Inspection on 22/01/07 for Milestone House

This inspection was carried out on 22nd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milestone House 15/08/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Milestone House Eastgate Seamer Scarborough North Yorkshire YO12 4RB Lead Inspector Pauline O`Rourke Key Unannounced Inspection 22nd January 2007 09:30 DS0000060382.V328307.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 DS0000060382.V328307.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. DS0000060382.V328307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milestone House Address Eastgate Seamer Scarborough North Yorkshire YO12 4RB 01723 864528 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) North Yorkshire County Council Mrs Ruth Marie Collin Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000060382.V328307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Milestone House is a respite centre registered by North Yorkshire County Council to provide short stays for up to 7 younger adults with a learning disability. Mrs Ruth Collin is the Registered Manager. The home is a large detached building situated on the outskirts of Scarborough. It has been adapted to provide accommodation for service users who may have a physical disability as well as a learning disability. Each of the bedrooms is for single use and 4 of them have ensuite facilities whilst 3 of them are on the ground floor. The home is set in a well-maintained and mature garden that is accessible to all service users. Information about the service is available on request and is also available in different formats. On the 22nd January 2007 the cost of the service was between £229 and £236, the actual amount is dependent on a financial assessment of the potential service user. They and their carer are informed of the cost of a stay prior to their admission. DS0000060382.V328307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered from the provider, service users and other professionals since the last visit to the home, which took place on 15th August 2005. A site visit to the home, which was split over two visits in one day was carried out on 22nd January 2007. It focused on the key standards. An inspection of some of the premises, including one bedroom, was undertaken. A number of records were also examined. Discussions were held with the Registered Manager, three members of staff on duty and the two service users. Feedback was also received from the service users and two professionals in response to questionnaires sent prior to the visit. What the service does well: What has improved since the last inspection? The service continues to develop and the access to training for staff is the driving force of this. This means they have a wider range of skills that allow them to fully meet the needs of service users. The take up rate of service users has increased from 23 to 50 since they have moved to this location. The service is better used and so can now continue to develop to meet the needs of all the users. DS0000060382.V328307.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000060382.V328307.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 DS0000060382.V328307.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are involved in the assessment process through their preferred method of communication and can be assured their needs can be met at Milestone House. EVIDENCE: Anyone who uses the respite services at Milestone House already has a comprehensive and detailed care plan of which respite forms a part. The service user files seen during the visit contained multidisciplinary assessments. Records were also seen detailing the process of short visits, teatime visits and overnight stays that enabled the service users and staff to get to know each other. This trial process allows the service users to express their opinion of the service. Information is provided to the service users in a variety of formats including ‘widget’, ‘I speak’, and ‘plain English’ alternatively service users can bring with them their preferred form of communication. Discussions with the manager and staff highlighted their awareness of ensuring the balance of care and social needs within the home was appropriate and service users needs could be properly met. This decision making process includes the social needs of a service user because service users can become fixated on each other and DS0000060382.V328307.R01.S.doc Version 5.2 Page 9 this needs to be managed sensitively. The assessment process allows the manager to ensure the staff have the necessary skills to meet the service users needs. DS0000060382.V328307.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users are as involved as they are able to be in their care planning process and they are supported by the staff in their daily lives when at Milestone House. EVIDENCE: The service user files seen during the site visit contained detailed information pertinent to the individual. One plan seen split the detail in to days, nights, and known behaviours and how to react and deal with those behaviours. Milestone House specializes in the support of service users who have an autistic spectrum condition and have an accreditation from the National Autistic Society. Those service users who have this condition, their care plans have an autistic behavioural profile. This includes an identified link-worker with other services. A daily diary is kept and this identifies activities, important relationships in their life and these help staff communicate DS0000060382.V328307.R01.S.doc Version 5.2 Page 11 effectively with the service users and gives the service users a chance to express themselves clearly without verbalising their needs. During the site visit one service user was observed making their own decisions, i.e. when to get up, what they wanted for breakfast and what they were going to do during the day. Staff were observed facilitating these decisions and used minimal guidance. Service user files also contained detailed risk assessments and these are reviewed on a regular basis. DS0000060382.V328307.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users continue to take part in educational, and social activities whilst at Milestone House. They also enjoy a varied and balanced diet. EVIDENCE: The service users who access services at Milestone House do so as part of a larger more involved care package. Staff enable service users to continue with their organised activities either at college, a local day service or through social events. However service users do have the opportunity to use their break at Milestone House as a complete break from their other activities. Observations made during the site visit saw staff enabling a service user to make their own plans and not take part in the usual activities as outlined in their care plan. Service users access the local community when they on a respite stay and records showed that they had been to the local garden centre café, community DS0000060382.V328307.R01.S.doc Version 5.2 Page 13 centre for tabletop sales, shops and other available facilities. Information was available in the activity room of local events on during the coming months. There is a visitors policy in place and the service users care plan identifies anyone who they do not want to see whilst they are on a respite stay. The daily routines are dictated through the week by other activities the service users are attending. Evidence was seen of a service user dictating their own routine with appropriate support from staff. One service user spoken with said that they were able to spend as much time in their bedrooms as they wanted and there was no pressure to join in with any activities. The service users daily routines are part of their care plan but as the result of a complaint by a service user the manager has implemented a check sheet for service users booking a stay as to how often if at all they would like to be checked through the night, by the night staff. This will help the manager when she is planning the stays and allow staff to be fully informed of the service users wishes at all times. A 4-week menu is provided in a format that is understandable by the service users and takes in to account those service users who are autistic. The main meal of the day is flexible enough to allow service users to go out to the local pub or get fish and chips from the local fish shop. The dietary needs of the service user are considered before any decisions about what is for the meal are made. The service users are encouraged to assist in all aspects of meal preparation from shopping to preparing and helping clear up. However it is not compulsory to help the staff. One staff member was observed discussing individual dietary needs with one of the service users to ensure they had appropriate and interesting meals whilst away from home. The staff at Milestone have spent the last six months in a training programme to enable them to assist a service user who has been a regular visitor with a nasalgastric tube feed. The manager has involved all appropriate professionals and the service users parents and the last element of training still to be organised is with the service user themselves so that the care plan is person centred. Health care staff and the parents are going to continue offering support with this procedure until staff feel competent to do it. Several staff spoken with have enjoyed the specialised training and feel confident they will manage. Risk assessments are in place and the County Council insurances have also been involved in this process. DS0000060382.V328307.R01.S.doc Version 5.2 Page 14 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): 18, 19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users are encouraged to be as independent as possible whilst receiving appropriate support as outlined with their care plan. EVIDENCE: The service user care plans seen during the site visit contained detailed information about the support required by the individual. A service user spoken with during the visit said that staff gave them the support and encouragement they required. Staff were seen enabling a service user to be independent in their personal care with minimal guidance and assistance. The service users are encouraged to let staff know if there is a member of staff they do not want to assist them and this is done through verbal and nonverbal methods of communication. Where a service user has identified someone they do not want assistance from then this information is recorded in their care plan. DS0000060382.V328307.R01.S.doc Version 5.2 Page 15 The service users continue to maintain contact with their usual health practitioners whilst they are in for a respite stay. There is an arrangement with the local surgery for emergency cover for service users staying who are outside of their usual districts. District nurses also provide support. There is a clear medication policy in place and evidence was available to show that staff have completed a learning distance course in The Safe Handling of Medicines. Staff spoken with said that they did not handle the medication if they had not undertaken the training. The storage and administration records for the medication were appropriate. A conversation was held about the possibility of obtaining a lockable fridge for medicines that require storing in the fridge. Where possible service users are encouraged to be self-medication but where this is not possible the staff support the service users in the way that enables them to be as independent as possible. DS0000060382.V328307.R01.S.doc Version 5.2 Page 16 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): 22 and 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Concerns and complaints are dealt with positively and used to help develop the services at Milestone House. The service users are protected from abuse through a stringent selection process and regular training. EVIDENCE: A complaints policy is in place and it is available in several different formats so that the service users can access it if they need to. Feedback received from several relatives indicated that they were not fully aware of the complaints process. A discussion was held with the manager about this and she said that they would highlight the complaints policy in their next quarterly newsletter. A record of complaints is held along with any investigations and outcomes. The manager uses this information to help develop the service provided at Milestone House. An example of this has been referred to earlier in this report. The service users are protected from possible abuse through rigorous employment procedures and through staff training. Staff spoken with during the site visit were clear about their responsibilities in the event of suspected abuse. Information was around the building for an advocacy service and the service users spoken with were confident they could raise any concerns with their carers or someone within their care package. The care plans contained clear risk assessments in the use of restraint, where necessary and what the DS0000060382.V328307.R01.S.doc Version 5.2 Page 17 procedure was if restraint had to be used. The care plans were pertinent to the individual and very clear in their instruction. DS0000060382.V328307.R01.S.doc Version 5.2 Page 18 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): 24 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users live in a well-decorated homely environment that is accessible to everyone. EVIDENCE: The home is converted building providing 7 bedrooms, 5 of which are ensuite. The rooms are well decorated and are equipped with a bed, bedroom furniture and television. The rooms seen were warm and clean. There are 3 quiet rooms, 1 which is used as a sensory room, 1 is an arts and craft room and the other is a general lounge area with television, DVD/Video player and a music centre. All areas of the home are accessible to the service users and there is generous outside space for them to use as well. Since the home moved to its current location there has been 100 increase in its use moving from 23 to 50 service users. DS0000060382.V328307.R01.S.doc Version 5.2 Page 19 There is a small laundry area that is designed to only do washing in an emergency for the service users and the sheets. The washer has a specified programme to meet disinfection standards. DS0000060382.V328307.R01.S.doc Version 5.2 Page 20 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): 32, 34 and 35. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff that are well trained and supervised support the service users. EVIDENCE: North Yorkshire County Council has a rigorous recruitment process and staff files seen contained an application form, two written references and a Criminal Records Bureau disclosure. The service users are encouraged to take part in an orientation process for staff as part of the recruitment process and the manager values their input.. The files containing details of training they have undertaken and supervision notes is now kept by the member of staff they are pertinent to. Staff spoken with confirmed that they had undertaken the statutory training and were more enthusiastic about the specialist training they undertook. One member of staff said that the training she had done on autism had really helped her practice when dealing with service users who were also autistic. Other staff spoken with said that they had enjoyed the training on the nasal-gastric feeding which means they will be able to continue to care for service users as their needs change. DS0000060382.V328307.R01.S.doc Version 5.2 Page 21 Feedback received form relatives and other professionals was very positive about the care and attitude of the staff. DS0000060382.V328307.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users benefit from living in a well-managed and safe environment where their views are regularly sought about the service provided. EVIDENCE: The Registered Manager has been in post longer than two years. She moved the service to its current location two years ago. She is committed to the job and is involved in panel including outside agencies to try and change the way services are provided in line with the modernisation agenda. This means they carried out a census of the service users stating who did what and when. They then asked them if they wanted to change the way they do things and the agencies themselves see if they can effect change without going through the DS0000060382.V328307.R01.S.doc Version 5.2 Page 23 care management approach. If the services can’t be done then it goes to a panel to be discussed. The manager is also working with Community Education Service to develop social activities. Whilst these activities do not always affect the service users of Milestone House they are reaching future and possible users of the service. As part of their quality assurance programme service users are asked to complete questionnaires. These are a pictorial document and they are assisted by their families to fill them in. The home holds a current National Autistic Society accreditation for autism specific services. This accreditation is renewed annually. The assessors, a panel of three independent adjudicators, spend time seeking the views of service users, their families and outside professionals. They also scrutinise policies, procedures and working practices. North Yorkshire has service improvement plan that managers have to complete and these identify areas that the staff are looking to improve. The staff spoken with during the site visit said that they had received training in, back care, first aid, food hygiene, COSHH, and fire training. Records held in the office confirmed that these courses had been completed and North Yorkshire County Council offers them on a rolling programme over the year. The health and safety documents required to confirm that equipment is regularly serviced and maintain was checked. The accident book is maintained and where necessary accidents are reported to The Commission. DS0000060382.V328307.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 4 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 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X DS0000060382.V328307.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000060382.V328307.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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