Inspection on 21/04/05 for Milbury 9 Rosslyn Crescent

This inspection was carried out on 21st April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 12/04/06

Milbury 9 Rosslyn Crescent 10/11/05

Milbury 9 Rosslyn Crescent 21/10/04

Milbury 9 Rosslyn Crescent 26/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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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 Care Services 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ Lead Inspector Julie Schofield Unannounced 21 April 2005 2.25pm 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 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 Stationary 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 Care Services Version 1.10 Page 3 SERVICE INFORMATION Name of service 9 Rosslyn Crescent Address 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ 020 8908 3410 Telephone number Fax number Email 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 Kesawarani Ravindran CRH, PC 4 Category(ies) of LD 4 registration, with number of places Milbury Care Services Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 October 2004 Brief Description of the Service: 9 Rosslyn Crescent is a detached house situated in a residential turning off the busy East Lane road. 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 2 cars at the front. Milbury Care Services Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on an afternoon in April 2005 and lasted a total of 4 hrs and 5 minutes. During the inspection the Inspector had discussions with the deputy manager and 2 members of staff. There were 3 residents living in the home and there was 1 vacancy. None of the residents were able to communicate verbally. Care records were inspected and a site inspection took place. The Inspector would like to thank the deputy manager and staff for taking part in the inspection and for the opportunity to meet the residents. What the service does well: There is a good system in place for pre-admission visits to the home, which provide the prospective resident with opportunities to see the house, to meet the staff and the residents and to take part in whatever activities are happening. Visits include an overnight stay and these visits help the prospective resident to become familiar with their new home. They also facilitate the settling in period. Reviews of the needs of residents and of their placements were up to date and case files contained a number of risk assessments to promote independence. The venue for activities outside the home e.g. shopping and having a meal out met the cultural needs of a service user. There was a good system for enabling residents to maintain contact with their families and telephone calls to the family enabled them to keep up to date with what was happening with the resident. Residents benefited from maintaining family links. The use of photographs, as visual prompts, in menus and in menu planning was more suited to the needs of residents than written information. Milbury Care Services Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milbury Care Services Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Milbury Care Services Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 An assessment of the resident, prior to admission, ensures that the home can meet the needs of the service user and should be recorded. The resident’s satisfaction with the choice of home is demonstrated during the trial visits to the home as part of the pre-admission procedure. These should be recorded. EVIDENCE: A new resident is to move into the home on the 30th April. A copy of an assessment of the prospective resident carried out by the manager of the home was not available although the deputy manager said that the manager had visited the prospective resident at the care home where they were currently living. The deputy manager described the pre-admission process, which included visits to the home by the prospective resident and a visit to the home by a relative of the prospective resident. The visits took place during the day and there was also an overnight stay. There was no record of the visits or of the reactions of the current residents to the prospective resident although the deputy manager said that the introductory visits had gone well. Milbury Care Services Version 1.10 Page 9 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 standard(s) 6, 9 The new person centred care plans were still in the process of being completed. However, the format of these is comprehensive and identifies the personal, social and health care needs of the resident. The changing needs of residents are discussed in review meetings and the home should have a copy of the minutes as these record any agreed plans of action. Risk assessments enable the resident to live as independently as possible. EVIDENCE: The case files were inspected and they contained a person centred care plan although only one of the plans had each section completed. The deputy manager said that the placements of all residents had been reviewed in January but minutes of the meetings were not available for each of the residents. There were risk assessments on file, which were tailored to the individual needs of residents. These included risk assessments for manual handling, bathing, using transport, falling, self-injury etc. The home has a missing persons’ procedure. Milbury Care Services Version 1.10 Page 10 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 standard(s) 12, 13, 14, 15, 17 Residents have a day care programme and access to activities inside the home and in the community, which provide stimulation, interest and enjoyment. Choice and venue for activities take into account the cultural needs of residents. Residents’ benefit from the support by staff to maintain relationships with family members. Residents’ nutritional needs are met through the provision of a diet that is wholesome although more variety in the weekly menu is needed. Residents would benefit from an up to date monthly record of their weights as this can help to detect health problems. EVIDENCE: All residents have a day care programme, which includes 4 days attendance at a day centre. On the other weekday there are opportunities to go out of the home and on the day of the inspection a resident had gone to purchase an outfit for their birthday, the next month. The day that each resident is based at home varies so that each resident enjoys individual attention and can pursue activities of their choice. Milbury Care Services Version 1.10 Page 11 Residents have the use of the home’s own vehicle and taxis to access community facilities. The deputy manager said that residents enjoy meals out, shopping trips, visits to the pub, visits to parks etc. The cultural needs of residents are respected and when purchasing clothing or having a meal an Asian resident has the opportunity to use Asian shops and restaurants. The deputy manager said that residents go to clubs and discos and that they enjoyed a holiday in the Isle of Wight in 2004. Within the home the staff said that in the evenings there are games, puzzles, colouring etc for residents to take part in. The music centre in the lounge is in need of repair. Staff supported residents to maintain contact with their families and friends. This includes providing an escort for a resident to visit their family and keeping in touch by telephone. When review meetings are held, or social events the families of residents are invited. The deputy manager said that 10 relatives had attended a resident’s birthday party. Residents can entertain their visitors in their room, if they wish. Sometimes social events are held in a Milbury care home and residents from their other homes are invited. A visitors book was on display on the ground floor. A member of staff said that photographs had been taken of meals, after they had been prepared, so that the photographs could be used as prompts for menu planning with the residents, which takes place on a Sunday. The menu on display included a lot of fish dishes. The home is aware of the cultural, religious and dietary needs of residents and knew what foods to avoid for individual residents e.g. non dairy products for one resident. The evening meal took place during the inspection and the meal was wholesome. It consisted of turkey, rice and vegetables. The monthly records of the individual weight of residents were not all up to date. Milbury Care Services Version 1.10 Page 12 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 standard(s) 19 Access to health care services in the community enables residents to maintain their general health and to seek appropriate intervention when needed. EVIDENCE: There was evidence on file of access to routine health screening e.g. blood tests and of referrals being made to health care professionals, as required. An example of this was a referral to the dietician. Examples were given by the deputy manager of contact with the GP when health care concerns were identified. Out patient appointments had taken place at Kingsbury Hospital and a member of staff had escorted the resident. There has not been recent contact with the chiropodist and the deputy manager said that residents did not wish to co-operate with an examination of their feet. Annual dental and optical checks were due in April although appointments had not been made. Milbury Care Services Version 1.10 Page 13 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 standard(s) 22, 23 The welfare of residents is promoted and protected by having a complaints procedure in place. A format that is appropriate to the needs of the residents enables them to exercise their right to complain. Records must include the outcome of investigations. Protection of vulnerable adults training for staff and familiarity with the home’s procedure contribute towards the safety of residents. All staff should complete their protection of vulnerable adults training. EVIDENCE: The home has a complaints procedure and a user-friendlier version to meet the needs of residents. The procedure includes timescales for action. Although the procedure refers to the CSCI contact details are needed. The deputy manager said that 1 complaint had been reported in the 12-month period prior to this inspection. The complainant had been a resident. Although an investigation had been carried out the result had not been recorded in the book. There was a comments/suggestions/complaints book on display on the ground floor. The deputy manager has completed their protection of vulnerable adults training and said that there is a rolling programme of training for members of staff. Some staff are still to attend. Although the policy refers to the CSCI contact details are needed. There is a user-friendlier version to meet the needs of residents although this would benefit from more pictures/illustrations as the deputy manager said that the residents do not use Makaton. She said that no allegations or incidents of abuse have been reported in the 12-month period prior to this investigation and that the home does not practice restraint. Staff have received training in non-violent intervention. There are procedures in place to safeguard the financial affairs of residents. Milbury Care Services Version 1.10 Page 14 Milbury Care Services Version 1.10 Page 15 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 standard(s) 24, 25, 27, 28, 30 Some repairs are needed to ensure that residents enjoy a comfortable environment. The provision of single rooms ensures that the resident’s right to privacy is respected. Residents are able to enjoy a comfortably furnished open plan lounge and dining area that meets the individual needs of residents and have the use of sufficient toilet and bathing facilities in the home. Residents live in a home where standards of cleanliness are good. EVIDENCE: A site inspection took place. In the room occupied by the wardrobe handle was lost and the keys to the wardrobe were missing. One of the window restrictors was not lockable and there was peeling paintwork on the windowsill. Two crates containing files were being stored in the room. In the room occupied by AP the chair was a garden chair. There were cracks in the woodwork and peeling paintwork on the outside of window frames. Stained glass in the window was cracked. A doorstop was needed to prevent the hole in the wall that had been made by contact with the door handle. The room occupied by J.O. needed a doorstop to prevent the hole in the wall that had been made by contact with the door handle. It was noted that there was water on the floor Milbury Care Services Version 1.10 Page 16 of the ensuite shower room of the ground floor bedroom that was vacant. All other parts of the home were satisfactory. Each resident has their own single bedroom. The first floor bedrooms each have a wash hand basin and there is a bathroom and separate toilet close by. The ground floor bedroom has an ensuite toilet and shower. Each bedroom provides the resident with a comfortable space in which to relax. There was an open plan lounge and dining area on the ground floor, which was comfortably furnished and decorated. The deputy manager confirmed that the home does not service incontinent laundry although the washing machine contains a sluice facility. Laundry facilities were suitable and sufficient for the layout of the home and for the number of residents. Access to the laundry room does not involve walking through any area where food is prepared or consumed. The home was clean and tidy and there were no offensive odours. Milbury Care Services Version 1.10 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 Staffing levels are sufficient to respond to the needs of residents. Residents benefit from a staff team where supervision is given to develop knowledge and understanding and to review care practice. EVIDENCE: The rota was examined and staff on duty confirmed that most of the staff working in the home were permanent members of staff. The deputy manager worked weekend shifts. There were 2 staff on duty during the day and 1 member of staff on duty at night. There was always a female member of staff on duty when assistance with personal care tasks was required by a female resident. The inspection in October 2004 identified the need for an effective quality assurance system to be put in place. The timescale for action has not expired. The members of staff confirmed that both staff meetings and individual supervision sessions were held on a monthly basis and that they could raise issues at staff meetings. The deputy manager said that the new manager was initially undertaking all the supervision sessions with members of staff as part of her induction to the home and of appraising the individual merits members of staff. Milbury Care Services Version 1.10 Page 18 Milbury Care Services Version 1.10 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42, 43 Health and safety practices in the home promote a safe environment for both residents and staff although staff should undertake training in infection control. Residents, staff and visitors to the home are supported by valid insurance cover. EVIDENCE: The deputy manager confirmed that staff have received training in manual handling, fire safety, first aid and food hygiene. She said that they have not received infection control training. There were valid certificates for the checking/servicing of the gas supply to the home, the portable electrical appliances, the fire precautionary systems and equipment etc. There was evidence of the fire alarms being tested on a weekly basis and of fire drills being undertaken. The accident book was examined and it was noted that the reference number on the counterfoil remaining in the book when the page has been detached had not always been completed. Milbury Care Services Version 1.10 Page 20 There was a certificate of insurance cover on display in the home, which was valid for the period 1/4/05 to 31/3/06. It provided cover up to a minimum of £5 million. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 3 x 3 Standard No Milbury Care Services Standard No 31 32 Version 1.10 Score x x Page 21 11 12 13 14 15 16 17 x 3 3 3 3 x 2 33 34 35 36 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 3 Milbury Care Services Version 1.10 Page 22 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 YA6 Regulation 15.1 Requirement That the person centred care plans are completed for each resident and that reviews are undertaken and recorded. (Timescale for the recording of reviews has expired). That the monthly record of the individual weights of residents is kept up to date. Timescale for action 01 October 2005 2. YA17 12.1 3. 4. YA22 YA22 5. 6. YA23 YA24 01 September 2005 and ongoing. 22.7 That the complaints procedure 01 includes details of how to contact September the local CSCI office. 2005 22.3 That the record of complaints 01 includes the outcome of September investigations. 2005 and ongoing. 13.6 That all staff undertake 01 protection of vulnerable adults December training. 2005 16.2&23.2 That the home carries out the 01 repairs to the bedrooms i.e. December 2005 provides a working lock for wardrobes, provides a working lock for all window restrictors, makes good and repaints areas where paintwork is peeling, fills cracks in woodwork and makes good, replaces glass that is cracked, fills and makes good holes in the walls. Version 1.10 Page 23 Milbury Care Services 7. 8. YA35 YA42 13.3 13.3 An effective quality assurance system must be put in place. That staff undertake infection control training. 30 June 2005 01 December 2005 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. 4. 5. 6. 7. 8. Refer to Standard YA2 YA4 YA6 YA14 YA17 YA19 YA23 YA24 Good Practice Recommendations That there is an assessment on file, undertaken by the manager as part of the pre-admission procedure. That a record is kept on file of the pre-admission visits to the home by the prospective resident (and their representative). That the home contacts the local authority for a copy of the minutes of the review meetings held in January. That the music centre in the lounge is repaired. That more variety is included in the main dishes listed on the weekly menu. That routine healthcare appointments are booked in advance to ensure that the appointment maintains the regularity of contact and does not become overdue. That the protection of vulnerable adults procedure includes contact details for the local CSCI office. That crates of files are removed from the residents room, that the garden chair is replaced by a comfortable chair, installs door stops on the skirting board to prevent door handles making contact with walls and that the cause of the water on the floor of the ensuite is investigated and remedial work carried out, if required. That the manager works occasional weekend shifts in the home to ensure consistency in the quality of care. That the reference number on the counterfoil remaining in the book when the page has been detached is completed. 9. 10. YA33 YA42 Milbury Care Services Version 1.10 Page 24 Commission for Social Care Inspection 4th 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 Care Services Version 1.10 Page 25 - 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. 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