Inspection on 26/06/06 for Milestone

This inspection was carried out on 26th June 2006.

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 27 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 16/12/05

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 26th June 2006 10:00 Milestone DS0000007104.V300223.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 Milestone DS0000007104.V300223.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. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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.V300223.R01.S.doc Version 5.2 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. 16th December 2005 Date of last inspection Brief Description of the Service: Milestone provides 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 in rooms and the second block has 8 self-contained flats. The communal areas are accessible to all service users, including potential wheelchair users but some of the rooms and flats are not. There is no lift at the home. The home is 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 five vacancies. Fees for a place at the home range from £800 upwards. The home makes the reports of the Commission’s inspections available in the reception of the home. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in June 2006. The inspector met with the new manager and staff and spoke with seven of the current nine service users. Most of the service users did not want to talk with the inspector for very long but said that they had no problems. One service user was very unhappy with staff but there have been recent incidents with this service user and his unacceptable behaviour so the issues he raised have been addressed with the home manager outside of this report to protect his confidentiality. The inspector was pleased that a permanent manager is now in post as it appears that this home has suffered from a lack of consistent management for a long time. It has not been possible to put in place effective plans for improvement with the management changes that have taken place but the inspector will need to see evidence of significant improvement at the next inspection. What the service does well: The standards assessed at this inspection showed that the home makes sure that: • prospective service users’ needs are assessed by staff before they move to the home and staff decide if they can meet those needs before they offer someone a place. • there are care plans in place that are based on most of the areas of need that have been identified before someone moves to the home. • generally there are good systems in place to monitor how medication is held and given out to service users. Service users are supported to selfmedicate when they have been assessed as able to do this safely by staff and other members of the care team. • the home has showed recently that it acts quickly and correctly to make sure that service users are made safe when they allege that abuse has occurred. • the communal areas of the home are large enough for the number of service users and they are kept clean and tidy. • rooms and flats are large enough and have enough toilet and bathroom facilities to meet the standard. • the home is fully staffed and there are enough staff on duty at all times. • staff are offered regular supervision and appraisal of their performance from the manager or team leader which covers their conduct and service users’ needs. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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.V300223.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users’ needs are assessed by staff before they move to the home and staff decide if they can meet those needs before they offer someone a place. This means that service users know that the staff believe they can provide them with a service, help them develop skills and then move on from the home to a less supported environment. EVIDENCE: The service user guide and statement of purpose have recently been changed. There is new legislation in place now that will come into force on 01/09/06 and 01/10/06 which will require services to state exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Recommendations 1 & 2) No one has moved to this home since the last inspection but this was assessed at the last inspection and the manager talked through the process she would follow for assessing the needs of a new service user and this meets the standard. There had been no problems highlighted in this area at the last inspection. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are care plans in place that are based on most of the areas of need that have been identified before someone moves to the home which means that service users know that staff are aiming to support them with issues that have caused them problems in the past. Some areas of need are not addressed in care plans, which means that service users are not being offered a complete service at the home and not being supported in all areas that they need help with. Areas of risk are assessed and plans drawn up to manage or minimise those risk but the plans are not always comprehensive or effective which means that service users are not being supported to change behaviour that has caused them problems in the past and are not being supported to move on to less supported accommodation as effectively as they could be. Service users are quite independent at this home in many ways but they are not being given all the information they need about the potential consequences of their actions so that they can make informed choices about their behaviour while at the home. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 10 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. Some work has been done on care plans but there are still different formats in operation. One service user’s assessments stated that they needed a structured week to assist them to maintain this programme at the home but here was no care plan around activities. There was no evidence of cultural, religious/spiritual/sexuality or social needs being addressed in care plans. One service user’s care plans were last reviewed April 2005. The manager said that they are getting ready to do a lot of work around care planning. It is possible to say that the previous requirement is met but additional requirements are made here. (See Requirements 1 & 2) Service users at this home are quite independent in some ways and would seem able to make their own decisions with little staff input. However discussions with the manager and staff showed that service users may not be being given information about the consequences of their choices and actions in order to make fully informed decisions. An incident that occurred during the inspection showed that staff are not making service users fully aware of the legal consequences of drug use in the home. One service user spoke with the inspector about a concern he had about how he was being treated and while the inspector was satisfied that the organisation was following their procedures (apart from taking too long to inform the service user of the outcome of his appeal), this service user did not have an independent advocate in place other than his social worker who he said did not contact him regularly. (See Requirements 3 & 4) The home uses risk assessment forms to assess risk. The incident that occurs during the inspection gave the inspector cause for concern that although risks around drug use were being identified, effective action plans were not being put in place or these plans were not being followed to support service users to minimise those risks and manage certain behaviour appropriately. (See Requirement 5) Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As stated before, service users are relatively independent and able to come and go from the home as they choose. There isn’t an in-house programme of activity designed to develop service users skills and support them to change behaviour and develop more independent living skills, in order for them to move onto more independent accommodation. Service users are not made fully aware of their rights and responsibilities and staff are not consistently reinforcing the consequences of them not taking responsibility for their own behaviour which means that they may not be clear about what will happen if they continue with certain behaviour while at the home. Work is being done to ask service users what the want to eat but there are still regular problems with service users not being happy with what they are offered. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 12 EVIDENCE: The manager has arranged for a percussionist to come to the home to see if there’s scope for a regular group. There is a cooking group on Sunday. The home does not organise many other in-house activities and if service users are not linked into external centres they spend most of their time doing nothing. Many of the care files talk about how service users need structured weekly plans to avoid them reverting to behaviour that has got them into difficulties on the past. The manager said that she is about to start looking into an inhouse programme with staff. (See Requirement 6) Service users’ relatives can visit the home unless there are behavioural reasons why they must be excluded. This has happened recently but the inspector was satisfied that this had been dealt with appropriately. Again the incident that occurred during the inspection showed the inspector that service users are not aware of their responsibilities with regard to certain behaviour in the home, or if they are aware, staff are not reinforcing he consequences of that behaviour. (See Requirement 3) There are comments about the food in the service user meeting minutes showing that some people are still not happy with what is offered. The manager talked about how they are offering support to and trying to find training for the cook to enable them to cook food that is requested. Service users are working with key workers to draw up their food ‘wish list’. (See Requirement 7) Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users at this home do not generally need direct help with personal care but are offered support around developing life skills such as budgeting, shopping and cleaning. When service users have a particular health problem they are supported to access specialist health care advice and support from other professionals. Generally service users are not supported to attend regular GP, dentist, optician and chiropodist appointments to make sure that good levels of health are maintained. Generally there are good systems in place to monitor how medication is held and given out to service users. Service users are supported to self-medicate when they have been assessed as able to do this safely by staff and other members of the care team. The medication stock checking systems must improve. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 14 EVIDENCE: Service users at this home are physically very independent and generally do not need assistance with personal care. The type of support they receive is advice, assistance and prompting to maintain their cleanliness and around life skills such as budgeting, shopping and cooking. Staff conduct health and safety checks of the rooms and flats every week and there are care plans in place around these life skills for some service users but some of the flats and rooms were not in an acceptable state of cleanliness. This issue has been addressed under Standard 24. There was little evidence on files of service users being prompted or supported to attend regular GP and other clinic appointments such as dentists and opticians to maintain levels of health. The manager is new and so could not say whether this is because this does not happen or if it is just not being recorded. (See Requirement 8) The inspector examined the medication administration charts and the stock of medication held. In general, there are good systems for the monitoring of medication held at the home and service users are supported to self medicate when they have been assessed as safe by staff and members of their wider care team. However some problems were found. Some service users have been prescribed food supplements and laxatives but they never take them. There is now a list of staff who are trained to give medication with samples of their signatures but they do not have samples of the signatures they use to sign the medication administration charts. On some random stock checking one of the four medications counted did not tally with the record and one medication showed that it had been out of stock for one dose when it should have been given. (See Requirement 9 & Recommendation 3 & 4) Milestone DS0000007104.V300223.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems for listening to service users day-to-day concerns have improved and more action is now taken to try and make things better for service users but more must be done to make sure that the views of service users and people involved in home are recorded and acted upon. The home has showed recently that it acts quickly and correctly to make sure that service users are made safe when they allege that abuse has occurred. External professionals are involved where necessary to make sure that the investigations into these allegations are carried out correctly. Training records were not available to fully assess if all staff have been offered effective training around protection of vulnerable adults. EVIDENCE: There was a previous requirement that 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. There is a book that is used that now shows that day-to-day concerns (such as being unhappy with the food) are being recorded as issues that need to be addressed. Action taken in response to these concerns and timescales for this action needs to be recorded. There is more work that can be done in this area but there was evidence that service user meetings are being used as a time when service users can talk about how they feel about the service and staff are being encouraged to take action to make things better. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 16 The manager talked about how she receives comments from service users families and other people who call in but these are not being recorded anywhere as comments and concerns about the service. Work has been done on the previous requirement but there is still further work necessary for it to be fully met. (See Requirement 10) There was a recent allegation at the home about a member of staff which was not proved but the correct procedures were followed to make sure that the service user was safe and the issue investigated properly. This has been recorded in the complaints book though and these issues must be recorded separately as allegations as they contain confidential information. (See Requirement 11) 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. This had been done. The organisation has a policy around adult protection that is in the reception area of the home. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 17 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, 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The communal areas of the home are large enough for the number of service users and they are kept clean and tidy. Rooms and flats are large enough and have enough toilet and bathroom facilities to meet the standard. Service users can bring their own furniture and possessions into their flats to individualise them to their own taste if they choose. Generally the rooms and flats are not decorated or furnished well enough and are not kept clean enough. EVIDENCE: The inspector toured the building and all service user rooms. The communal areas were clean and hygienic but most of the rooms had some problems. Most of the service users said they were happy with their rooms but they did not all contain the minimum amount of furniture as stated in the standards and some were in need of decoration. Many of the rooms or flats smelled stale. Many of the carpets were sticky. One service user said their shower had not Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 18 worked for a long time and staff confirmed that there had been many problems with his boiler and he did not have hot water. (See Requirements 12 & 13) None of the current service users need equipment or adaptations to help them move around the home. Many of the rooms and flats are on the first floor and there is no lift at the home so it not suitable for people who cannot manage stairs. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 19 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 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is fully staffed and there are enough staff on duty at all times, which means that service users receive support from effective numbers of permanent staff. It was not possible to fully assess if the home has effective recruitment procedures in place because the records are kept at head office and the home has not competed the Commission’s recruitment checklist. This means that it was not possible to fully assess if the home is doing all it can to make sure that new staff are who they say they are and have been checked as safe to work with vulnerable adults. Training records are not complete and there is not an annual training and development plan in place that identifies what training the staff team requires and when it will occur. It was not possible to fully assess if the training needs of staff are met and if service users are therefore being offered support from staff who are fully qualified to do so. Staff are offered regular supervision and appraisal of their performance from the manager or team leader which covers their conduct and service users’ needs. This means that service users are being offered support from staff who are offered ongoing advice and guidance from their managers. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is currently fully staffed and over 50 of staff hold or are undertaking the NVQ Level 2/3 in Care. There was a previous requirement that the Registered Individual must 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. This had been done and showed that the new staffing levels are deemed effective and sufficient to meet the needs of the service users. There are always at least two staff on shift with most shifts having an additional team leader and Manager available. The numbers of incidents have not increased as a result of the change in shift patterns. There was a previous requirement that the Registered Individual must ensure that the Commission’s recruitment checklist is completed and held on file at the home for all staff (This is necessary because the organisation keeps staff recruitment and personnel files at its head office). This has not yet been done. (See Requirement 14) There was a previous requirement that the Registered Individuals must ensure that all staff undertake moving and handling training. As before, training records were not complete so it was not possible to assess fully if all staff have had this training (although evidence was provided to the inspector before the final report). (See Requirements 15) There was a previous requirement that the Registered Manager must ensure that the Induction and Foundation programme meets the requirements of the Skills For Care standards. The induction record on staff files does not meet these requirements in that it is a checklist of areas to be covered as opposed to a workbook to be completed by the staff that takes six weeks to complete for induction and six months for foundation. (See Requirement 16) The manager talked about cultural issues within the staff team and about how the majority of the staff team were black and the staff team does not reflect the make up of the service user group. While this may not be an issue if the staff team can fully understand the needs of the service users the previous interim manager had felt that there were some problems within the team caused by lack of understanding of different cultures. The manager talked about how she is planning a training programme for the team that focuses on team building and issues of professional conduct. These issues will be assessed more thoroughly at the next inspection when the manager has been on post for several months and had more time to fully assess and address the issues. An incident occurred during the inspection that required staff to use the Drug Policy and Procedure. The inspector was concerned that staff are not generally Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 21 operating according to policy, were not following their own care plans and did not have a full understanding of the issues. (See Requirements 17 & 18) The manager and team leader supervise all staff regularly and the records showed that the required areas are being addressed in supervision to support and develop staff. Annual appraisals of staff performance are conducted and targets set for the forthcoming year. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new manager in post who showed that she understands the needs of service users and how staff should meet those needs. She has not been in post long enough for a fair assessment to be made or to say yet that this home is well run. The home has some systems in place for monitoring its service but there is not yet a comprehensive quality assurance system in place that makes sure that all areas of the home are regularly assessed and plans put in place to improve every year. Service users are not fully consulted about what they want and what they think of the service they are offered. There are systems in place to monitor health and safety, which are generally operated effectively by staff and means that service users are protected from harm while at the home. The fire safety and electrical systems are not checked regularly enough. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 23 EVIDENCE: There was a previous requirement that 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. There is a new manager who has been in post since April 2006. She had completed the Registered Manager’s forms and returned them to the Commission but they had been sent back to her because of some error. These must be completed and returned as soon as possible. (See Requirement 19) The new manager has been working with this service user group for ten years and been in management for four and half years. She holds the Management NVQ 4 but has not yet started the NVQ Care Level 4. (See Requirement 20) Throughout the inspection the manager evidenced her awareness of the needs of the service users and her understanding of how staff should meet those needs. The monthly visits to the home by a senior manager have not been sent through to the Commission regularly. The manager is new in post so could not confirm if the visits had not been occurring or if the problem was that they haven’t been forwarded to the Commission. (See Requirement 21) The home does have some systems in place for monitoring quality at the home. The home does not use an externally accredited quality assurance programme to assess its service and ensure that a programme of continuous improvement is in place. The service user meetings have begun to be used as a method of gathering service user views on the home. The manager did not believe there was an annual plan for the home that was based on the views of service users and which detailed how the home was going to improve to meet the needs of those service users over the coming year. The manager acknowledged that quality assurance and service user involvement were areas that need to be worked on a lot at this home and the inspector agreed that this would be looked at in more detail at the next inspection. (See Requirements 22 & 23 and Recommendation 5) The inspector checked the health and safety records and documentation in the home. One fire test had been missed in June 2006 and fire drills were not occurring as planned. The Portable Appliance Testing certificate and the five yearly annual electrical system certificate were not on file. (See Requirement 24) All other health and safety documents were in order. Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 N/A 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) & (2) Requirement Timescale for action 31/10/06 2. YA6 15 (1) & (2) 3. YA7 YA16 12 (1) & (2) 4. YA7 12 (1) & (2) The Registered Manager must ensure that care plans are in place to cover all areas of need that are identified with service users and that these plans are reviewed at least annually. The Registered Manager must 31/10/06 ensure that needs assessments and care plans address service users needs around culture/ethnicity/religion/sexuality and social requirements. The Registered Manager must 31/10/06 ensure that service users are made fully aware of the consequences of their actions at the home in order that they can make informed decisions and take responsibility for their behaviour at the home. The Registered Manager must 31/10/06 ensure that staff research into local agencies or individuals who can advocate for service users and then make service users aware of these people. Active efforts must be made to encourage service users to use support from independent advocates who ideally share some DS0000007104.V300223.R01.S.doc Version 5.2 Milestone Page 26 5. YA9 12 (1) & (2) & 15 6. YA12 YA13 YA14 12 (1) & (2), 15 & 16 (2) (m) & (n) 16 (2) (i) 7. YA17 8. YA19 12 (1) (a) 9. 10. YA20 YA22 13 (2) 22 11. YA23 18 (1) (c) (i) 12. Milestone YA24 16 (2) (c) & 23 (2) of their cultural, ethnic and social background. The Registered Manager must ensure that effective risk management plans are in place that are made clear to service users, that identify action staff will take to manage or minimise behaviour that is not acceptable at the home. The Registered Manager must ensure that staff follow these plans. The Registered Manager must ensure that service users have a structured weekly programme in place that includes activities in the local community and links with in-house programmes. The Registered Manager must ensure that service users are offered healthy, nutritious meals of their choice, cooked in the way they require. The Registered Manager must ensure that service users are encouraged and supported to attend regular GP, dentist, optician and chiropodist appointments and that records show evidence of this support. The Registered Manager must ensure that the medication stock checking procedures are effective. 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. Previous requirement: Unmet timescale 31/03/06 The Registered Manager must ensure that a separate confidential record is maintained of all allegations made about staff. The Registered Manager must conduct an audit of all service DS0000007104.V300223.R01.S.doc 31/10/06 31/10/06 31/08/06 31/08/06 31/07/06 31/10/06 31/07/06 30/09/06 Page 27 Version 5.2 (d) 13. YA24 16 (2) (c) & 23 (2) (d) 14. YA34 19 (1) (b) & (4) 15. YA35 18 (1) (c) (i) 16. YA35 18 (1) (c) (i) 17. YA35 18 (1) (c) (i) users rooms and flats to make sure that all furniture and fittings required by the standard are provided. All furniture and fittings must be in good working order. The Registered Manager must ensure that service users are regularly supported to keep their rooms and flats to an acceptable level of cleanliness. Any carpets or other fittings that are so dirty that they are beyond repair must be replaced. The Registered Individual must ensure that the Commission’s recruitment checklist is completed and held on file at the home for all staff. Previous requirement: Unmet timescale 31/03/06 The Registered Manager must ensure that the Induction and Foundation programme meets the requirements of the Skills For Care standards. Previous requirement: Unmet timescale 31/03/06 The Registered Individuals must ensure that all individual staff’s training needs are brought together into an annual training and development plan that sets out the required statutory and additional training the staff team needs in order to meet the aims and objectives of the home and the assessed needs of the service user group. This plan must identify when the training needs will be met. A copy of this plan must be forwarded to the Commission. The Registered Manager must ensure that staff are fully aware of their legal responsibilities with regard to illegal drug use in the home and the organisational procedures that are in place around this. DS0000007104.V300223.R01.S.doc 31/08/06 31/08/06 31/08/06 31/10/06 31/07/06 Milestone Version 5.2 Page 28 18. YA35 12 (1) (a) 19. YA37 S11 Care Standards Act The Registered Manager must ensure that staff address and record all issues of illegal drug use appropriately and that the police and other professionals are involved as required. 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. Partly met previous requirement with timescale of 31/03/06, now reworded to: The Registered Individual must ensure that an application for a new Registered Manager is made to the Commission. The Registered individuals must ensure that the Registered Manager begins the NVQ Level 4 in Care. The Registered Individuals must ensure that the monthly monitoring visits occur and reports of these visits are forwarded to the Commission as required. The Registered Individual must ensure that there is a comprehensive quality assurance system in place at the home that continuously monitors all areas of the service. This system must be based on the views of service users and other stakeholders and must produce an annual business and development plan that shows how the home will improve and better meet service user needs. The Registered Manager must work with staff and service users to develop a comprehensive and effective system of service user DS0000007104.V300223.R01.S.doc 31/07/06 31/08/06 20. YA37 18 (1) (c) (i) 26 31/01/07 21. YA39 31/07/06 22. YA39 24 31/10/06 23. YA39 12 (1) (2) (3) & (4) & 24 31/10/06 Milestone Version 5.2 Page 29 24. YA42 13 (4) (a) & (c) involvement that allows service users to comment on and influence the service they receive. The Registered Manager must 31/07/06 ensure that all health and safety procedures are operated effectively and all the required documentation and records are in place. 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 YA1 Good Practice Recommendations The Registered Individuals should begin work on establishing exactly how each service users’ fees break down and put these in their service user guide. (This will become a legal requirement on 01/09/06 for current service users and 01/10/06 for new service users). The Registered Individuals should revise the Service Users Guide so that it is more accessible and useful for the service user group. The Registered Manager should make sure that a sample of staff’ initials is recorded on the list of staff authorised to administer medication. The Registered Manager should make sure that during medication reviews, GPs and consultants are made aware of medication that service users never or rarely take and that these medications are removed from prescriptions or made into medication that can be taken as required by the service user. The Registered Individuals should consider using a professional, externally accredited quality assurance tool at the home. 2. 3. 4. YA1 YA20 YA20 5. YA39 Milestone DS0000007104.V300223.R01.S.doc Version 5.2 Page 30 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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