Inspection on 16/12/05 for Milestone

This inspection was carried out on 16th December 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestone 27/02/08

Milestone 23/05/07

Milestone 26/06/06

Milestone 23/08/05

Milestone 19/01/05

Milestone 16/07/04

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

CARE HOME ADULTS 18-65 Milestone 1 Milestone Court, Wales Close London SE15 2SL Lead Inspector Lisa Wilde Unannounced Inspection 16th December 2005 12:00 Milestone DS0000007104.V271050.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 Milestone DS0000007104.V271050.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. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Milestone Address 1 Milestone Court, Wales Close London SE15 2SL 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) 020 7639 8628 Turning Point London & S.E.Region Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 14 (fourteen) men with mental disorder other than dementia, 1 (one) of whom may be over 65 years old. 23rd August 2005 Date of last inspection Brief Description of the Service: Milestone is registered to provide accommodation and care for 14 men who have a forensic mental health background. The home is purpose built and divided into two blocks. The first block has accommodation and facilities for six service users and the second block has 8 self-contained flats. The communal areas are accessible to all service users, including potential wheelchair users. The home is located off the Old Kent Road close to Peckham and New Cross. There are nearby facilities and services including public transport, shopping, leisure, health and social care support. At the time of the inspection there were four vacancies. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in mid-December 2005. The inspector spoke with some service users, staff and the manager. Most service users weren’t in the building or did not want to speak to the inspector but the ones who did said they had no problems and were happy with staff and their rooms or flats. The Registered Manager of this service has been on leave since August 2005 and staff and service users have not yet been informed whether he is returning to the service. This has caused some uncertainty and anxiety for the home. A temporary manager has been in place for this time who showed on this inspection that she is competent and fit to manage the service but she said that she will not be able to manage the service for very long into the New Year. This management issue must be addressed by the organisation as a priority. What the service does well: From the standards assessed at this inspection, the home showed that: • the home undertakes a full assessment of a prospective service user’s need before they are offered a place. • prospective service users visit the service for a series of trial stays to meet service users and staff and get to know the home before they decide finally to move there. • the home has contracts with all service users that outline all the services that are to be offered. • service users know their needs and goals are described in their individual plans and action is identified to meet those needs and achieve those goals. • service users have high levels of independence at this home and taking reasonable risks is seen as an essential part of life at this home. • service users are offered a variety of activities and development opportunities within the local community. • service users are supported to see their family and friends as they choose. • service users are provided with a well-balanced and nutritious menu that they have chosen and which is flexible to their changing needs. • service users confirmed that they are offered personal and healthcare support from staff as they choose to have it. • medication is handled and stored safely and service users can work towards taking their own medication once they have shown that they are able and their doctor and care team agree with the decision. • service users know how to complain and are listened to when they do voice concerns. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 6 • • • service users are being offered support by an appropriately qualified staff team. the home has systems in place to gather the views of service users on what they think about the home and the service they are offered. the health, safety and welfare of service users are promoted and protected at the home by policy, procedure and staff practice 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milestone DS0000007104.V271050.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 Milestone DS0000007104.V271050.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, 4 & 5 Service users know from the outset that the home has established if it can offer them an effective service. Prospective service users visit the service for a series of trial stays to meet service users and staff and get to know the home before they decide finally to move there. Service users have an individual legal document that describes what they can expect when staying at the home. EVIDENCE: The manager described the process for assessments of potential service users. The files showed that service users have a written assessment that covers all areas of need and risk. Service users are invited for a series of trial stays following being offered a place. There were previous requirements that the Registered Manager must ensure that references to the old legislation and regulatory authority within the existing license agreements are either removed or updated to reflect the new arrangements and that the Registered Manager must ensure that the new licence agreement is signed, dated and on file for all service users and that all required details within the licence are completed. All service users now have in place the same, newly signed license agreement. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 9 Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Service users know their needs and goals are described in their individual plans and action is identified to meet those needs and achieve those goals. Service users have high levels of independence at this home and risk is seen as an essential part of life at this home but identified risks are managed and minimised so that service users are given information to make choices about what are reasonable risks to take. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that the assessments, care plans and risk assessments for all longer-term service users are redone to include as much detail as for the more recent service users. Of the sample of files examined, some of the old files have now been redone and those files include the required information. The manager said that a lot of work has been done but there is still some to do to make sure that all files are consistent and complete. The previous requirement is therefore partially met and repeated. (See Requirement 1) Milestone DS0000007104.V271050.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): 12, 13, 14 & 17 Service users are offered a variety of activities and development opportunities within area. They are assisted to identify activities and programmes within the local community and then are supported to access those opportunities as required. Service users are supported to see their family and friends as they choose. Service users are supported to find ways to meet people and develop intimate relationships if they choose to. Any restrictions on visitors are made because of the visitor’s behaviour and to safeguard service users and staff safety. The system of food provision has changed recently and the service users are still adjusting to the new procedures. Service users are provided with a wellbalanced and nutritious menu that they have chosen and which is flexible to their changing needs. Service users have now been made aware of their ability to opt out of the communal food programme when they are aiming to develop their life skills in order to move-on from the home. EVIDENCE: Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 12 Longer-term service users are very independent and the manager said that generally they come and go as they please. Other service users are linked into local facilities and services as they choose, Staff aim to enable them to have a weekly activity programme but often service users choose not to engage with this. Monthly reports and reviews on file showed that staff consistently encourage service users to have an active week and make service users aware of the choices in the local community. Visitors are allowed between the hours of 10am and 9pm. This has recently been altered in consultation with service users to allow staff to have a detailed handover at lunchtime and ensure that visitors are not coming and going in that time in order for the people in the building to be effectively monitored. Visitors may be barred if their behaviour breaks the service user’s licence agreements or impacts on the safety of service users or staff. These bans will be reviewed at regular intervals. There was a previous requirement that the Registered Manager must ensure that the policy around food specifically states that service users can move out of the communal food system when they are working towards developing their practical skills in order to move-on and ensure that service users are made aware of this. This had been done and sent to the Commission prior to the inspection. Milestone DS0000007104.V271050.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, 19 & 20 Service users at this home require low levels of assistance with personal care issues, support coming more in the form of prompting and reminders to undertake personal care. Service users confirmed that they are offered personal and healthcare support from staff as they choose to have it. Care plans show that personal care and health care needs are met by staff or by accessing other professional services within the community. Medication is handled and stored safely and regular checks take place to make sure that service users are protected by staff’s administration of medication. Service users can work towards taking their own medication once they have shown that they are able and their doctor and care team agree with the decision. EVIDENCE: Staff talked through the health and personal care needs of service users. Service users at this home are generally very independent and do not need direct personal care support. Support is mostly offered in the form of prompting, reminding and assistance with more general life skills tasks. There were previous requirements that the Registered Manager must ensure that all staff responsible for the handling and administration of medication receive medication training, that the Registered Manager must ensure that the Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 14 medication file is stored confidentiality in the home, that the Registered Manager must ensure that the random self-medication stock checks that take place are recorded on the medication administration sheets, that the Registered Manager must ensure that the system for stock checking all medications is operated effectively and that the Registered Provider must ensure that the requirements and recommendations made in the pharmacist inspectors report of the July 2004 inspection are fully complied with by the given timescale. The medication stocks and records were checked and all previous requirements were met and no further problems were found. Milestone DS0000007104.V271050.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 & 23 Service users know how to complain and are listened to when they do voice concerns. Service users are mostly protected from abuse by all staff attending training and by policies and procedures being in place for staff to follow should they become aware of any potential abuse, although not all current borough procedures are available in the home. EVIDENCE: The organisation has a complaints procedure and the home keeps records of any complaints that are made. Currently informal concerns of issues are not held centrally which means that patterns of day-to-day concerns cannot be audited and records any action taken cannot be maintained. (See Requirement 2) There was a previous requirement that the Registered Provider and Manager must ensure that staff receive relevant training from the local authority in Adult Protection issues. Some staff have attended this and others have been booked o it for early in 2006. The previous requirement is partially met and repeated. (See Requirement 3) The manager thought that Lambeth’s new procedure for adult protection was available to staff but it could not be found on the day of the inspection. (See Requirement 4) Milestone DS0000007104.V271050.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, 25, 26 & 30 Generally the home’s communal areas are clean, spacious and comfortable. All service user’s rooms or flats meet the size requirements of the standards. Service users state that they are happy with their rooms and flats. None of the current service users have physical disabilities that require and adaptations or equipment. EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that worn carpets (including that in Flat 8) are replaced. The manager stated that this and further decorations and replacements had taken place or dates had been booked to complete the work towards the end of the financial year or early in the new year. The inspector could only check some bedrooms on this inspection as not all service users wanted the inspector to enter their rooms. All service users who spoke to the inspector said they were happy with their rooms. On the day of the inspection the communal areas of the home were clean and free from odours. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 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 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 All staff ether hold or are undertaking the required NVQ in Care which means that service users are being offered support by an appropriately qualified staff team. The staffing levels have currently been reduced on the morning shift and this needs further review before it can be ascertained fully if this is effective. EVIDENCE: The rotas have recently been altered from three staff being on duty at all times to two staff being on duty in the morning shift with one or two managers being additional. Some staff voiced concerns over this level of staffing although management said that they had conducted a risk assessment and found this level of staffing to be appropriate. A review of this staffing level must be conducted. (See Requirement 5) There was a previous requirement that the Registered Individuals must ensure that 50 of staff hold the NVQ Level 2 in Care (or equivalent). All staff apart from the team leader and manager either hold the NVQ 2 or 3 or are currently undertaking it. The team leader is currently undertaking the NVQ Level 4 in Management. There was a previous requirement that the Registered Individuals must ensure that all staff personnel records are made available for inspection at the home Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 18 at the next announced inspection. Inspections are generally not announced by the Commission now. The home must complete and hold the Commission’s recruitment pro-forma on personnel files by the next inspection (See Requirement 6) The manager was not certain if the current Induction and Foundation programme in place for staff met the requirements of the Skills For Care standards. (See Requirement 7) There was a previous requirement that the Registered Individuals must ensure that all staff undertake moving and handling training. This has not yet occurred and the requirement is repeated. (See Requirement 8) There was a previous requirement that the Registered Manager must ensure that a copy of the staff training and development programme is sent to the Commission. This had been done prior to the inspection. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Although the home is currently well run by a manager who is fit to be in charge, they are not a permanent manager and the future management arrangements have yet to be confirmed. The home has systems in place to gather the views of service users on what they think about the home and the service they are offered. The health, safety and welfare of service users are promoted and protected at the home by policy, procedure and staff practice. EVIDENCE: The current manager evidenced her competence during this inspection however she is a temporary manager brought in to cover the extended leave of the Registered Manager. (See Requirement 9) The home has achieved the Investors In People Award. There is an organisational quality team. The home sends out an annual survey to service users and an annual report is produced. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 20 There are regular residents meeting where day-to-day issues are discussed and the minutes are made available to service users in the lounge. There was a previous requirement that the Registered Manager must ensure that some record is maintained of which service users are in the building for use in case of fire. This is now occurring. There was a previous requirement that the Registered Manager must ensure that certificates for the safety of the electrical installation of the premises and portable electrical appliances are sent to the Commission. This had been done. There was a previous requirement that the Registered Individuals must ensure that copies of critical incidents are sent to the Commission at the time of the event. This is now occurring as required. Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 21 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 X 3 3 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 2 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milestone Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 3 X DS0000007104.V271050.R01.S.doc Version 5.0 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) (& (2) Requirement The Registered Manager must ensure that the assessments, care plans and risk assessments for all longer-term service users are redone to include as much detail as for the more recent service users. Previous requirement: Unmet timescale 30/11/05 The Registered Manager must ensure that a record is maintained of all concerns and issues, in order for day-to-day patterns of concern to be audited and any action taken to be recorded. The Registered Provider and Manager must ensure that staff receive relevant training from the local authority in Adult Protection issues. Previous requirement. Unmet timescales 30/10/04, 31/05/05 & 31/12/05 The Registered Individuals must ensure that a copy of the Lambeth’s new procedure for adult protection is available in home and staff are familiar with it. The Registered Individual must DS0000007104.V271050.R01.S.doc Timescale for action 31/03/06 2. YA22 22 31/03/06 3. YA23 18 (1) (c) (i) 31/03/06 4. YA23 13 (6) 31/01/06 5. Milestone YA33 18 (1) (a) 31/03/06 Page 23 Version 5.0 6. YA34 19 (1) (b) & (4) 7. YA35 18 (1) (c) (i) 8. YA35 18 (1) (c) (i) 9. YA37 8 ensure that a comprehensive review of the new staffing levels is completed six months after it was introduced and copy of this review is sent to the Commission. The Registered Individual must ensure that the Commission’s recruitment checklist is completed and held on file at the home for all staff. The Registered Manager must ensure that the Induction and Foundation programme meets the requirements of the Skills For Care standards. The Registered Individuals must ensure that all staff undertake moving and handling training. Previous requirement: Unmet timescale 30/12/05 The Registered Individuals must ensure that the management arrangements for the home are finalised and should the previous manager not return, an application for a new Registered Manager is made. 31/03/06 31/03/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milestone DS0000007104.V271050.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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