Inspection on 09/11/05 for Milehouse Lane (25)

This inspection was carried out on 9th November 2005.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milehouse Lane (25) 04/05/07

Milehouse Lane (25) 26/05/06

Milehouse Lane (25) 22/04/05

Milehouse Lane (25) 09/12/04

Milehouse Lane (25) 06/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mile House Lane (25) 25 Mile House Lane St Albans Hertfordshire AL1 1TF Lead Inspector Hazel Wynn Unannounced Inspection 9th November 2005 10:00 Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 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 Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 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. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mile House Lane (25) Address 25 Mile House Lane St Albans Hertfordshire AL1 1TF 01727 835413 01727 835413 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 Limited Marie O`Flaherty Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7), Physical disability (3) of places Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate up to 3 people with physical disability on the ground floor only (when associated with a learning disability). 22nd April 2005 Date of last inspection Brief Description of the Service: 25 Mile House Lane is a large detached domestic style property in a residential area to the south of St Albans. It has been converted for use as a residential care home and offers single room accommodation for up to seven adults with learning disabilities. Three of the bedrooms are located on the ground floor and are suitable for wheelchair users. Shared facilities include a large domestic kitchen, L shaped lounge and a conservatory. The home does not have a lift and the four service users on the first floor must be fully ambulant. There is a fully assisted bath with overhead hoist tracking on the ground floor and a shower room on the first floor. Staff members have their own sleep-in room with en-suite WC and shower unit. The manager’s office is on the first floor. The front of the house is for car parking, and the large garden at the rear is suitable for wheelchair users. The home is close to one of the main roads leading to the centre of St Albans. It is within walking distance of a public house/restaurant, local shops and public transport routes. The home has its own transport for regular runs to and from the various day centres, for shopping trips and excursions. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 9th November 2005, by the home’s lead inspector. The outcomes from the findings of this inspection for service users, appeared good (which is a ‘snapshot’ on the day that this inspection took place). This inspection consisted of face-to-face feedback with staff on duty; the staff gave good feedback about their support and training programmes. The inspector met with service users and a conducted a sampling of records including care plans, accident/incident, medication storage and records, staff records, complaints/compliments records and care plans/service users’ files and fire safety records. A requirement was made in respect of the management of medication (in respect of some medications not dated on opening). What the service does well: What has improved since the last inspection? The manager manager’s application to the Commission for Social Care Inspection to be registered manager of the home was successful and the home is being well run. One of the service users has been supported to obtain and care for a collection of finches and this has become of great interest to him and others in the home. The bathroom has been redecorated to provide a more attractive environment for the service user. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Comprehensive assessments are carried out for each new service user in respect of needs and aspirations and regular reviews take place. The home does not admit service users if the assessment of needs reveals that it would not be possible to meet those needs or aspirations. Prospective service users visit the home and ‘test drive’ it before any decisions for placement are made. EVIDENCE: A prospective service user is currently being assessed by the home, and the tool in use was seen at this inspection. A very comprehensive assessment including risk assessments are carried out by a person qualified to carry out the assessment. The assessment includes the input of significant others. The registered manager stated that in assessing other prospective service users, a decision would be made not to offer a placement because their needs would be better met in an alternative placement or the assessment process had revealed that the service user would not be compatible with the current service users. The service supports prospective service users well to make a decision on whether the home is right for them; following a full assessment, visits take place followed by an individualised transitional programme prior to a confirmed placement. The registered manager stated that a panel decision on funding is awaited before the decision to offer trial placement can go ahead. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 9 and 10 The service users needs, changing needs and personal goals are reflected in their individual plan. The service users are supported to make decisions about their lives and participate as fully as possible in all aspects of life in the home; their views are listened to and acted upon. Independence is promoted. Confidentiality is respected and safeguarded and records securely stored. EVIDENCE: The sample of care plans, looked at during this inspection, provided evidence that service users are assured that their assessed needs and aspirations are clearly stated on their care plan with guidelines to staff to ensure that they are appropriately met. Progress of the care plans are tracked, when the keyworkers meet with their supervisors each month. Regular reviews are held and evidence of this was seen in the whole life review notes. Activities include the promotion of independence, service users are encouraged to take part in decision making and to be involved in the domestic activity of the home as part of the one to one time planned in. One service user showed an interest in birds and has obtained a collection of finches, which are accommodated in a well-kept finch cage in the lounge. He is supported to care for and enjoy these as part of his care plan. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 10 Confidentiality policies and procedures are in place at the home and this subject is included in the induction-training programme and in ongoing training. The records pertaining to the service users are securely stored therefore ensuring confidentiality, as evidenced at this inspection. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 11 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): 11 - 17 Personal development is promoted and service users take part in age, peer and culturally appropriate activities. The service users are supported to access and to be part of their community engaging in appropriate leisure activities. Personal, family and sexual relationships are promoted appropriately and service users rights are respected and responsibilities are recognised. A healthy diet is promoted and enjoyed in comfort. EVIDENCE: From the care plans sampled, evidence was gained that personal development is promoted. Individual and joint activities, records of which were seen at this inspection, are age, peer and culturally appropriate. As stated earlier in this report one service users interest in birds is being met by supporting him to obtain a finch aviary and staff are learning with him how to breed these. The inspector saw many photographs of activities both in house and at community venues and the service users were obviously enjoying these activities. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 12 Policies and procedures are in place in relation to personal, family and sexual relationships. Records of contact with people who are important to individuals and the support given for the maintenance of this contact was seen in progress notes. The service users enjoy the garden and are supported to continue doing so without creating a nuisance to neighbours; relationships with neighbours have strengthened greatly due to the consideration service users are learning to afford to them. Two service users had not long returned from a two-week trip in Malta and all of the service users have taken holidays or trips according to their preference. Community activities recorded included trips to the cinema, pubs, restaurants and bowling. One service user enjoys travelling on and off buses and his file shows that he manages to enjoy this hobby frequently. The community dietician supports the service users to maintain a healthy diet whilst enjoying food of their choice. The dining area of the home is comfortable and reasonably spacious. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 13 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 - 21 Personal support is provided as required and according to preference. Physical and emotional needs are met. Service users are not yet able to retain and administer their own medication due to their complex needs and profound learning disabilities. Ageing, illness and death would be handled with respect and in accordance with the individual’s wishes. EVIDENCE: Individual personal care is set out in the care plans, a sample of which was seen at this inspection; guidelines to staff for the implementation of this care in accordance with the service users preference is clearly stated on the care plan. The progress notes indicated clearly that physical and emotional needs are being met appropriately and are kept reviewed. None of the service users at this home are yet able to manage or administer their own medication. The inspector has met with all of the service users and has assessed that their needs are to such a degree as would deem it unsafe for them not be thoroughly supported by persons competent to aid their medication needs. There were no gaps on the Medication Administration Record, medication was well stored but there were some medications that had not been dated on opening and a requirement was made in this respect. Dates on medication help assist in the auditing process to reconcile drugs to the Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 14 records and to ensure medication is used within its ‘used by’ date. A sampling of blister packs showed that medication had been administered as recorded. Policies and procedures are in place in respect of ageing, dying and death. The home is still providing support to a service user who has left the home; his mother has provided compliments to the care team stating that she was very happy with how efficiently her son’s ill-health was acted upon and a treatment regime commenced. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 15 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 and 23 The service users views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. EVIDENCE: Various forms of communication, included basic forms of Makaton are used to support service users to air their views, which are acted upon, others also advocate on their behalf.; this is evidenced in progress and communication notes. When service users showed that they were uncomfortable about a service user who was not compatible with the rest of the group action was taken to remedy this, whilst also taking into consideration his rights and needs; this was clearly recorded. Robust staff recruitment policies and procedures are adhered to as evidenced in the staff files; enhanced checks are obtained along with two professional references and fully completed application forms. Any gaps in former employment are explored and a record of this is maintained with the application form. Notes of the interview were maintained in the staff file or in the unsuccessful applicant file, a sample of these were seen and discussed at this inspection. These robust procedures ensure service users are kept safe. Abuse awareness training is provided as part of the induction process and this training is updated as evidenced on the training planner and on staff files. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 16 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, 27 and 30 The home is clean, hygienic, comfortable and safely maintained. The bathrooms provide for privacy and suit individual needs EVIDENCE: The home was observed to be comfortable and health and safety records provided evidence that safety measures are in place. The following health and safety records were sampled and found to be clear and up to date: Fire safety records, daily fire safety panel checks, weekly fire safety points testing, fire safety drill (the last one took place on 21st September 2005) fridge temperature checks, bath/shower hot water checks, Accident and |Incident Records (no admissions to A & E during the period between inspections) Training records, Risk Assessments both individual and environment including COSHH and Medication Administration Records. When the inspector arrived to carry out this unannounced inspection the fire safety contractor was carrying out his annual checks and servicing of the fire safety system and equipment. Food in the fridge was covered and dated on opening, colour coded food boards are used to aid good hygiene and food probes are in use to ensure food is thoroughly cooked. Staff were observed to wash their hands before making beverages. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 17 The bathroom had been freshly decorated to provide for an attractive, appropriate environment for service users. The lock on the door was in good working order providing privacy for those using the bathroom. Bathing aids are kept serviced in the interests of personal safety and all staff attend mandatory moving and handling training. Moving and handling risk assessments, for supporting individuals, and for tasks such as handling heavy articles, were in place. . Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The service users are supported by a competent and trained, effective, staff team. The staff recruitment policy and procedure is robust and is implemented so to ensure service user safety. The staff team are well supported and formal supervision is provided. EVIDENCE: The staff on duty were carry out their duties and interacting with the service users competently, effectively and appropriately. The staff training files held current/recent training certificates and the training planner provided for a rolling training and update in training programme. Agency staff are used as rarely as possible but where a gap cannot be filled every effort is made to ensure the agency staff that have got to know the residents (and systems in place) are selected to cover any gap in the rota. Service users are protected by robust recruitment procedures. A sample of staff files held the necessary enhanced CRB/POVA checks and two professional references. A fully completed application forms and interview form was retained on the sample seen. Any gaps in former employment are explored and a record of this is maintained with the application form. Notes of the interview were maintained in the staff file or in the unsuccessful applicant file, a sample of these were seen and discussed at this inspection. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 19 Staff spoken to confirmed that they are well supported and receive formal supervision, in which the progress of individual service users is tracked; care staff are named keyworkers for individual Service Users. A record of the supervision schedule was also seen at this inspection. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 20 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 - 43 The home is well run. There is a registered manager implements a good ethos, provides clear leadership and has a good management approach in the provision of this service. The service users can be confident that their views underpin all self monitoring, review and development by the home and that their rights and best interests are safeguarded by the home’s policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. Service users do benefit from competent and accountable management of the service. EVIDENCE: Throughout this report evidence has been provided that this is a well run home and that policies, procedures and protocols are implemented and self audit takes place on a regular basis. Regulation reports from the proprietor’s visit and audit each month are forwarded on a regular basis to the CSCI. The manager delegated the chair to her deputy during this inspection so that she could give her apologies for absence for part of the staff meeting in progress. The registered manager chose to assist part of the inspection and was keen to Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 21 show some new systems in place that benefited the service users; these were the new assessment tool and new care plan formats. The registered manager discussed how she utilises the skills within the team to the optimum benefit of the service users including trying to match the keyworkers and service users, which creates the forum to achieve the best potential from the staff and from the service users they support. The registered manager stated that she keeps in touch with another placement where a former service user is being assessed and keeps in touch with his mother so that she can continue to provide support. The registered manager praised her team for their commitment to aiming to provide the best possible service including some of the day care to the service users. The registered manager ensures that monthly service user meetings take place so that service users have a formal time to air their views. Records are well maintained and a sampling of service user financial accounts showed the accounting and balances to be transparent and properly managed. The registered manager was disappointed to find that since her last audit two medications had not been dated on opening; a requirement was made. In every other respect medication was well managed and their were no gaps in recording. The environmental risk assessments have all been reviewed in the last few months and individual service users risk assessments are kept under review as part of the monthly tracking system. Individual service users’ risk assessments are formally reviewed at least annually. Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 3 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mile House Lane (25) Score 3 3 1 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000019467.V267561.R01.S.doc Version 5.0 Page 23 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 YA20 Regulation 13(2) Requirement All medication must be dated on opening. All new stock opened must be dated on opening (It is not possible to date medication already opened and used and not dated). Timescale for action 09/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Mile House Lane (25) DS0000019467.V267561.R01.S.doc Version 5.0 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. You have been warned!