing a spoon, and with joining in with one resident making a joke of taking a bag from the kitchen. Answers to the relatives/advocates survey question about whether staff have the right skills and experiences varied from ‘sometimes’ to ‘always’. A staff training grid, viewing of sample certificates, and feedback from the actingmanager showed that five staff of the fourteen working at the home have completed the NVQ in care qualification at level 2 or above. This represents 36 of the staff team, with two more needed to complete the NVQ course to reach the minimum expected standard of 50 . It is noted that some other staff have completed the LDAF award, an optional precursor to the NVQ. However, as there was additionally feedback about NVQs being more difficult than other training courses to acquire within Milbury, and as no other staff were being put forward for the NVQ course, a requirement is made in this area, to help ensure that residents are supported by a suitably competent team of staff. Training records showed that most staff have completed suitably-recent training in the standard courses of emergency first-aid, manual handling, fire safety, food hygiene, and health & safety. The majority of staff has additionally attended courses in challenging behaviour, and on autism, since the last inspection, which shows good attention to the needs of the residents. A newer staff member’s training certificates were found to cover suitable areas such as food hygiene, health & safety, abuse prevention, and challenging behaviour within four months of their starting work at the home. This is sufficiently timely. There was also feedback from newer staff about receiving in-house induction, including a week’s initial shadowing of senior staff. The AQAA noted the recent appointment of a regional training and development manager. The acting-manager noted that this person has requested information about staff in respect of particular training areas, which suggests good standards of overseeing support for training. A supervision chart in the office confirmed that individual supervisions of staff take place at least once every two months. A random supervision record for one staff member was viewed. It contained appropriate information, such as about both training plans and the supervisee’s ideas for residents’ development. Two weeks of roster from around the time of the inspection were analysed. They showed that staffing levels of three staff were adhered to except on one occasion where they were one short due to two staff being off sick. Six shifts were marked as ‘sick leave’ overall. Shortages were covered by bank staff, Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 26 permanent staff including the acting-manager working additional or altered shifts, and on two occasions agency staff were used, all of which shows effort to uphold staffing levels of three staff. It was previously required for four staff to be working at all times. However, this was for when there was occupancy of eight residents, not the current seven. The acting-manager explained that four staff are planned for when there are excursions for residents, and are aimed at across the weekend. The roster analysis however found only three occasions where four staff actually worked together, usually during the week. Coupled with some feedback from relatives/advocates about residents needing more stimulation, it is judged that insufficient staffing was being provided overall at the home, particularly at weekends. A written review of staffing levels must be undertaken at the home, taking into account residents’ individual and collective needs for activity and stimulation, to ensure that staffing levels on each day of the week and weekend meet residents’ needs. The AQAA noted that only two staff have left employment in the last year. Staff at this inspection had mostly been present at the previous inspection. The acting-manager noted that, with two new staff starting work around the time of the inspection, there would be no vacancies within the staff team. The recruitment documents of one newer staff member were checked through. These included an application form, identification documents, and a Criminal Records Bureau check. They were all suitable. Other documents such as written references were recorded about, but originals were with the local personnel department of Milbury. A phone call established that the originals are in place, and that gaps in employment are explored. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from an appropriately-run home, despite the inspection taking place in-between people being employed in the role of permanent manager. Management approaches were pro-active, supportive of staff, and resident-focussed. The service benefits from good standards of self-monitoring, especially by relevant people based at the local head office. Suitable standards of health and safety are also in place at the home. EVIDENCE: The home’s registered manager ceased to work at the home in May 2007. An acting-manager was promptly appointed. She was present during the Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 28 inspection. She showed appropriate knowledge of the home, residents, and care practices. She also provided evidence of continuing to proactively manage the service, particularly through the introduction of new ideas. There was positive feedback from staff about management arrangements in the home, noting for instance that the acting-manager is approachable and supportive, and that she helps to cover sickness absence. Hence a suitable interim appointment is judged as having been made. A permanent manager started work in the home in early August. She introduced herself to the inspector before the drafting of this report, and noted that she moved from another Milbury home to take this post. Only two staff meetings had taken place in 2007 according to records. As staff meetings can help with staff support and consistency of care provision, it is recommended that these be provided on at least a monthly basis. The organization ensures that annual service reviews take place. These request feedback from all involved stakeholders. A meeting is then held at the home to consider the previous review and all feedback, and plan for future developments and goals. Records showed that such a meeting would be taking place during August. Monthly checks of the home continue to take place by the local operations manager. Additionally, a regional quality assurance manager has been appointed who helps with the monitoring of the home. This included an unannounced visit to the home in February, a report about which was seen to identify strengths and weaknesses. There was evidence of the actions from this report having been addressed. CSCI surveys were sent to the home in following receipt of the AQAA, with a response deadline that would precede the inspection. However, most of the surveys were not distributed from the home until after this deadline, which prevented some stakeholders from making comments until after the inspection visit. It is strongly recommended that future surveys be distributed promptly. Effective monthly health & safety checklists were being completed. They included details of any concerns, such as fire-safety devices on some doors not working, and about ensuring that these were addressed. The home has a fire-safety risk assessment dating from December 2006. It was signed off by the company’s local health and safety officer. There was also evidence of five staff receiving fire-safety refresher training in early 2007. The AQAA noted about general risk assessments being in place and in date, about standard checks taking place regularly such as for water and fridge temperatures, and about appropriate policies being in place. Sample checks of these confirmed appropriate practices. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 29 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 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 X 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 3 3 3 X X 3 X Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 30 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. 1 Standard YA1 Regulation 5 Requirement The home’s Service User Guide must have: • a clear summary of the complaints procedure, • contact details of the CSCI, and • information about which services are covered by the fees. This is to provide sufficient information to any prospective residents and their stakeholders. Timescale for action 15/10/07 2 YA14 16(2)(m, n) 3 YA16 12 4 YA19 17(1)(a) s3 pt 3(m) Previous timescale of 15/2/07 partially addressed. A range of appropriate activities 15/09/07 and stimulation must be consistently provided to residents each week, including at weekends. Breakfast must be made 01/09/07 available to each resident when that resident is ready, to provide a suitably individualised service. Health care records within 01/10/07 residents’ files were occasionally not up-to-date. This could lead to health checks being missed or not re-booked, and so must be addressed. DS0000017553.V344021.R01.S.doc Version 5.2 Page 31 Milbury 694 Pinner Road 5 YA20 13(2) 6 YA20 13(2) 7 YA24 23(2)(b, d) Where prescription labels on medications do not correspond with the expected frequency of administration, every effort must be made to get the labels amended. This is to help prevent incorrect administrations. Checks need to be made of opened medication bottles to ensure that they are within-date in terms of effectiveness, including through the recording of a date of opening. Otherwise, the medication may cease to be fully effective over time. The cracks and bulging within the wall that connects the laundry area to one service user’s bedroom, and within the resident’s bedroom walls, must be promptly and properly rectified. 01/10/07 01/10/07 01/10/07 8 9 YA30 YA32 23(2)(d) 18(1)(c) 10 YA33 18(1)(a) Previous timescale of 1/12/06 partially addressed. The lounge carpet must be kept 15/08/07 suitably clean at all times. There must be written and 01/10/07 pursued plans about how the provider organization will ensure that the home meets the minimum expectation of 50 of the staff being qualified at NVQ level 2 in care. This is to help ensure that residents are supported by a suitably competent team of staff. A written review of staffing levels 15/09/07 must be undertaken at the home, taking into account residents’ individual and collective needs for activity and stimulation, to ensure that staffing levels on each day of the week and at weekends meet residents’ needs. Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations If the principle is for residents to own their Personal Planning Books, individual planning should take place to enable them to have these books easily accessible, such as in their rooms, as far as reasonably practical. Consideration should be given to ensuring that two servings of a protein food are always provided across each day, to help residents to follow a balanced diet. Consideration should be given to better enabling residents to make complaints, and to ensuring that relatives are aware of the complaints procedure. If health assessments and plans are to be used within the home, they should be kept up-to-date [repeated recommendation]. The training recommended by a speech-therapist, on nonverbal communication skills for staff, should be acquired. As staff meetings can help with staff support and consistency of care provision, it is recommended that these be provided on at least a monthly basis. It is strongly recommended that future CSCI surveys be distributed promptly, to enabled stakeholders to make comments before the inspection visit. 2 3 4 5 6 7 YA17 YA22 YA19 YA19 YA38 YA39 Milbury 694 Pinner Road DS0000017553.V344021.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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