Inspection on 27/02/08 for Milestone

This inspection was carried out on 27th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestone 23/05/07

Milestone 26/06/06

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 David Halliwell Key Unannounced Inspection 27th February 2008 09:30 Milestone DS0000007104.V355531.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.V355531.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.V355531.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.co.uk www.turning-point.co.uk Turning Point London & S.E.Region Delrene Walker Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 14 23rd May 2007 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 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 no vacancies. Fees for a place at the home are £869.04 per week. The home makes the reports of the Commission’s inspections available in the reception of the home. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place over 2 days and was undertaken by the Inspector responsible for Milestone. The Inspection covered all the key standards and involved a tour of the premises, a review of the homes records and formal interviews with 2 staff and the Manager and 5 of the residents. Informal interviews were conducted with other residents as a part of the inspection of the home. The Inspector spoke with a clinical nurse professional from the team that supports some of the residents. The Inspector also had the opportunity to talk with some family members of one of the residents. Also as a part of the inspection process the Inspector reviewed the information submitted by Milestone in their most recent Annual Quality Assurance Assessment (AQAA). 8 requirements were made as a result of this inspection and 2 good practice recommendations. One of these requirements is a repeat requirement. This inspection found a good deal of very positive work has been done by both the Manager and the staff group to meet the problems / issues that were identified in the 17 requirements and 5 recommendations that were made at the last inspection. Since then many new procedures and processes have been drawn up and are now in the process of being implemented. When these new practices have been fully established at Milestone then even more positive progress will be achieved and it is hoped that this will be by the time of the next inspection. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: The standards assessed at this inspection showed that the home makes sure that: 1. The Manager is making a wide range of improvements in practice and procedures within the home that have had and will continue to have positive benefits for the residents and for the staff group. 2. The needs of men who want to move to the home are assessed by staff before they move to the home. 3. There are care plans in place that are based on the areas of need that have been identified before someone moves to the home. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 6 4. 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. 5. The communal areas of the home are large enough for the number of service users and they are kept clean and tidy. A recent refurbishment of the home means the decorations and furnishings within the home are very good and generally that standards are high. 6. Rooms and flats are large enough and have enough toilet and bathroom facilities to meet the standard. 7. The home is fully staffed and there are enough staff on duty at all times. What has improved since the last inspection? What they could do better: Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 7 Specific areas for improvement identified in this report are as follows: 1. Care Plan reviews should be developed to monitor the success or otherwise of the care plan objectives and that they are revised in the light of the review findings. 2. The Manager should ensure photographs of residents are attached to each of the resident’s files and to their MAR sheets. 3. The Manager should ensure that all identified risks that are identified in the care plans and risk assessments are addressed by appropriate care plan objectives. 4. Guidance needs to be put in place on the medication records for each resident who uses PRN medication. 5. Certificated evidence will be required to be seen for staff who have completed POVA training. 6. The Manager should ensure that an inventory for each resident is kept on the residents’ files of their valuable belongings. 7. Water temperatures in many areas have consistently been too high for the safety of the residents. The current recording process of water temperatures around the home needs a new trigger (procedure) to ensure that faults are reported immediately and where temperatures exceed the prescribed limits immediate action is taken to rectify the problem. 8. The Manager should ensure that all staff are asked to sign to say that they have read and had a chance to discuss the home’s policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. 9. Certificated evidence must be held on each member of staffs file for all training qualifications achieved, including NVQ, nursing and social work qualifications. 10. The Manager must ensure that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. 11. The Manager must ensure that staff do not “hide” in the office and that they continue to integrate more with the residents. There should be an open door policy most of the time with the office. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents will soon have the information that they need to make a decision about living at Milestone. Their needs are being assessed and their aspirations are taken into account in the assessment process and each resident does now have an individual and appropriate contract with the home. EVIDENCE: Standard 1 – At the last inspection a recommendation was made to encourage the development of a more accessible and useful service user guide for residents and prospective residents. The Manager explained that since the last inspection in May 2007 a new residents handbook / service user guide has been drawn up that now includes appropriate and useful information in an accessible format for the residents. A copy of the newly developed guide was shown to the Inspector for information. On review of the guide, the Inspector recommended that details of the Commission for Social Care Inspection need to be included in the complaints section. The Manager explained that this draft guide or handbook should be going to the printers in the near future. She said that when printed it will be distributed to the residents who all have a copy in their rooms. During the course of the inspection residents who spoke to the Inspector confirmed that they do have copies of the existing old guide. This Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 10 means therefore that residents and prospective residents have sufficient information available to them to make a choice about where to live. Standard 2 – At the last inspection 2 requirements and a recommendation was made with reference to this Standard. The Manager explained that since the last inspection a new needs assessment process has been introduced and implemented for all the residents living at Milestone and that their cultural and faith needs are being regularly assessed. She also said however that some residents could be very reluctant to discuss these needs with staff and often do “clam up” when asked. 4 of the 14 residents files were inspected all of which had a comprehensive needs assessment and care plan in place. Cultural and faith needs were seen to be a part of the assessment undertaken by Milestone’s staff team and were also evident in the referring teams Care Programme Approach (CPA) assessment papers. Details however seen on these needs assessment documents were very brief and therefore of limited value. This may be a reflection of the said reticence of the residents to provide this information or of the staff’s own recognition of the real value of recognising a residents needs in this area and in aiming to meet them through the care planning process. Inspection of the unit’s training records indicate that staff have received equality and diversity training and that there is in place a new set of good practice guidelines concerning faith and spirituality. The Manager explained that the information (including CPA documents) received at Milestone from the referring mental health teams form a substantial part of the overall needs assessment for each resident. She said that care plans are drawn up based on the needs identified. There was no evidence at this inspection of any recently placed resident at Milestone having been inappropriately placed with respect to being “not ready to move to the home”. A previous requirement has now been met. Standard 5 – At the last inspection the Inspector found that not all residents at Milestone had a fully completed written contract, details to do with rooms to be occupied and fees charged had been omitted. At this inspection 4 of the 14 residents files were inspected and each file had a fully completed contract in place. The Manager told the Inspector that she has ensured all the residents do now have a properly completed contract in place. The Inspector reminded the Manager that these contracts should be renewed annually to reflect rent and any other changes. Therefore the previous requirement has now been met. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make decisions about their lives with assistance as needed. Their care plans are based on their assessed needs, however the reviews of these plans need to focus more on the progress that has been made over the period under review as to the achievements or otherwise in meeting the care plan objectives. Residents could be better supported to take risks as part of moving towards a more independent lifestyle. EVIDENCE: Standard 6 - The Inspector reviewed 4 of the 14 residents’ files and found evidence of individual plans having been drawn up for each of these residents. The Manager explained to the Inspector that since the last inspection a good deal of work has been carried out by the staff team on the development and overhaul of residents care plans and a new model and format is being implemented. The new model should ensure that all residents needs are planned for, monitored and reviewed including the social care and rehabilitative needs of the residents. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 12 The review of the residents’ files showed that some positive progress has been made towards achieving the requirement. The care plans seen were more detailed, with specific care plan objectives that related to the assessed needs of the resident. In most cases the care plan objectives were linked in with an action plan for both the resident and key working staff to follow so that the objective may be achieved. The Manager informed the Inspector that the care plans are reviewed every 3 months and documentation was seen on file to support this. However the monthly reviews of these care plan objectives lacked sufficient detail relative to the progress or lack of it that had been made in meeting the objectives. At the review stage, care plan objectives and action planning should be reformulated to either reflect the progress or the lack of it in order to better meet the resident’ needs in the future. Sometimes care plan objectives may be changed or removed where it becomes apparent they are unrealistic or unachievable. It is a requirement therefore that reviews monitor the success or otherwise of the care plan objectives and that they are revised in the light of the review findings. Care plans had been signed by residents and were dated. The care plans could also be seen to be linking in with the relevant care programme approach documentation of the mental health clinical teams. It was identified at the last inspection that there was a need to develop the needs assessment process to include residents’ cultural and religious needs. Care plan objectives should also include these areas of a person’s life. Most of the information required in schedule 3 of the Regulations was seen by the Inspector to be documented on the files although photographs of residents were not included on all of the files inspected. This form of identification is of particular use to new or agency staff who may not know the resident and so it is recommended that the Manager ensure photographs of residents are attached to each of the residents files and to their MAR sheets (see also under Standard 20). Of the residents interviewed by the Inspector all said that they had been involved in the drawing up of their individual care plans. They said they felt that they had been properly consulted as to their own views and wishes and that what they had said had been properly considered in their care plans. Staff interviewed also told the Inspector that they thought residents have a good input to their care plans and with the support they receive. Standard 7 - Regular residents meetings are held within the home, minutes of which were seen at this inspection, and there is an opportunity for residents to make their views known about relevant topical issues. Evidence was seen that showed residents had meetings on the following dates: 8.2.08; 24.1.08; Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 13 6.12.07; 8.11.07 and monthly before this. Residents are enabled to make decisions about their lives with assistance as needed. Standard 8 – At the last inspection a requirement was made for the development of a comprehensive and effective system of service user involvement that allows the residents to comment on and to influence the services they receive. At this inspection the Inspector felt that some progress has been made in this area: • Residents are having a real input to their needs assessment and care plans • Residents meetings have become more focussed and participative • Feedback is more regularly gained from residents about what they want to do and the activities they need to pursue in order to meet their care plan objectives. The previous requirement has now been met. Standard 9 - Risk assessments were seen on each of the files reviewed as a part of the initial assessment undertaken by Milestone. However from inspection it was evident that some key working staff had not integrated the risks assessed with the care plans and the care plan objectives. This might mean that not all the risks are fully addressed in the delivery of care and support to the resident, The Manager acknowledged this to be the case. It is therefore required that all identified risks are identified in the care plans and are addressed by appropriate care plan objectives. Effective risk planning helps in making the appropriate decisions about a suitable placement and then in taking risks as a part of developing an independent lifestyle. At the last inspection a requirement was made that related to identified risks and to the visitors policy. The Manager explained to the Inspector that since the last inspection the visitors’ policy has been reviewed and revised and the issue identified at the last inspection that was to do with children visiting the home has now been put right. Children are allowed to visit the home however the Manager explained that a risk assessment must be undertaken before this access is granted so that any protection issues may be addressed. This requirement is now met. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. EVIDENCE: Standard 12 – The Inspector did find evidence that project workers and support staff appropriately encourage the maintenance of resident’s relationships with family and friends if residents also wish to do so. The Manager told the Inspector that visitors to the home are encouraged and that they use the visitor’s book to sign in. The visitor’s book was seen in the hall and was evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff, although when Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 15 the Inspector looked at the files there was little evidence to show how a person’s cultural and religious needs had been assessed and considered in care planning terms. This needs to be addressed. The Manager told the Inspector that residents do not currently attend college or adult education classes. Standard 13 - Interviews with residents demonstrated that they do attend some local community events although their wishes for an active community social life are somewhat limited. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told the Inspector that they like to go to the shops, the library and to the cinema. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. Residents interviewed said that they thought local transport facilities were pretty good. All residents living at Milestone are registered to vote in elections and are supported by staff to do so if they wish. The Inspector saw that some information is made available within the home about local activities for residents to take up if they wish. The Manager showed the Inspector how on each of the resident’s files an activity timetable for the week has been drawn up. This identifies a programme of activities for the resident and enables their keyworkers to provide encouragement and appropriate support to the resident. A previous requirement to do with an inadequate level of activities has now been met Standard 15 – Some of the residents interviewed by the Inspector said that they do keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. One resident had recently re-discovered his family and at the time of this inspection his 2 daughters and a grandchild were visiting him in his flat. They said they are encouraged to visit him at Milestone and have always been made to feel welcome. They also said they were really pleased with the care and support their father has received while he has lived at Milestone. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that resident’s rights to privacy, respect and dignity are respected. Residents who were interviewed confirmed that they felt staff respected these rights. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 16 Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. Interviews both with staff and residents confirmed that residents participate in some household chores mainly shopping and cooking but also some household cleaning. This is seen to be a part of the community living experience. There are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 – The Manager explained that during the week residents shop and cook for themselves with support as appropriate and as needed from staff. This is seen as an important part of the rehabilitative process that should enable residents to live more independently at a later date. However on Sundays all the residents and staff eat together. Residents will prepare these meals sometimes with staff assistance and both the residents and staff told the Inspector that they really enjoy these occasions. The Inspector asked the Manager whether a dietician is ever asked for assistance, given that at present one resident is diabetic. The Manager said that where necessary a dietician’s advice is sought, as will the advice of the clinical team in CPA reviews where weight or diet is an issue. . Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way that they prefer and require and that their physical and emotional needs will be met. Service users can rely on the home providing a well managed service with regards to medication. EVIDENCE: Standard 18 – The Manager told the Inspector that residents have the choice of when they get up, when they go to bed and what they do during the day. The residents interviewed at this inspection also said that they choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Residents did not raise any concerns with the Inspector about their key workers. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 18 Residents at Milestone continue to receive regular input from their Consultant Psychiatrist, Community Psychiatric Nurses and from other professionals in their clinical teams. Standard 19 – With regards to the health care of the residents the Manager informed the Inspector that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told the Inspector that annual health checks take place at the GP surgeries. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with the Inspector said that they go to see their GPs as and when necessary and that they have the monthly meetings with their clinical teams. They said they prefer not to go to the dentist. The Manager told the Inspector that an optician visits Milestone quarterly and last visited in November 2007. Forms are in place to monitor residents’ visits to these healthcare professionals however they are still only being used patchily. Discussion was had with the Manager about this who said that it might be because there is a duplication of this information being recorded. Evidence of this was seen by the Inspector on the resident’s files. Previous requirement is met. Standard 20 - The unit’s policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. A member of staff who was interviewed indicated to the Inspector that they were aware of the policy and know what the procedures are when administering medication to the residents. A list of staff signatures was available in the medication records so as to clearly identify the signatures recorded on the MAR sheets. The Manager told the Inspector that staff only administer medication to the residents once they have completed training to do with the safe handling of medicines. The Manager informed the Inspector that some residents do self medicate but with supervision. Following a recommendation previously made by the Inspector, the Manager said that risk assessments have now been completed in conjunction with residents who are unsupervised. This is welcomed as it should help to minimise any potential hazards for the resident or others. Inspection of the medication records MAR sheets found no unexplained gaps and the Manager explained that staff who administer any medications are required to sign the MAR sheet records immediately after the residents have been given their medications. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 19 Under Standard 6 a requirement has been made that also refers to this Standard i.e that a photograph of each resident be placed on a new medication front sheet on the MAR sheet records so as to help Milestone staff ensure they are administering medication to the correct resident. The Manager told the Inspector that this would be completed and the Inspector said that evidence would need to be seen by the next inspection. This is welcomed as it should assist in the protection of residents. The Inspector also looked at the medication records for each resident who uses PRN medication to see if there is staff guidance relating to the PR medication. The Manager said that there is no such guidance in place. It is now therefore recommended and should be in place for each resident, be held in the medication files and readily accessible for staff and residents alike when needed. The guidance should set out clear information for each person using PRN medication covering possible side effects, when to give the medication and when not to give it. This should be completed in conjunction with the resident’s GP. When in place it should help in protecting the residents, ensure that PRN medication is given appropriately and when required and be of great assistance to staff who have to give residents PRN medication. The Inspector undertook a stock take of medications held in the home, together with the Manager. Records kept were inspected and stock levels of medications were seen to be satisfactory. Appropriate medication cabinets were seen in the office. A previous requirement relating to this has now been met. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users views can now be fully confident that their complaints will be acted upon at Milestone. Residents are protected from abuse, neglect and selfharm by the policies and procedures of the home. EVIDENCE: Standard 22 – At the last inspection the Inspector made a requirement that all concerns and complaints on a day-to-day basis are recorded and dealt with under the appropriate policies and procedures. At this inspection the Manager explained that a new approach has been taken and any concerns or complaints are dealt with under the complaints procedures. The Manager said that staff actively encourage residents to make any concerns they have known and staff know they must act upon them and try to resolve issues whereever possible. The complaints policy was inspected, as was the associated handbook and leaflets. These need to be consistent in the information they cover, they need to include updated contact information about the Commission for Social Care Inspection so that if residents complaints are not dealt with satisfactorily at the agencie’s final stage, there is a route to contacting the Commission if they wish. There have been 2 formal complaints since the last inspection recorded in the complaints record book and both of these complaints were made 4 days prior to this inspection. At this early stage, procedures so far have been followed, as the policy requires. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 21 Also as a part of the inspection process the Inspector spoke with a number of the residents and checked with them whether they knew how to make a complaint if they needed to do so. They confirmed that they knew who to speak to and some mentioned the complaints leaflets. Concerns are also recorded in the complaints record book and these focus more upon the day-to-day “grumbles” rather than complaints. 7 concerns were recorded for January 2008 in the book and these covered minor issues such as rubbish being left in the courtyard, a light bulb being broken and a resident who is playing their music too loudly. Evidence was seen that action had been taken to resolve the issues raised as concerns. Residents do therefore feel that their concerns and complaints are being listened to and acted upon. Standard 23 – The Manager advised the Inspector that there is in place a policy for the Protection of Vulnerable Adults and that staff have been provided with training and guidance about what actions they need to take if the need arises. The Inspector saw the policy in the Unit’s policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. Training records seen by the Inspector evidenced the fact that 9 of the 11 staff have received POVA training from an authorised trainer in the last 3 years. The Inspector pointed out that it is important that certificated evidence is held on staff files that would support attendance at this and all training received. This POVA training will help ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Milestone. Certificated evidence will be required to be seen within the timeframe given at the end of this report. It is recommended that the Manager ensure an inventory for each resident is kept on the residents’ files of their valuable belongings. This will help protect both the residents and staff from abuse. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents do live in safe and comfortable surroundings and said that they are happy living in this environment. Residents may be assured that the home is clean and hygienic. EVIDENCE: Standard 24 – Together with the Manager, the Inspector reviewed all areas of the home to assess the quality of the environment and décor. The Manager explained that the home underwent a major refurbishment last year where much needed redecorations and updates were carried out. The positive results gained for residents and staff of this major refurbishment were self evident and these standards in the home are high. The home is split up into 2 main units. The first has bed-sit type rooms for 6 residents and the second unit has 8 one bedroomed self-contained flats. Each has a small kitchen area, lounge, bathroom etc. and in addition to this there is Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 23 a large communal area and practice kitchen. There is generally a comfortable atmosphere and units are individually decorated with input from residents with regard to choice of colour and furniture. Residents that the Inspector spoke with confirmed this. Generally the home was found to be clean and hygienic. 4 resident’s bedrooms were inspected with the permission of those residents. They all told the Inspector that they are happy with their rooms and that they like living at Milestone. This all means that residents live in a homely and comfortable environment. General maintenance throughout the home was seen to be good. The Manager told the Inspector that there is a company that is contracted to carry out all the home’s maintenance. Any faults or repairs are noted in the home’s maintenance book by staff and they are then attended to by the contracted company. No problems were identified with this system at this inspection. The home was seen to be clean and no unpleasant odours were noted. The Manager showed the Inspector evidence that the electrical wiring safety check was carried out successfully in April 2003 and this is understood to be valid for 5 years. It will therefore need to be renewed this year 2008. The Inspector asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They revealed that although these tests have been carried out each week as is required water temperatures in many areas have consistently been too high for the safety of the residents. The current recording process of water temperatures around the home needs a new trigger (procedure) to ensure that faults are reported immediately and where temperatures exceed the prescribed limits immediate action is taken to rectify the problem. This is a requirement. The Manager has explained that they have been having problems for many months with the boiler and that a new boiler was installed last October 2007. However the problem remained unresolved. As a result of this inspection the Manager has subsequently assured the Inspector that a subsequent visit by the Corgi engineers has rectified the problem of the high water temperatures and that now all the hot water tests reveal they are within the prescribed limits. Maintenance certificates were seen for the following areas that confirmed they have been serviced and passed as satisfactory by professional expert contractors: • Fire alarm – December 2007 • Emergency lighting – February 2008 • Fire extinguishers – December 2007 Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 24 The Manager told the Inspector that the fire alarm points are tested every week and the Inspector was shown records that confirmed this. The records indicated that the last test had been carried out on 8th February 2008. These measures all help to ensure that the residents live in a safe environment. Standard 30 – The Manager showed the Inspector the home’s infection control procedure, which seems to be working effectively. This means that the residents live in a clean and hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Laundry is not taken through areas where food is prepared. The home has appropriate sluicing facilities and these were seen by the Inspector to be appropriate. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff and by the home’s recruitment policy and procedures. Some improvements are still required in the recruitment and training of staff. EVIDENCE: Standard 32 – The Manager showed the Inspector staffing records and 3 of the 11 staffing files were inspected, having been chosen at random. The Manager informed the Inspector that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. The Manager could not confirm that all staff had been asked to sign to say that they had read, had a chance to discuss the policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. It is required that the Manager ensure all staff do this. The Manager told the Inspector that since the last inspection she has carried out a major overhaul of the training processes being used for the homes staff. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 26 There is now in place a qualifications audit for each member of staff and a training audit. These information matrixes identify for each member of staff, their qualifications and all the training that they have received and that which is planned for the forthcoming year. This is a very useful management tool as it sets out the exact position with regards to staff training at Milestone. The Manager also explained that there is a training programme underway that is being provided by both external and internal (Turning Point) trainers. Courses provided for staff include: 1. Care of medicines, 2. 1st Aid, 3. Risk assessment, 4. Health and safety, 5. Fire safety, 6. Manual handling, 7. Food hygiene, 8. Drug awareness, 9. Equality and diversity, 10. POVA, 11. Infection control, 12. Mental Capacity Act The training matrix referred to above identifies that most of the staff group have received all the above training in within the last 3 years. Unfortunately however the inspection of staffing files did not provide the required certificated evidence. As a part of the inspection the Inspector also spoke with a member of the Southwark clinical team, a CPN who works with many of the residents at Milestone on a weekly basis. Both the Manager and he told the Inspector that the clinical team also provide some staff training input on mental health and complex needs issues as needed and on a regular basis. This no doubt greatly assists the Milestone staff’s understanding of their residents needs. At the last inspection a requirement was made that all staff must have the required skills, abilities and understanding to best meet the needs of the resident group. This requirement has now been met With regards to staff and their NVQ training, the Manager told the Inspector that staff have completed their NVQ training at level 2 or above or have parallel qualifications such as a nursing or social work qualification. However certificated evidence was not available for inspection. It is therefore a requirement that certificated evidence be held on each member of staffs file for all training achieved including NVQ, nursing and social work qualifications. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 27 Residents interviewed told the Inspector that staff are approachable and the Inspector saw staff taking time to deal with resident’s questions. Standard 34 – The Manager told the Inspector that the home has good recruitment polices and procedures in place. She said that recruitment information for staff recruited prior to November 2006 would continue to be held centrally because Turning Point conducted all recruitment processes then at their headquarters. However for all new appointments, information will be stored in the home. As a part of the inspection process the Inspector selected three staff files at random. It was required at the last inspection that the agency use a file checklist system for recruitment so as to prevent any delays that may occur and to ensure documents are available for inspection. The Manager said that she is now using this approach for the most recent appointments in December 2007. However because these appointments are very new, staffing files have not yet been drawn up. It was therefore not possible to evidence the new system being used in practice. As referred to in the Standard 32 above, 3 of the 11 staffing files were inspected at random. Inspection of these staff files, because they were for staff recruited before 2006, did not have all the appropriate documentation available for inspection, although the Manager did say that it was available at headquarters. Subsequently satisfactory evidence to do with CRB checks was shown to the Inspector with respect to the 3 staff members whose files were inspected. Amongst the information unavailable on these 3 files were: • CRBs (Criminal Record Bureau checks), • A form of identification such as a passport or birth certificate, • An employment contract, • Evidence of professional qualifications. It therefore remains a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. Standard 35 - The Manager informed the Inspector that a structured induction programme is offered to all new staff. Since there have only been 2 very recently appointed staff they have not yet gone through the induction process and therefore no evidence exists for this inspection. The training and qualifications audits referred to under Standard 32 enables the Manager to know the identified training needs of the staff group and to arrange further and appropriate training so that staff may best meet the needs of the residents. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. With the developing quality assurance system they may be confident that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 – The Manager at Milestone told the Inspector that she has worked at the home for nearly 2 years having come into post in April 2006. She said she holds the NVQ level 4 in Management as well as a BA Hons in Sociology. Staff at interview spoke positively of the Manager and think that the management of the home is generally good. Records show that she has undertaken periodic training. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 29 Standard 39 – The Manager told the Inspector that at present there are a number of quality assurance mechanisms in place at Milestone that together constitute the home’s quality assurance process. The Manager told the Inspector that in November 2007 a new internal quality assessment tool (IQAT) was launched that will monitor the agencies performance against each of the key National Minimum Standards under the Care Standards Act 2000. This new approach is not yet fully implemented, however the Inspector was shown a number of files by the Manager that will when completed form the new IQAT. This will provide a very useful tool for future inspection and in the completion of the Aqaa documents. The Manager explained that in addition to this a residents survey was carried out in 2007 that sought their views on different aspects of the care and support provided at Milestone. As well as this there are the weekly and monthly audits covering the following areas: • The Manager’s weekly file audit – these are checks carried out regularly on administration and recording systems that are used for the running and management of the home, including for example medication records checks; healthcare appointments; concerns and complaints; and other health and safety checks. • Care plan audit monthly – checks carried out on progress being made with residents individual care planning targets and with file order. There is as well as this a business Plan, drawn up on May 28th 2007 for the period 2007/2008.The Manager explained that this links Milestone in with the overall quality assurance objectives of the parent agency Turning Point and vice-versa. On inspection of the business plan the Inspector could see the agency’s (Turning Point) overall objectives and Milestone’s specific QA objectives set out together in the business plan. Objectives have timescales set against them, success criteria, and a lead person tasked with ensuring implementation of the plan objectives. Some further discussion was had with the Manager as to what other elements might be usefully included in order to ensure a complete approach to developing quality assurance processes. Some suggestions were: • Questionnaires for residents, relatives and referring professionals seeking their feedback on different aspects of the service. For instance residents might be asked for their views on the environment within the home, the effectiveness of the care support they receive etc. Professionals who have referred people to Milestone could be asked about the effectiveness of the service in meeting the Care Programme Approach care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 30 • • • A review of any accidents that have occurred. Issues raised by residents at community meetings. Issues raised by staff at staff meetings. A summary and analysis of the key points arising from these areas mentioned above could then be used to inform the annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed the Inspector that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date and satisfactory pass certificates were seen by the Inspector for: Boiler & Gas –May 2007 Electrical installation – April 2007 Portable electrical appliances – August 2007 Fire alarms – December 2007 Fire equipment – December 2007 A water and legionnaires test was last carried out on 3.10.07 – all clear. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm – weekly, last record seen 8.2.08 Fire extinguishers Emergency lighting - last record seen 8.2.08 Accident records were checked by the Inspector. They had been completed appropriately and Regulation 37 notices sent out as required. At the last inspection a requirement was made to do with the regularity of staff checking the home’s fire systems, at this inspection reords indicated checks have been carried out as required so the previous requirement has now been met. Also at the last inspection another requirement was made to do with the evacuation procedure during fire drills. The problem identified was that some residents did not leave their rooms according to the procedure and that there was no plan of action in place to rectify this problem. At this inspection the Inspector spoke about this to the member of staff at Milestone who is responsible for fire matters. He told the Inspector that since the last inspection all the staff and residents have received fire awareness training and that there is now a contingency plan in place in case some residents do not evacuate as required. The member of staff who is conducting the fire drill will take a roll Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 31 call and will ensure a check is immediately carried out for any person missing from the call. Therefore the previous requirement has now been met. At the last inspection another related problem to that above was identified. There was no record of who was in the building and who had gone out. The Manage explained that this has now been addressed and a new “in / out book” is in place in the hall and that all residents now use this on entry and exit from the home. Inspection of the records showed it is being used as described by the Manager. Therefore the previous requirement has now been met. Hot water temperatures were also checked and records indicate problems with temperatures in excess of the acceptable range. This is addressed under Standard 24 where a requirement has been made. At the time of this inspection no fire doors were seen to be wedged open however there was a fault on one of the fire doors into the residents lounge. This meant the door could not remain open. The fault was seen by the Inspector to be recorded in the maintenance book and the Manager told the Inspector it is due to be repaired in the near future. Generally the building appeared to be secure. All of this means that residents benefit from a competently run and accountable management of the services at Milestone. Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 32 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14 Requirement Care Plan reviews should be developed to monitor the success or otherwise of the care plan objectives and that they are revised in the light of the review findings. The Manager should ensure photographs of residents are attached to each of the resident’s files and to their MAR sheets. The Manager should ensure that all identified risks that are identified in the care plans and risk assessments are addressed by appropriate care plan objectives. Certificated evidence will be required to be seen for staff who have completed POVA training. Water temperatures in many areas have consistently been too high for the safety of the residents. The current recording process of water temperatures around the home needs a new trigger (procedure) to ensure that faults are reported immediately and where temperatures exceed the prescribed limits, immediate action is taken to rectify the DS0000007104.V355531.R01.S.doc Timescale for action 01/04/08 2. YA6 YA20 13(2) 01/04/08 3. YA9 12 (1) (a) 01/04/08 4. 5. YA23 YA24 13 23 01/04/08 01/04/08 Milestone Version 5.2 Page 34 problem. 6. YA32 12 (1) (a) & 18 (1) (c) (i) The Manager should ensure that 01/05/08 all staff are asked to sign to say that they have read and had a chance to discuss the home’s policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. Certificated evidence must be 01/04/08 held on each member of staffs file for all training qualifications achieved, including NVQ, nursing and social work qualifications. The Manager must ensure that 01/04/08 documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. Previous requirement: Unmet timescales 31/03/06; 31/08/06;20/5/07. 7. YA32 12 (1) (a) & 18 (1) (c) (i) 19 (1) (b) & (4) 8. YA34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA23 Good Practice Recommendations Guidance needs to be put in place on the medication records for each resident who uses PRN medication. The Manager should ensure that an inventory for each resident is kept on the residents’ files of their valuable belongings Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milestone DS0000007104.V355531.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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