Inspection on 12/04/06 for Milbury 9 Rosslyn Crescent

This inspection was carried out on 12th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milbury 9 Rosslyn Crescent 12/06/07

Milbury 9 Rosslyn Crescent 10/11/05

Milbury 9 Rosslyn Crescent 21/04/05

Milbury 9 Rosslyn Crescent 21/10/04

Milbury 9 Rosslyn Crescent 26/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Milbury 9 Rosslyn Crescent 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ Lead Inspector Julie Schofield Key Unannounced Inspection 12th April 2006 08:10 Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milbury 9 Rosslyn Crescent Address 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ 020 8908 3410 020 8908 3410 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 Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: 9 Rosslyn Crescent is a detached house situated in a residential turning off East Lane. It is close to North Wembley station and about 10 minutes walk to the shops. The home accommodates 4 service users in 4 single bedrooms. The ground floor accommodation consists of an open plan lounge/dining room, laundry room, toilet, kitchen and a bedroom with en-suite facilities. The first floor accommodation consists of 3 single bedrooms and a separate bathroom and toilet. There is a garden at the rear of the property. There is off street parking for 3 cars at the front. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Wednesday in April 2006. It consisted of 2 visits, on the same day. The first visit began at 8.10 am and finished at 11.50 am. The second visit began at 2.20 pm and finished at 6.15 pm. The deputy manager was on duty during the second visit. The Inspector would like to thank the deputy manager and carers for their assistance during the visits and for the opportunity to sit with residents. During the inspection discussions with the deputy manager and members of staff took place, records were examined and a site visit was carried out. None of the residents are able to communicate verbally and so the Inspector observed the support given to residents. The company would prefer that enquiries in respect of the fees charged be made to the home. What the service does well: What has improved since the last inspection? Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 6 During the previous inspection, which took place in November 2005, 14 statutory requirements were identified and of these 9 have been met, 2 requirements have been partially met and the timescales for 2 requirements have been extended. The minutes of review meetings now include the date on which the meeting is held and a list of persons attending the meeting. A review of how residents spend their “day off” has taken place and changes have been made to their activities programmes. When residents use the company car they are provided with an escort, in addition to the driver, staff accompanying residents outside the home have the use of a mobile telephone and each resident has a risk assessment for using transport. The member of staff has the expertise and knowledge required to prepare a meal that meets the cultural, religious and dietary needs of the residents. Medication records are up to date. Window restrictors have a working lock and all bedrooms are free from odours. Some staff have attended infection control training as part of a rolling programme and there are sufficient staff on duty to support residents both inside and outside the home. A new dishwasher has been installed and the music centre is now in working order. What they could do better: In respect of supporting residents a policy is needed in the event of residents being escorted by staff in the community. All residents must have the opportunity of an annual holiday and planning needs to happen early in the year. All staff must receive protection of vulnerable adults training. The nonviolent crisis intervention training that was cancelled needs to be rescheduled. Statutory requirements have been identified both in this and in previous inspections in respect of the environment. Where paintwork is peeling it needs making good and being redecorated and cracked glass panes need replacing. The carpet that is stained with white marks needs to be cleaned, or replaced, and scuffing on the bedroom wall, behind a rocking chair needs making good and being redecorated. Sliding wardrobe doors must be made good or replaced, headboards on beds need to be cleaned or replaced, net curtains need to cover the window to ensure privacy, missing tiles and bath surround and skirting board need replacing in the bathroom, dead insects must be removed from the light fitting in the bathroom and the toilet seat in the ensuite shower room needs to be attached to the pedestal. A programme of works, and risk assessment, is required for the repairs, redecoration and Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 7 refurbishment that are needed. The testing of the portable electrical appliances must be up to date. In respect of the recruitment, supervision and training of staff, each staff file must contain proof of ID and evidence of a valid CRB disclosure. The home needs a training and development plan. Records of induction training need to be complete and up to date. All staff need to undertake equal opportunities training and infection control training. The staff team needs to meet the target of 50 of carers being qualified to NVQ 2 or 3 level and the registered manager needs to achieve an NVQ level 4 qualification. Staff appraisals must be carried out on an annual basis. Recommendations are made that residents are supported by advocacy services, that the format of the care plan is one which meets the needs of residents, that the office copy of the individual care plans has an up to date record of the monthly evaluations, that the home receives notice when the transport taking residents to their day centre is going to be much earlier than usual, that the new vehicle to be purchased for the home is large enough for all residents to go out together, that there are individual risk assessments for the non-provision of a bedroom door key, that a record is made of the preferred daily routines of the resident and that placing authorities are encouraged to give feedback on the quality of the service at review meetings. 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 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards were inspected during this inspection as no new resident has been admitted to the home since April 2005. EVIDENCE: Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive person centred plans have been drawn up for each resident so that the service provided can meet the individual needs of the resident. The system in place for reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. Residents exercise their right to make decisions within their day-to-day living although they may need assistance by members of staff to achieve this. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. EVIDENCE: Three residents’ files were examined and it was noted that each contained a person centred plan which included a large number of care needs, some of which were common to each plan examined and some which were in relation to the particular needs of an individual resident. Care needs included religious and cultural needs. The support required from staff was identified for each care need. This plan is kept in a file in the resident’s bedroom but the format Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 11 of the plan needs to be one, which the resident can understand. There was evidence that the plans had been reviewed twice during 2005. A statutory requirement was identified during the previous inspection in November 2005 that a record is kept of the date on which review meetings are held and a note is made of persons attending the meeting. This has now been met. The resident’s copy of their plan had been evaluated on a monthly basis and the last evaluation had been carried out in March 2006. The copy of the plan, which is kept in the office, did not contain an up to date record of the monthly evaluations. The home has a system of key working. None of the residents are able to communicate verbally and not all the residents have a family member who is in regular contact with them. Therefore residents would benefit from the support of an independent advocate. As residents are unable to communicate verbally a discussion took place with members of staff in respect of offering choice to residents so that the residents are able to make decisions within their daily lives. Staff agreed that residents were able to make their wishes known, if there was something that they did not want, by pushing this away or by getting up and leaving. In some circumstances staff interpreted body language and facial expressions. Staff said that residents were less likely to be confused when offered a choice if the choice was between 2 items or 2 courses of action. A member of staff said that if assistance with personal care was given at 8 pm and they asked the resident whether they wanted to stay in their room or come downstairs the resident would either point at the chair in their room or would get their slippers. All of the residents require assistance in managing their personal allowance and in dealing with any problems in respect of benefits received. Financial records were examined for each resident. Each resident had a savings account and there was a record in the home of the balances held. Accounts included information about expenditure, receipts and a running total for money held in the home. The service manager audits the accounts, on a monthly basis. The case files, which were examined, contained risk assessments. These included risk assessments in respect of falling on the stairs, epilepsy, manual handling, using the company car etc. The risk assessments include risk management strategies. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents attend day care services, which provide an opportunity to develop their social skills. Residents develop their independent living skills through opportunities in the home to carry out domestic tasks. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle although a risk assessment is needed to promote the safety of residents. All residents would benefit from the opportunity to take part in an annual holiday, where new experiences can be enjoyed. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships and to observe their religious practices. Residents are encouraged to make decisions and their wishes are respected. Residents are offered a varied and balanced diet to promote their well-being and the diet respects their religious and cultural needs. EVIDENCE: Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 13 During the inspection 3 of the 4 residents were preparing to go to the day centre and when the transport arrived one of the residents was still eating breakfast, which they had to leave. A member of staff said that the transport was earlier than usual. (On the day of the inspection schools were closed for the Easter holiday and traffic on the roads was reduced). Each resident attends a day centre on 4 days per week and has one “day off”. A statutory requirement was identified during the previous inspection in November 2005 that the home reviews the support given to residents on their “day off”. Staff confirmed that this has now been met. They said that each resident has an activity planner and these were made available for inspection. It was noted that on the “day off” laundry and cooking were recorded for most residents although staff said that an activity was also chosen that the individual resident enjoyed. Examples of these were given, and there was a record in a resident’s daily diary, of going out for lunch etc. Residents continue to use resources in the community including shops, parks, restaurants, cinema etc. A statutory requirement was identified during the previous inspection in November 2005 that when residents use the company car an escort is provided, who is not also the driver. This has now been met. A statutory requirement was identified that when staff accompany residents outside the home they have the use of a mobile phone. Staff confirmed that this has now been met. A statutory requirement was identified that there must be individual risk assessments for residents using transport. The risk assessments were available for inspection and so this has now been met. The deputy manager said that the home does not have a policy on escorting residents in the community and so this statutory requirement remains outstanding. It was noted that the size of the company car was not sufficient for all residents and escorts to travel together. The deputy manager gave examples of the activities taking place in the home and these included massage, music sessions, beauty sessions, arts and crafts, foot spa, videos, music and dance etc. Support is given to residents so that they can follow their religious beliefs and one of the residents has an escort when they visit the Temple. Last year only 2 of the residents went on holiday. The deputy manager said that the 2 residents went on holiday later than had been originally planned and that it was then too late for the other 2 residents to go away. Only 1 resident has support from family members. The family visit the resident in the home on a monthly basis and the resident occasionally visits their family. Staff confirmed that contact with other families is initiated by the home but when messages are left calls are seldom returned. Staff confirmed that before entering a resident’s room they would knock on the door. As the resident is not able to invite them into the room they would wait a little while after knocking, before entering. Residents are not provided with a key to their room. It was observed that some of the residents prefer to spend Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 14 time in their rooms and this is respected. It was also observed that although residents were offered the opportunity to take part in activities, after returning home from the day centre their wish to sit and to relax instead of taking part was respected. Residents are encouraged to take responsibility for some housekeeping tasks, supported by staff, and these included helping with laundry, shopping, laying and clearing the table etc. A statutory requirement was identified during the previous inspection in November 2005 that the expertise and knowledge required by staff preparing dishes to meet the cultural, religious and dietary needs of residents is reflected in the choice of member of staff for cooking duties. Staff confirmed that this is now met. A member of staff said that the menu included food items to meet the needs of an African-Caribbean resident and an Asian resident. One resident is following a low fat diet and another resident does not have any dairy products in their food intake. Menus were inspected and it was noted that there was a balance of meat, poultry and fish. The carbohydrate selection was varied and included potatoes, rice, noodles and pasta. Fresh fruit was a menu item and was available in the kitchen, for residents to help themselves. A member of staff said that when the menu was drawn up residents were involved in menu planning. They were shown pictures of food and the resident either showed some interest in the picture or pushed it away. During the inspection a meal of curried mince, rice and vegetables with a dessert of fresh fruit was served. It smelt appetising and residents enjoyed the meal. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive assistance with personal care in a manner, which respects their privacy and dignity. Residents’ health care needs are met through access to health care services in the community. The general health of residents is promoted by taking medication, as prescribed by the GP, with assistance from members of staff that have received appropriate training. EVIDENCE: It was noted that a case file contained information for staff to enable them to support a Hindu resident so that the resident’s cultural and religious needs are met. A discussion took place with the staff on duty about the appearance of the residents as it was noted that residents were smartly dressed. Staff said that it was important to buy items of clothing, which were of good quality, and to know how these should be washed to maintain clothing in a state of good repair. Staff said that a smart appearance was part of a positive self-esteem. It was observed that when a resident needed assistance with personal care e.g. prompting to go to the toilet, this was done with tact and in a quiet manner. Although files contained lists of likes and dislikes they did not contain individual working records setting out preferred routines. The staff team Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 16 contains both male and female staff and a member of the same sex assists residents with personal care. Each of the 3 files inspected contained a health action plan and there was evidence that the plans are reviewed. The members of staff on duty confirmed that they escorted residents to health care appointments, as required e.g. hospital out patient appointments with the psychiatrist. They said that residents had regular appointments with the dentist, chiropodist and optician. When necessary, appointments were made for the residents with the GP. Residents also had access to routine health screening services e.g. blood tests and preventative health care e.g. flu jabs. Records of the weight of individual residents are kept on a monthly basis and were up to date. A statutory requirement was identified during the previous inspection in November 2005 that medication records are complete and up to date. An examination of the records confirmed that this requirement is now met. Medication was stored in a locked cupboard and administered from blister packs. These were examined and the blisters that had been opened were in accordance with the records. Staff on duty who were responsible for administering medication confirmed that they had received training and that they had reported any concerns about the resident’s reaction to medication e.g. drowsiness. Guidelines and a risk assessment were in place for a resident who has epilepsy. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place to protect the rights of the residents. An adult protection procedure and awareness of interagency guidelines help to promote and protect the welfare and safety of residents. All members of staff need to undertake protection of vulnerable adults training so that they can develop the knowledge and understanding necessary to provide a safe environment for residents. EVIDENCE: A complaints procedure is in place. The procedure includes the stages within the process and covers both referring matters to the manager of the home and referring to a senior manager in the company when the matter is unresolved at a local level. The procedure refers complainants to other agencies who monitor complaints i.e. the CSCI. The deputy manager said that no complaints have been recorded since the previous inspection. A copy of the procedure is provided in each resident’s bedroom. However, as residents are unable to communicate verbally, as in Standard 7, the use of advocacy services is recommended. A protection of vulnerable adults procedure is in place in the home. The home also has a whistle blowing procedure. A protection of vulnerable adults investigation was initiated recently and carers responded appropriately by following the correct procedure. Two members of staff who have started working in the home have not undertaken protection of vulnerable adults training. A member of staff said that the non-violent crisis intervention training that had been planned but unfortunately was postponed. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which although is comfortably furnished, is in need of some repairs and redecoration to improve its appearance and provide a pleasing environment for the residents. Residents live in a home where standards of cleanliness are good although not all staff have received training in infection control procedures. EVIDENCE: A tour of the premises took place. A statutory requirement was identified during the previous inspection in November 2005 that locks are provided for window restrictors, areas where paintwork is peeling is made good and repainted and glass that is cracked is replaced. There is partial compliance with this requirement as window restrictors have locks but the rest remains outstanding. A statutory requirement was identified during the previous inspection in November 2005 that the carpet, which has white marks, is cleaned and that the scuffing on the bedroom wall, behind the rocking chair is made good. This remains outstanding. The deputy manager said that there are plans to redecorate and refurbish the home and that the programme of works includes the areas identified as outstanding statutory requirements. It Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 19 was noted during the tour of the premises that sliding wardrobe doors in a first floor bedroom were scratched and marked, headboards on beds needed cleaning or replacing, net curtains that were too short needed replacing, missing tiles/the bath surround/skirting board in the first floor bathroom need replacing, dead insects inside the light fitting in the bathroom need removing and the toilet seat in the ensuite shower room needs to be attached to the toilet pedestal. A statutory requirement was identified during the previous inspection in November 2005 that all bedrooms are free from odours. This was confirmed during the site inspection. A statutory requirement was identified during the previous inspection in November 2005 that all staff undertake infection control training and there is partial compliance. The deputy manager said that this topic is included in a rolling programme of training and some of the staff team have completed this training while others are waiting to attend. Laundry facilities in the home were inspected. Access to this area does not involve walking through an area where food is prepared, stored or consumed. The appliances are commercial quality and the washing machine includes a sluicing cycle. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 20 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 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. Residents are supported by staff that have the opportunity to develop their skills and knowledge by undertaking NVQ training. The home needs to ensure that recruitment practices protect the welfare and safety of residents. Without a training plan the home is unable to demonstrate that the training provided enables staff to meet the objectives contained in the Statement of Purpose and is tailored to meet the individual and changing needs of residents. Annual staff appraisals, which identify the training and developmental needs of members of staff, are overdue. EVIDENCE: Staff identified the qualities and skills that they thought were necessary in order to provide a good quality service to residents. These included being respectful, having the ability to coach, motivate and encourage residents, having patience, being able to work as part of a team and enabling residents to achieve their potential. A statutory requirement was identified during the previous inspection in November 2005 that 50 of staff achieve an NVQ level 2 or 3 qualification. A discussion took place with the deputy manager about the progress being made in meeting this target and she said that the acting manager and herself were undertaking NVQ level 4 training, 4 staff Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 21 (permanent and bank staff) have completed level 2 training, 1 staff member (bank) is undertaking level 3 training and 2 staff (permanent and bank) have almost completed level 2 training. Discussions took place with staff regarding NVQ training and 1 staff member said that they would be starting level 2 training next month and another member of staff was hoping to complete their training in May. A statutory requirement was identified during the previous inspection in November 2005 that there are sufficient staff on duty to support residents both inside and outside the home. The rota demonstrated that staffing levels were sufficient and this requirement is now met. It was noted that there are 3 staff on duty on each shift during the day and that the manager’s hours are supernumerary. Two staff files were examined. The members of staff were recently appointed. Each file contained an application form and 2 satisfactory references. One file contained an enhanced CRB disclosure but no proof of ID. The other file contained proof of ID (passport details) and a Pova First check. The CRB disclosure had been obtained from a previous employer and is not portable. A copy of the training and development plan for the home was not available for inspection. However the deputy manager said that the company employed a training officer and that a booklet containing a list of available training courses was sent to the home on a quarterly basis. Training records for members of staff were available for inspection. It was noted that on the 2 staff files examined, each contained an induction training record booklet. Neither book was complete. Training in respect of equal opportunities is included on the list of statutory training and some of the staff team have already completed this. Annual appraisals include an assessment of training and developmental needs but not all staff had an annual appraisal in 2005. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager needs to complete her NVQ level 4 training in management and care as continuing to develop knowledge and skills contributes towards an effective manager who is aware of the needs of residents and staff. Annual service reviews of the home monitor the quality of the service provided to residents and contribute towards the development of the service. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use, although the testing of the portable electrical appliances is overdue. EVIDENCE: The registered manager was on maternity leave at the time of the inspection. She has not yet completed her NVQ level 4 in management and care qualification. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 23 A discussion took place with the operations manager about quality assurance and quality monitoring systems within the home. She said that it is her responsibility to prepare an annual service review for each of the homes within her portfolio. The previous operations manager completed the 2005 annual service review. This is in addition to the monthly visits made to the home, as specified in Regulation 26 of the Care Homes Regulations, copies of which are forwarded to the CSCI. It would be difficult to obtain direct feedback from service users or from their relatives and service user surveys would not be appropriate. The home should encourage placing authorities to give feedback regarding the quality of the placement when attending review meetings. Recorded risk assessments were in place for using equipment, moving around the house, a utility breakdown, fire safety, night security etc. Records and valid certificates were available for servicing and checking the fire alarms (on a weekly basis), the emergency lighting and fire precautionary systems in the home, the fire extinguishers, the Landlords Gas Safety Record and the electrical wiring installation (valid for 5 years from January 2005). The certificate for the checking of the portable electrical appliances was dated 2/05. Staff on duty confirmed that they had undertaken manual handling, first aid, fire safety and food hygiene training. The accident records were inspected. The home records information, on a monthly basis, which is sent to Head Office so that action taken etc can be monitored. Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X 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 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA13 Regulation 13.4 Requirement That the home has a policy on escorting residents in the community. (Previous timescale of the 01 January 2006 not met) That all residents have the opportunity to enjoy an annual holiday. That the planning for and booking of the holiday takes place early in the year to enable this. That all staff undertake protection of vulnerable adults training. That the non-violent crisis intervention training is rescheduled and that all staff attend. That areas where the paintwork is peeling are made good and repainted and glass that is cracked is replaced. (Previous timescale of the 01 December 2005 not met). That the carpet, which has white marks, is cleaned and that the scuffing on the bedroom wall, behind the rocking chair, is made good. (Previous timescale of DS0000017488.V287533.R01.S.doc Timescale for action 01/07/06 2. YA14 16.2 01/11/06 3. 4. YA23 YA23 13.6 13.6 01/08/06 01/09/06 5. YA24 16 & 23 01/09/06 6. YA24 16.2 01/09/06 Milbury 9 Rosslyn Crescent Version 5.1 Page 26 01 January 2006 not met). 7. YA24 16.2 That the sliding wardrobe doors are made good or replaced, that the headboards on beds are cleaned or replaced, that all net curtains meet the window sill to ensure privacy, that missing tiles/the bath surround/skirting board in the first floor bathroom are replaced, that dead insects inside the light fitting in the bathroom are removed and the toilet seat in the ensuite shower room is attached to the toilet pedestal. That a timetable for the programme of works planned is drawn up and a risk assessment is undertaken in respect of the health, safety and welfare of residents during this process. Copies of both the timetable and the risk assessment to be faxed to the CSCI. That all staff undertake infection control training. (Previous timescale of 01 December 2005 not met). That 50 of staff achieve an NVQ level 2 or 3 qualification. (Previous timescale of 31 December 2005 not met). That each staff file contains proof of ID and an enhanced CRB disclosure, which has been obtained by the current employer. That the home develops a training and development plan. That the record kept of induction training given to a new member of staff is complete and up to date. That all staff undertake equal opportunities training. That all overdue annual staff DS0000017488.V287533.R01.S.doc 01/09/06 8. YA24 13.4 09/06/06 9. YA30 13.3 01/09/06 10. YA32 18.1 01/10/06 11. YA34 19.1 01/07/06 12. 13. YA35 YA35 18.1 18.1 01/09/06 01/07/06 14. 15. YA35 YA35 18.1 18.2 01/09/06 01/09/06 Page 27 Milbury 9 Rosslyn Crescent Version 5.1 appraisals are carried out. 16. YA37 9.2 That the registered manager achieves an NVQ level 4 in management and care qualification. That the portable electrical appliances are tested and that a copy of the certificate is forwarded to the CSCI. 01/05/07 17. YA42 13.4 01/07/06 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. 2. 3. Refer to Standard YA6 YA6 YA6 Good Practice Recommendations That advocacy services are available to residents who are unable to communicate their needs verbally. That the format of the plan of care is suitable to meet the needs of the resident. That when the care plans are evaluated on a monthly basis a record of the evaluation and the date on which it takes place is kept on both the resident’s copy and on the copy kept in the office. That the manager requests that a telephone call is made to the home, in the event of the transport arriving significantly early to collect residents. That when a new company vehicle is purchased the vehicle chosen is large enough to accommodate 4 residents, driver and escorts. That a risk assessment for the non-provision of a bedroom door key is drawn up and placed in the resident’s case file. That working records setting out preferred routines are drawn up for each individual resident and are used by carers. That feedback about the quality of the placement and of the service provided in the home is sought from the placing authority when attending review meetings. 4. 5. 6. 7. 8. YA12 YA13 YA16 YA18 YA39 Milbury 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 28 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 9 Rosslyn Crescent DS0000017488.V287533.R01.S.doc Version 5.1 Page 29 - 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. 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