Inspection on 12/06/07 for Milbury 9 Rosslyn Crescent

This inspection was carried out on 12th June 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milbury 9 Rosslyn Crescent 12/04/06

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 Clive Heidrich Key Unannounced Inspection 12th June 2007 2:10 Milbury 9 Rosslyn Crescent DS0000017488.V340411.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 9 Rosslyn Crescent DS0000017488.V340411.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 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 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 Mrs Kesawarani Ravindran Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th November 2006 Brief Description of the Service: 9 Rosslyn Crescent is a detached house situated in a residential turning off East Lane. It is reasonably close to North Wembley station and about 10 minutes walk to the shops. The home accommodates 4 people 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 has 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, with street parking also permitted. The home’s Service User Guide is available on request. Fees for placement were made available to the CSCI. They are available on request from management at the home. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last full inspection of this service took place in April 2006. A shorter (‘random’) inspection then took place in November 2006 to follow-up on progress with addressing shortfalls from the April visit. The CSCI have also been involved in some Safeguarding Adults meetings, to do with particular residents, since the last key inspection. There are further details about this under standard 23. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. This inspection took place across two weekdays in mid-June. It lasted nine 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. None of the residents are able to communicate through language. The inspector made fruitless non-verbal attempts to get direct opinions from residents. Consequently greater attention was paid to observing the quality of life of residents, and how staff interacted with them. The inspection process within the home also involved discussions with staff, checks of the environment, and the viewing of a number of records. Two surveys were also sent to involved professionals in advance of the inspection, but with no reply. Feedback was provided to the manager at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: Staff treat residents kindly and respectfully. Residents’ non-verbal communications are generally understood, and their choices respected. A good standard of home-cooked and healthy food is provided. Residents are supported to pursue individual activities in the home and the community. Residents receive diligent medication support that ensures that they receive prescribed medicines appropriately. Individualized healthcare support is generally provided. Residents have individual care plans that generally reflect the support that they need. Staff work together to meet residents’ needs and wishes. They are encouraged by management. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst it was clear that residents access a range of individual activities in the community through staff support, shortfalls in recordings meant that there was little evidence of consistency and regularity with community support, including on residents’ days off from day services and at weekends. There were two shortfalls with healthcare. Professional dental input had not happened since 2005, and epilepsy records where needed were not always upto-date. This could have a detrimental effect on applicable residents’ health. The hot tap in the main toilet used by residents was found to produce water that could scald. Checks of this had not identified the issue, which needs addressing before an accident is caused. The occasional physical aggression from one resident to others was not being sufficiently addressed, insofar as there was no overall plan about aiming to prevent reoccurrences. This puts other residents at risk of unnecessary anxiety. There are repeated statutory requirements about the exterior décor of the building, and about reaching NVQ targets for staff and the manager. It was clear that the training issues are in the process of being addressed. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 7 A full list of requirements is requirements and recommendations are to be found at the end of this 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 9 Rosslyn Crescent DS0000017488.V340411.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 9 Rosslyn Crescent DS0000017488.V340411.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): None of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The last person to move into the home moved in back in 2005. The home has no vacancies. Consequently, as the last assessment of these standards was suitable, they have not been assessed further on this occasion. EVIDENCE: Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have individual plans that reflect their needs, and which are kept reasonably up-to-date. Improvements are being made by gradually making the plans more picture-based and person-centred. Residents’ decisions about their lives are respected. Staff endeavour to provide residents with information to help with decisions, at a level reflective of the resident’s communication ability. Risk scenarios are considered based on the individual resident, and are supported where appropriate, otherwise action is taken to reduce the risk. EVIDENCE: The care files of two residents were checked through. Each resident holds a file in their room within which they had personal profiles dating from February 2007, and which contained an amount of icons designed to assist with understanding. The files also had individual health action plans, personal care plans, the most recent formal review meeting, along with complaints Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 11 procedures, service user guides, and other standard information documents. The manager and staff team are in the process of updating these files to make them much more person-centred and with photos that reflect the individual’s lifestyle. This has been mostly achieved for one resident, with others’ files to follow. There is also a file on each resident easily available to staff. These files contained copies of the care plans, a communication profile, letters to and from professionals, and health records. Hence the care plans are available to both residents and staff. The care plans are reviewed on a monthly basis, mainly about how the plan has progressed. Detailed guidance is added to the plan for particular areas where needed. It was evident that the plan generally reflects the individual support needs of the resident. The home has a system of key-working. Key-workers spoken with had a good understanding of their roles and of their key-client’s needs. There were records of a newly-started monthly evaluations of care plans that involve the individual resident. These set short-term goals that can be reviewed. The most recent formal reviews of the services for each resident were held in October 2006. Records showed funding authority involvement, and of family and day services being invited, along with the resident themselves and staff from the home. Key goals from this process were evident, and staff had some awareness of them from feedback, citing for instance about healthy eating plans and acquiring suitable holidays. The manager noted that further review meetings are planned for shortly. None of the residents are able to communicate through language. Staff explained that residents make choices through their actions, such as by refusing requests, pushing food away, or by taking staff by the hand. Staff assist this process by trying to explain requests, noting that most residents can understand verbal cues to some extent, and by the use of pictures/photos or physical prompts such as car keys. Staff members’ were observed to make requests appropriately, and both understood and respected residents’ choices in response. The inspector also noted that residents have the freedom of the communal areas of the home, and can come and go from their rooms as they please. The only exception was when one resident went to the kitchen during the cooking of hot food, which staff judged as too risky based on their past behaviour. Staff intervened verbally in an appropriate manner, and on finding the resident unwilling to leave, acquired some fruit for them to snack on whilst waiting for dinner. Only some of the residents have family members who are in regular contact with them. It was previously recommended that independent advocacy be sought for those residents without family contact. The manager confirmed that requests have been made in this respect. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 12 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 one resident. They had a savings account and there was a record in the home of the balances held. The account 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. Checks of money out from bank-books corresponded with the resident’s records in the home. There were manual-handling risk-assessments on file that considered suitable factors and provided a plan of handling for each applicable scenario. The risk assessment file also had appropriate consideration of risk scenarios for residents as a group, and individually where applicable. It is noted for instance, that there is now an expectation for an escort to assist residents in the car in addition to the driver. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Services at the home have been changed to better enable residents to be more involved with planning their lifestyles, particularly through the use of photos and pictures. However more support is required to enable residents to be consistently involved in independently living skills. Residents have good overall support to access a range of community activities. However there was insufficient evidence of consistent support at the weekends and on days off, despite suitable staffing numbers. Residents have placements at day services. Holidays are being provided, and leisure opportunities in the home are available. Family relationships are maintained where possible. A good standard of home-cooked and healthy food is provided. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 14 EVIDENCE: The service at the home is significantly improving its support to residents to enable better communication. A lot of relevant photos have been taken on the house camera, for use with menu-planning, showing which staff are working each day, and enabling pictorial-based care plans to be owned by residents. Each resident now has a day planner in their room with which to support them with advance knowledge of activities for the day. All residents have had referrals to a speech therapist, whose recently-begun assessments will enable more individual communication planning to be set up for each resident. Some key policies and documents, such as the statement of purpose and the complaints procedure, have also been made more picture and icon-based. So whilst there is much to do to complete these processes and allow them to make a greater difference to the lives of each resident, the intention is clear. In terms of residents’ skills development, there was reasonable attention being paid to this within care plans and review meeting goals for individual residents. Staff fedback about the home-living skills that they support or prompt residents with. However, records were only occasionally made about such things as the resident bringing laundry downstairs or helping to lay the table. During the inspection, it was observed that such things as meals and drinks were brought to the table ready-prepared, and there was little observed evidence of residents being encouraged to take part in independent living skills. Consequently, whilst staff did engage residents in community activities and also games in the home, there were also times when residents were sitting by themselves for unduly long periods. Residents must be provided with plentiful opportunities to improve their independent living skills, at an appropriate level to their individual abilities. All residents continue to have placements at particular day services. They all attend four days a week, with one day off on which to be supported by staff to pursue individual activities. Transport arrangements are in place to assist each resident to their day service. The manager noted that she aims to be present by the expected time of transport, so that she can provide support if any transport is running late. There is also a 5-seated car for use by residents. Staff stated that there are three drivers within the staff team, and that where drivers are needed for a particular activity, they are generally planned for. The manager noted that there are details for other transport options if needed, such as Dial-a-Ride and public transport timetables, and hence no-one misses out on activities due to transportation difficulties. Nonetheless, there are vehicles that could easily transport all residents and supporting staff together, and so the previous recommendation to review the suitability of the current vehicle is re-stated. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 15 None of the residents are assessed as capable of going out alone. There was feedback from staff about the variety of activities that they support residents with, including going to the cinema, to shows, and to places of worship. During the inspection, one resident had just come back from the hairdressers, and another later on went out for a walk locally. A day-trip to Whipsnade Zoo was being planned for the weekend. Records also showed residents’ involvement in a local recreational club, going to a party, and withdrawing money from the bank. It is clear that residents are provided with support to use a variety of community resources. Analysis of records however showed that there was a lack of consistent support for activities for the two residents checked on. Records checked were their individual daily records, individual activity logs, and the handover book. There was sometimes no entry about community support on the resident’s day off from day services, or at the weekend where there are now extra staff working. There was also no evidence for one resident of being supported to go to their place of religious worship, or of them pursuing a swimming goal. The manager insisted that good support is regularly provided. Resident’s money receipts provided some support for this. There must however be suitable and consistent records of the community support provided to each resident, to evidence that the support is consistently provided. Staff noted that two residents went on an enjoyable holiday to Blackpool for five days recently. A similar holiday to the south coast is being planned for the other two residents. This builds on the shorter breaks that residents had last year. Residents are encouraged to pursue their choice of activities in the home. Support was seen to be provided sometimes, for such things as puzzles and games. Records also showed that some residents purchase the services of an aromatherapist on a fortnightly basis. Residents are hence provided with reasonable opportunities to take part in leisure activities of their choice. As previously stated, staff support residents to maintain contact with family where possible. There was some written evidence of this, for general visits and at some formal meetings. This included strong overall feedback about the quality of care by one family. Residents are also provided with support to visit friends at such things as parties and recreational clubs. An appetising meal of beef pieces in a tomato and pepper sauce, with boiled potatoes and mixed vegetables, was provided to residents at 6pm during the inspection. The inspector sampled the meal, and found the beef in sauce to be reasonably spicy and very appetising. Residents ate the meal, with staff providing support where needed. One resident had adapted cutlery, to enable them to eat more independently. Staff explained that menus are written on Sundays during meetings with residents. Residents can suggest meals through the use of recently-developed Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 16 photo-cards that are additionally displayed daily to show the meals being provided each day. Menus show that residents receive a variety of nutritious home-cooked foods. Staff pointed out that, as they are of a variety of cultures that match those of the residents, culturally appropriate main-course meals are supplied to each resident at points each week. Checks of the kitchen found there to be a plentiful supply of food, including fresh fruit and vegetables, along with other snacks and staple foods. Milbury 9 Rosslyn Crescent DS0000017488.V340411.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with individualised personal support as needed. They receive diligent medication support that ensures that they receive prescribed medicines appropriately. Residents’ health needs are generally attended to, including through the provision of extra staff to support with attending health professional appointments. However, there were shortfalls in the support of appropriate dental and epilepsy care. EVIDENCE: Residents were overall dressed in individual and suitable clothing from the start of the inspection. Female residents had all had their nails painted. Staff noted that they can provide support for this, or that it can be provided through day services. Random checks of bedrooms found there to be a plentiful supply of clothing. Finance records indicated ongoing clothing purchases, and for professional adjustments of clothing. Staff were seen to knock on resident’s doors before requesting to come in. They also discreetly prompted certain Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 18 residents to use the toilet. Consequently, it is judged overall that residents receive personal support appropriately. Extra staff were provided during the inspection to support one resident to attend a hospital appointment. This followed a similar appointment a few weeks before that had not happened due to a refusal by the resident. On this occasion, the resident attended, and the appointment highlighted further issues to address that would not have come to light without the efforts of staff to provide the support that the resident needed. There were records of ongoing weight monitoring of residents. Feedback and observations showed that staff encourage healthier eating, such as through the ready provision of fruits and more nutritional meals. Each resident has a clear record of health appointments and outcomes. They show that GPs are accessed for general health concerns, check-ups take place for chiropody and the opticians, and that specialist healthcare such as with community nurses and psychiatrists take place where needed. Medication reviews were also evident. It was found that two residents had not had dental input since July 2005. The manager noted that there were no concerns in this area, and that as some residents can be resistant to dental treatment, the advice was to bring them only when concerns are identified. However, there was no record of this in the health records or health action plans. This could result in inconsistent dental treatment, and possible ailments arising due to the lack of professional input. Residents must be provided with support to acquire dental treatment, and any advice from the dentist must be clear within resident’s records and plans. One resident has ongoing professional treatment for their epilepsy. Specific guidance notes from a health professional were in place and available to staff. Feedback from staff showed reasonable awareness of the resident’s condition and appropriate responses. Staff have had training in this respect. Seizure records are kept on a designated form for each seizure, along with a chart of occurrences, so that health professionals can monitor the treatment plans. Whilst the forms showed good attention to capturing details about seizures, the inspector found one recent seizure within daily records that had not been specifically recorded about on the forms or the chart. The chart lacked a record of one other recent seizure. This can lead to false impressions about the effectiveness of the treatment plan. Seizure documentation must be appropriately and promptly filled in for all seizures. None of the residents are capable of self-medicating. Medication is stored in a designated medication cabinet. The cabinet was seen to be clean and tidy. Checks were made of the prescribed medicines of two residents. Records of administration were up-to-date and tallied with the medications removed Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 19 from the blister packs supplied by the pharmacist. Where an incorrect number of tablets had been supplied on one day in the blister pack, staff had suitably dealt with this, including recording about the issues in the staff communication book. The missing tablet was delivered from the pharmacist during the inspection. Checks of some as-needed medications found them to all be in date. There was no evidence of excess surplus stock. There were quantity records of medications being delivered from, and returned to, the pharmacist. Prescribed creams were being signed for as appropriate. As-needed medications were recorded about. The medication cabinet was not fixed to a wall at the time of the visit, due to recent redecoration of the office. The manager was aware of the need to resecure it. The manager notified the CSCI of residents missing medication in June 2006. The CSCI sent a letter of serious concern to Milbury about this, however a robust action plan was sent in response that included about reassessment of staff capabilities and additional daily checks to ensure that correct medicines had been offered to residents appropriately. The manager noted during this inspection that this had all taken place, that the daily checks continued to take place, and that there had been no further errors. Records confirmed the ongoing checks, which is encouraging as residents can now be assured of being provided with appropriate medication support. The manager noted that eight of the ten people in the team are currently assessed as capable of providing medication, which is an encouragingly high percentage. The assessment process includes using the pharmacist’s competency checklist, using Milbury’s competency checklist, and a written knowledge test, which is highly robust. Milbury 9 Rosslyn Crescent DS0000017488.V340411.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and allegations of abuse are diligently dealt with. Efforts have been made to include and inform residents about how to complain. Staff are suitably trained on recognising and whistleblowing abuse. Suitable procedures are in place overall to protect residents from abuse. However, insufficient protection is provided to residents in respect of occasional aggression from other residents. EVIDENCE: The home has a standard, bound Milbury complaints book in place. It recorded that one complaint had arisen since the last key inspection just over a year ago, in May 2006, arising from a member of public about standards of cleanliness outside the home. The book detailed a robust response. The issues were not apparent at this inspection. There have been no complaints to the CSCI during that period. Each resident has a pictorial complaints procedure in their room. The manager noted that procedures are also provided to relatives, and that house meetings can be used as complaint outlets by residents. It would now be good practice to identify how each resident would make a complaint, given that they do not use language. Two allegations of abuse arose at the home since the last key inspection. These resulted in Safeguarding Adults meetings taking place with Brent Social Services. Investigations proved inconclusive, however robust plans were Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 21 agreed by Milbury to minimise further risks of possible abuse. Parts of these plans were sampled during the inspection and found to have been addressed. Checks of training records found that all staff had training in abuse prevention since the last key inspection. This includes through a written test that shows whether they have sufficient understanding or not. There was also more recent evidence of management discussing whistleblowing procedures within individual staff supervision sessions. A further staff meeting is planned to review abuse awareness amongst staff, as per standard local Milbury practice. Discussions with some staff individually found them to have a good knowledge of whistleblowing procedures. One staff member effortlessly showed the inspector where the whistleblowing guidance document is kept, within an often-used staff file. Updated safeguarding policies were available within the home. The manager noted that a copy of Brent’s overall procedures was available. There was a previous statutory requirement for all staff to attend training on non-violent crisis intervention, in response to potential physical aggression from residents. Records and feedback showed that this had now been addressed for most staff. Records were being kept of the rare occasions when one resident was physically aggressive. This sometimes impinged on other residents. There was no clear strategy apparent within the resident’s care plan about how to address this issue, albeit that the manager was aware of what can sometimes trigger the behaviour. It was also apparent from observations that staff and the manager are skilled at working with the resident to effectively diffuse potential challenging behaviours. Nonetheless, the lack of clearly recorded strategy, the lack of clear monitoring of the incidents within the monthly accident/incident monitoring forms, the lack of recent behaviour therapist input despite a psychiatrist advising this, and that the affected resident’s care managers had not been alerted to the issues, suggest that more could be done protect the affected residents. All reasonable measures must be taken to protect residents from physical aggression by other residents. At one point, one of the residents came over to the inspector and took their biscuits. Staff challenged the resident, but in a respectful manner. On another occasion, another resident borrowed the inspector’s pen and then refused to return it after use. The manager noted that there was a ready supply of pens for the resident in the lounge, and provided the resident with one. The inspector also observed staff respecting residents’ choices, such as one resident giving a clear ‘no’ sign with their arm when requested to do something. Examples such as these suggest that residents live in an appropriately caring and equal environment that avoids punitive measures. Milbury 9 Rosslyn Crescent DS0000017488.V340411.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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in reasonably decorated and independence-enabling home that has recently benefited from some redevelopment work. Poor décor remains in a few areas, including for outstanding work on the window frames and sills. Residents have individual bedrooms that have also been redecorated and which meet their needs. Specialist equipment is acquired when needed. The home is generally kept clean and hygienic. EVIDENCE: It was apparent that much of the interior of the home has been redecorated since the last inspection. Alongside the standard repainting of most rooms, some furniture in residents’ rooms such as cupboards were new, one resident had a new carpet, and the upstairs bathroom had been retiled. The inspector was informed that the kitchen had been refurbished in 2006. It was very attractively designed, and in a good state of cleanliness. The manager particularly pointed out that the oven had been moved away from the entrance Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 23 door, so that one resident who holds onto furnishings to get around, would not scald themselves upon entering the kitchen. Consequently, only two statutory requirements remained, that of addressing peeling paintwork around window frames and sills outside, and making secure the toilet seat in the en-suite shower room. The frames and sills remained in a peeled and unattractive state, whilst the toilet had no seat in place at the time. The manager explained that a new type of strap-on seat had been tried, and found ultimately to be unsuccessful. Further designs were to be tried. To help prevent accidents and to help uphold the resident’s dignity, a successful new design must be found. There were some other areas of the home that need additional work: • The main downstairs toilet that residents use was in a tired state of decoration. The walls were bare and a little grimy, and different areas were of different shades of colour. The toilet door scraped against the floor, and had to be forced to make it close fully. The area needs refurbishment to help uphold a suitably homely environment, which the manager stated had been requested. • The wash-basin in that toilet had a hot tap whose thermostat did not work properly. Water quickly became too hot to hold a hand in. Records confirmed that water came out at around 60ºC, which could cause scalding to anyone using it. The water must be made safe for use. • The en-suite toilet area was slightly flooded on the first day of visiting, and the area smelt damp. The manager reported that there was no repeat on the second day. Nonetheless, the damp smell may indicate an unseen problem in the room. It should be investigated, to establish whether something unseen is causing dampness or leakage. • The laundry area has a rusted radiator and no panelling under the industrial washing and drying machines. This can compromise infection control, and so must be addressed. Significantly, the manager explained that she and the local operations manager are continuing to push for most of this work to be addressed. Only the hot water and flooding issues had not been previously identified. The main communal areas of the house consist of a lounge that seats five on comfortable sofas, an attached dining area that seats four around a table, and an attractively-kept garden. Consideration should be given to increasing the seating in both the lounge and dining areas, so that residents and staff can sit more easily together and maybe take meals together. The manager noted that occupational therapy referral has been made via the GP in respect of one resident whose mobility is decreasing. Meantime, a bathstool has been recently purchased, for which there was some positive staff feedback about it helping with supporting the resident to get in and out of the Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 24 bath. Similarly, equipment to help the resident to get in and out of the car has been acquired. Staff spoken with noted that they had received infection control training. They were seen to use disposable gloves where appropriate, and standards of cleanliness overall in the home were suitable. Training records confirmed that all staff have undertaken the training. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 25 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from excellent standards of appropriately trained staff in general and specific areas of need, with the exception of NVQ qualifications where the 50 standard is being worked towards. Suitable staffing levels are provided to meet residents’ needs, including for individually accessing community resources. Staffing is usually provided from within a core team of permanent staff. Residents are supported by suitably-supervised staff. Recruitment processes raised no concerns. EVIDENCE: The rosters for two weeks around the time of the inspection were analysed. They showed that two staff work the weekday mornings and evenings, with three generally working at all times of the weekend. One staff member additionally works the waking-night, with the manager working additional to all this. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 26 There was good evidence, from records and feedback, that staff work flexibly to meet any particular needs of residents. Hence extra staff worked during the morning of the inspection to assist one resident to attend some health appointments, and extra staff were planned for a weekend day-out. Staff confirmed that there are enough staff working when needed. It is also noted from rosters that any spare shifts are covered in-house. Hence the nine permanent staff at the home and the manager cover all shifts between themselves, which provides residents with useful consistency of known staff who know their needs and communications well. The manager noted that only 17 shifts in last 3 months were worked by bank staff, which is encouragingly low. Recruitment records are now stored at the company’s local head office, following national-level agreement with the CSCI. The CSCI will be checking that appropriate recruitment checks are in place at that level in due course. Checks of staff files kept in the home, for three newer staff, established through copies of documents that work permits where applicable are up-todate or being re-applied for. Each file also had a recruitment checklist within which a Criminal Record Bureau disclosure number and date of disclosure were recorded. This date preceded the person’s start date, as required. Other recruitment checks, such as for written references and identification, had been ticked off. The files and feedback also showed that staff receive regular supervision sessions within which their work is considered and support is provided. There was also evidence of detailed appraisals being carried out within the last year. The files further contained certificates of training that, for established staff covered all expected areas, including fire safety, appointed first aid, health & safety, food hygiene, medication, manual handling, equal opportunities, and abuse prevention. There was also specific training relative to residents’ needs, such as for epilepsy, autism, and non-violent crisis intervention. Training is through the provider organisation, local training specialists, or via e-learning. Most training had competency tests to pass, to enable certification, which is good practice. Training grids additionally confirmed that up-to-date training in key areas is generally in place for all staff, with the exception of NVQs. The home has one staff member with a relevant NVQ care qualification. Two staff had just had their NVQ induction at the time of the inspection, with three further staff being registered for the NVQ and awaiting induction. This shows that there is an intention of supporting staff to acquire the qualification, albeit that residents do not currently benefit from a suitably NVQ-qualified staff team. The statutory requirement about NVQ is therefore repeated to help ensure that enough of the staff team acquire the qualification. A training plan for the home for 2007 was in place, as previously required. It included information about planning to acquire training in the specific need Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 27 areas of individual or collective residents, and generally sought to address any shortfalls in the training provided so far, including for NVQs. The induction records of a newer staff member were checked. The home has a standard Milbury induction pack that has been previously judged by the CSCI as suitable. Much of the pack was filled in and signed off by the staff member and the manager, although more work was needed for completion. The manager noted that the pack allows in-depth consideration of key areas of care, and so she planned to work through it with each staff member, to help consolidate their knowledge. Other newer staff confirmed that they received induction training when starting work in the home. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 28 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an appropriately-run home that places due emphasis on residents’ needs and wishes. The development of the home is influenced by residents and their representatives. Management additionally support staff well to undertake the work of supporting residents. The home provides reasonable standards of health & safety, with many systems of checking for risks. Recommendations to further minimise risks are made. EVIDENCE: The current registered manager returned to work in the home during May 2006 following a period of extended leave. She has 13 years’ experience of working with people who have a learning disability, including many years of working for Milbury. In discussion, she showed due awareness of the needs of residents Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 29 and of her management responsibilities. She confirmed that she continues to work towards the NVQ4 qualification and Registered Manager’s Award, as per a previous statutory requirement. Staff provided positive feedback about management in the home. For instance, one person noted that they were confident that the manager is addressing the deteriorating mobility needs of one resident. Staff confirmed that they can raise concerns with management at any time. They also noted that there is good teamwork in the home, and that they get support from management overall. The staff communication book showed good support of staff by other staff, often for supporting a resident with a task. The book contained respectful entries. The manager was noted to recognise and respond to comments, and to thank staff for particular pieces of work or resident support, all of which shows good team-work. The CSCI were provided with a copy of the 2006 Annual Service Review of the home. It gave a brief account of the specific aims for the home across the coming year. There were outcomes of three questionnaires from that time, including two from residents’ family members. The feedback from these was found to be generally between quite and very positive. Records showed that senior management continue to undertake monthly checks of the home, including consideration of residents’ care. The manager noted that quality is improved by residents’ meetings, and individual resident reviews. These have caused, for instance, changes in furniture, increased activities, and better staff distribution when needed. The home has a number of health & safety monitoring systems. The kitchen had records of food temperatures, both for cooked meats and for within the fridge and freezer. Food in the fridge were labelled with dates of opening, were packaged suitably, and the whole kitchen area was found to be kept clean from the start of the visit. There are monthly health & safety checks around the home using a standard form. Similar audit checks are recorded for wheelchairs, first aid kits, and the home’s vehicle, for instance. There was a comprehensive risk assessment file in place, with reviews of risks taking place regularly. These included for slips and trips, residents going out, particular health needs, and for kitchen use. A separate fire-safety risk assessment was in place. The inspector noticed, on two different occasions, residents brush against the edge of the open door in the lounge. The door protrudes into the path of Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 30 people walking from the sofas to the hallway. It could cause bruising to a resident any time they brush against it. Consideration should be given to finding a way of preventing the door from protruding into the main lounge walkway. Consideration of accident book entries found three entries for June, all relating to residents. These were about an unexplained bruise, a scratch on the head, and a trip coming in from the garden. Monthly checks for previous completed months are recorded about, both by the manager and her line manager. They showed diligence about recording bruises and scratches. However improvements could be made by recording details about such things as the size and colour of bruises, and about any efforts to investigate the cause of the injury, so that causes can be eradicated where possible. Records showed that standard professional health & safety checks are kept up to date. These include for portable electrical appliances, electrical wiring, fire equipment, and gas systems. Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 31 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 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 4 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 2 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 3 X X 3 X Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 32 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 YA11 Regulation 12(1)(b) Requirement Residents must be provided with plentiful opportunities to improve their independent living skills, at an appropriate level to their individual abilities, so as to help provide them with opportunities for personal growth. There must be suitable and consistent records of the community support provided to each resident, to evidence that the support is consistently provided. Residents must be provided with support to acquire dental treatment, and any advice from the dentist must be clear within resident’s records and plans. Seizure documentation must be appropriately and promptly filled in for all seizures, so as to give accurate impressions to professionals about the effectiveness of the treatment plan.. All reasonable measures must be taken to protect residents from physical aggression by other residents. That areas where the paintwork DS0000017488.V340411.R01.S.doc Timescale for action 01/10/07 2 YA13 16(2)(m, n) 01/08/07 3 YA19 13(1)(b) 01/08/07 4 YA19 17(1)(a) s3 pt 3(j) 15/07/07 5 YA23 12(1)(a) 15/07/07 6 YA24 23(2)(o) 01/08/07 Page 33 Milbury 9 Rosslyn Crescent Version 5.2 is peeling outside are made good and repainted. Previous timescales of the 1/12/05, 1/9/06 and 1/4/07 not met. That the toilet seat in the ensuite shower room is sufficiently robust to meet the needs of the service user. Previous timescale of 1/1/07 not met. The hot water from the downstairs toilet must be made safe for use, to prevent scalding accidents. The downstairs toilet must be refurbished, to help uphold a suitably homely environment. The laundry area has a rusted radiator and no panelling under the industrial washing and drying machines. This can compromise infection control, and so must be addressed. That 50 of staff achieve an NVQ level 2 or 3 qualification. Previous timescales of 31/12/05 and 1/10/06 not fully met. That the registered manager achieves an NVQ level 4 in management and care qualification. 7 YA24 16(2)(c) 01/08/07 8 YA24 13(4) 01/07/07 9 10 YA27 YA30 23(2)(d) 23(2)(d) 01/09/07 01/09/07 11 YA32 18(1) 31/12/07 12 YA37 9(2) 31/12/07 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 YA13 Good Practice Recommendations That the company reviews the suitability of the motor vehicle provided for resident use, as the current vehicle DS0000017488.V340411.R01.S.doc Version 5.2 Page 34 Milbury 9 Rosslyn Crescent 2 YA22 3 4 5 YA24 YA28 YA42 6 YA42 cannot take every resident in one go. It would be good practice to identify how each resident would make a complaint, given that they do not use language, so that staff can more easily recognise any clear expressions of dissatisfaction with the service. The en-suite toilet area should be investigated, to establish whether something unseen is causing dampness and/or water leakage. Consideration should be given to increasing the seating in both the lounge and dining areas, so that residents and staff can sit more easily together and take meals together. Consideration should be given to recording details about such things as the size and colour of bruises within accident books, and about any efforts to investigate the cause of the injury, so that causes can be eradicated where possible. Consideration should be given to finding a way of preventing the door from protruding into the main lounge walkway, as it could currently cause bruising to a resident any time they brush against it Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milbury 9 Rosslyn Crescent DS0000017488.V340411.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!