Inspection on 23/04/08 for Milestone House

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestone House 08/10/07

Milestone House 25/07/06

Milestone House 23/01/06

Milestone House 19/01/05

Milestone House 14/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Milestone House 188 London Road Deal Kent CT14 9PW Lead Inspector Kim Rogers Unannounced Inspection 23rd and 25th April 2008 12:25 Milestone House DS0000023751.V361123.R02.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 House DS0000023751.V361123.R02.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 House DS0000023751.V361123.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milestone House Address 188 London Road Deal Kent CT14 9PW 01304 381776 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) milestonehouse@aol.com Mr Nicholas Martine Mr Nicholas Martine Mr Nicholas James Neil Martine Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th October 2007 Brief Description of the Service: Milestone House is registered to provide 24-hour residential care for up to 13 adults with learning difficulties/physical disabilities. At present there are 7 people living at the home. The home is located in a quiet residential area of the costal town of Deal. There are public amenities and good transport links close by. The house is a large detached listed building set back from the main road in a two-thirds of an acre of grounds. There is a large, secure car parking area to the front of the house. The accommodation is arranged over two floors and there are 12 en-suite bedrooms 10 of these being on the ground floor and purpose built in 1999. The communal space includes a large lounge, dining room, a conservatory and quiet room. At the rear of the property there is a large secure garden, which is well maintained. Mr Nicholas Martine is the owner and the Registered Manager of Milestone House. The current fees for the service range from £950 to £1730 per week For more information about the fees and services please contact the Provider. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this Key inspection. The Key inspection includes a site visit to the service. The site visit was carried out over two days, a total of about 10.25 hours. The inspector spoke to staff, clients, the Registered manager and sampled records including care plans, medication records, staff training and recruitment records. The inspector observed practice and had a look around the home. Staff and the manager assisted the process and the inspector was made to feel welcome. The inspector focused on the requirements made at the previous inspection. These have either been met or steps have been taken to meet them. The home has had a period of instability with a lack of direct management in place. Because of this standards at the home dropped. The Registered manager has now returned to working in the home full time. Currently clients have little control over their lives and over the way the home is run. The manager has acknowledged that staff, with further training, could help support people who have profound disabilities to have more of a say. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: Milestone House provides a pleasant, and well-maintained environment for clients to live in. The home is clean and there are systems in place to control the spread of cross infection. The home provides healthy, well-presented and nutritious meals. The cook made an alternative dinner for a person who did not like the meal being offered. Some staff are longstanding and know clients well. We saw that many clients were having kind and discreet support from staff, especially around lunch time. Most clients appeared happy receiving help from the staff team. Although most clients use wheelchairs, skin care has been maintained to a high standard. This means people have not been at risk from pressure sores. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Person centred plans are in place, but could be developed further, so the people they are about are supported to have a bigger say. The home have developed communication systems from training given by a privately provided trainer. We saw that the systems were available, but not being used regularly. Since the key inspection we have been told that a referral to speech and language has been made. The manager has started to put more photographic images into the home, such as food choices. People who need support with moving and handling must have clear guidelines of how to do this so they and staff are kept safe. Staff demonstrated to us as how they move people, and this appeared unsafe. The manager told us that this would be reviewed and improved. It is important that very clear guidelines are in place and that these are always followed. There needs to be consistent, efficient and effective management within the home. A fire drill must be held so that staff know how to evacuate on the event of a fire. There must be a fire risk assessment to make sure the home is safe. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 7 More activities need to take place outside the home so that clients are full members of the community. Staff must have the necessary training in both mandatory and specialist subjects so they have the competences and skills to work safely at the home and meet clients’ needs. The staff need to receive the necessary supervision and support to undertake their roles effectively. Staff must be competent at recognising and responding to suspected abuse. The registered manager needs to develop and implement quality assurance systems so clients know their views are listened to and acted on to improve the service. Personal restrictions that have been in place for a long time need to be reviewed to make sure they are still appropriate. 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 House DS0000023751.V361123.R02.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 House DS0000023751.V361123.R02.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 and 2 People who use the service experience good outcomes. Some information about the home has been produced in symbols to help people understand what the home offers, but the range of accessible format could be improved. Assessments of needs are carried out before a person moves in so the home can see if they can meet the persons’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that the manager carries out assessments of peoples’ needs before they move in. This is so he can see if the home can meet the persons’ needs. Care management assessments are also sought. No one has moved in to the home since the last inspection. The Annual Quality Assurance Assessment (AQAA) was basic but said the pre admission assessment form has been improved. There is some information about the home including a Statement of Purpose, Client Guide and contracts that have been written using symbols that may help understanding. We were shown these, and although this is a good start, they may need more personalisation to be meaningful to the people who live at the home. Milestone House DS0000023751.V361123.R02.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): Standards 6,7,9 People who use the service experience adequate outcomes. People who live at the home have complex communication needs, so their personal goal and support plans need to be created in a way they could be more involved in. Risks are assessed with a focus on keeping people safe rather than enabling them to lead more fulfilled lives. Communication could be better supported giving people more choice and control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that each person has a care plan that is kept in the staff office. The plans detail peoples’ needs and how staff are to meet these needs. Three care plans were sampled in detail. Staff said they have read the care plans, new staff said they had read some of the plans. We found some staff were aware of the detail of the plans when asked. This means that they are using the care plans and have an awareness of peoples’ needs. Staff complete daily records giving information about what the person has done that morning, afternoon and night, what they have eaten and that their Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 11 personal care and medication needs have been supported. It is good that these records are kept. There is little recording to say how people made choices, which could be improved on. This would help staff review and support personal development. By the second day of the inspection the manager had reviewed and updated all of the care plans. We were told that this review was in draft and the key workers (on behalf of the individual clients) and senior team would have chance to comment before this was finalized. The families and care managers are invited to give input at the annual review. The plans are relayed to clients, but are mainly in a written format. So these are understood by the person, an alternative way of consulting and displaying the most meaningful parts of the plan are recommended. We found that personal goals and aspirations could be supported better. The word ‘maintain’ features in care plans rather then develop, increase, improve. This suggests that people may lack opportunity to achieve their aspirations for the future, increase their skills and have the support to lead their lives as they go through lifelong development. We discussed this with the manager, who recognised that this area could be improved. It was recommended at the last inspection that person centred approaches be introduced to improve care planning. The manager has asked key workers to complete a person centred planning tool on behalf of clients. This is a start, however, without input from clients (with support from advocates where needed) and their families and the right training and support for staff it will not substantially change peoples’ lives for the better. Risk assessments are part of the care plans. Potential risks have been assessed with strategies recorded to reduce risks. These too were being reviewed prior and during the site visit. We found that there is some out of date information, for example some activities are risk assessed that people no longer take part in and the use of bed sides was assessed but these are no longer used. Some long-term behaviour had support plans that could be restrictive. These restrictions may be completely appropriate, but they would from a multi-agency review. Some people need to be moved and handled by staff but their guidelines were either not present or lacked sufficient detail to ensure that staff know how to do this safely. The commission had been alerted to manual handling issues in January 2008. The owner investigated and found no problems, however the manager organised that a qualified trainer supplied refresher training on 26/3/08. The staff demonstrated a technique around moving people that would put the staff and the client at risk if it continued without review. The manager said he would ensure guidelines are put in place to protect staff and clients. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 12 We found that communication could be better supported giving people more choices and control over their lives. For example some systems to support communication noted in care plans are not used. The environment may not support communication as well as it could, for example, people do not know who is on duty, what activities are on offer, what’s for dinner etc. Clients are told verbally, but the home is introducing photographs to help improve communication. We found that staff tend to make decisions for people but this has not been thoroughly assessed involving the client. Some limitations and restrictions on facilities and services have been made without assessment and consultation with people. The development of person centred plans will help to demonstrate who would like to do what. It will then be clear if individuals would like to become more involved in running the home, and how staff can support this to the maximum level. The AQAA showed little evidence of improvement and plans to improve but did recognise the need to improve communication support. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 13 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 and 17 People who use the service experience adequate outcomes. Clients could be more involved in planning and preparing meals and in the day to day running of the home. People enjoy in house activities but do not go out very much into the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that although each person has an activity planner covering Monday to Friday, they are produced in text. Staff tell clients what activities are scheduled for each day, and are offered the chance to participate or decline. This means clients may not know what is on offer or what is being planned in advanced. This could improve, so that people are offered the chance to choose from a range of preferred activities in advance. Activities on the plan do not always happen with a lack of alternative offered. An activity coordinator is at the home for five days a week. Staff said people enjoy art and craft sessions and art and craftwork is displayed in the dining room and conservatory. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 14 We found that most activities are in the home so people do not get out very much. This means that clients are not full members of the community. The AQAA says that they could be better at supporting people to be part of the community but does not say how they plan to do this. The manager said he is in the process of recruiting a dedicated driver for the minibus, which will give care staff more time to support outing opportunities. None of the clients have employment, but are supported to assist in personal chores with staff support. No-one attends college or further education classes. Details of clients’ friends and family are recorded in care plans. We found that clients are supported to keep in touch with their friends and families. Clients can have visitors whom they can see in their rooms, or in any other communal area. Due to limited community presence we found clients do not currently have much opportunity to form other relationships. Plans to increase relationships, friends and acquaintances are not in place. Clients do not have responsibility for any of the day-to-day running of the home, but have some support to do some household chores. We found that staff ‘do for’ people rather than ‘do with’ them. They do this with best intentions and need training and support if they are to enable and empower clients to develop their skills and participate more. A recommendation was made at the last inspection for clients to have a choice of meal. The home employs a cook who works Monday to Friday, and a separate weekend cook. There are menus but they are in a format that clients might not understand and are kept in the kitchen. There are photos of the meals available, which we saw. These could be used to plan the menu. This would help people choose from alternative main meals and make choices. Staff and the manager agreed that clients do not know what’s for dinner until it arrives in front of them. This means they do not have a choice. We found that clients are prevented from entering the kitchen; this means that they do not have the opportunity to make their own snacks and drinks. Staff said that clients are not involved in planning and preparing meals, as they should be. Clients do not take part in food shopping as this is done by staff online. We found that some people are allowed a dessert and some are not. This decision has been made for people without a proper assessment or consultation with them. The cook has written new menus and has included fruit based desserts. She has shared these with the manager who has started to take pictures of meals served. They plan to build up a portfolio of pictures so clients might choose what they have. Fresh vegetables were served on both days of the site visit and the meals were well presented. We found that staff support clients discreetly and respectfully with their meals. Some personal information about the support people need is displayed in the dining room with people’s names. This information should be in individual care plans to protect clients confidentiality. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 15 The manager agreed that there is potential for clients to be more involved in the food planning and preparation. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 16 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 and 20 People who use the service experience adequate outcomes. Clients receive adequate personal support but not all their health needs are monitored. Medication practice is safe protecting clients. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are recorded in individual plans, this ensures that people get the support they need in a way they prefer. There are facilities that suit peoples’ needs. Health needs are recorded in individual plans and the home has worked with some health professionals to meet people’s needs. Although there was clear evidence that medical and psychiatric referral had been made to support one person’s needs, it did not have the ‘social review’ through, for example, psychology. We saw that some staff found if difficult to support the person, and that the direct support strategies had not been looked at from a social viewpoint for several years. This means the way that behaviours are supported each day need more careful review. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 17 There is a health action plan tool, which staff are completing. Some were more complete than others although clients and their families have not been involved. There are weight monitoring and fluid intake charts in place. These had been completed as necessary, but it seemed that no action had been taken around falling weight of one person. We asked a senior staff member what action had taken place, but they could not recall. We discussed that the optimum weight had changed between day one and two, from 8 to 7 stone. The manager explained that 8 stone was a typing error, and the body mass index rating indicated 7 stone to be correct. Recorded information must be accurate, and the manager agreed that this would improve. We observed medication administration and storage and found this to be safe. Records of administration and receipt of medication are in order. No one currently controls their own medication and there are no plans in place to increase control for anyone. Guidelines for ‘when needed’ medication were not in place, as previously required at the last inspection, on the first day of the visit. The manager had addressed this by the second day of the visit. Guidelines for homeopathic remedies had also been done by the second day of the visit. We found that staff have basic medication training that relates to the system used. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 18 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 and 23 People who use the service experience adequate outcomes. The complaints procedure comes in text and a with symbol format. Clients would need support to use this. Staff need to be competent at recognising and responding to suspected abuse if they are to safeguard clients. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure, displayed in the hallway, but it is not written in a way and produced in a format that everyone can understand. Communication could be better supported, as previously mentioned, so that staff know when people are not happy about something. No complaints have been received directly to the home. The Commission has received one anonymous complaint about the home since the last inspection. This was referred to the provider for investigation, and was not upheld. Policies and procedures for safeguarding people who use the service are in place but when asked one staff did not know where they were and a second staff looked in the wrong file so did not find them. The policy was not up to date and did not contain all of the information staff may need. This means that staff do not have the information they need about safeguarding adults. We were pleased to learn from the manager that shortly after the inspection that staff are now aware of the policy location and that the recommended contact information has been updated. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 19 Links with external agencies are adequate but staff lack understanding of safeguarding procedures and how they work. Where staff lack such important skills and knowledge, they cannot support clients, should they wish to make disclosures. Without the necessary training and knowledge, they may not make a safeguarding referral through lack of understanding. We found that some staff have had training around Safeguarding Adults but not for some time, others have not had any training. When asked some staff had a limited understanding in this important area. This leads to inconsistent knowledge and practice within the service, which could place clients at risk. An adult protection investigation took place in respect of clients financial records not being in order. This has been investigated by the local social services and police and there has been no wrong doing found. The manager has improved the system so that records are more clear and transparent. No one takes control of their own money and there are no plans in place to increase control. Staff have access to petty cash if clients need money. We found that training in supporting people who may have problem behaviours is limited and some staff lack understanding in this area. We observed that a client was anxious during the visit. It appeared that the way one particular member of staff spoke to the client did not reduce anxiety, while other staff who took a different approach seemed to decrease the person’s anxiety. The most effective way should be agreed and documented in the person’s support plan as a preferred way of support. The AQAA says that training is planned for staff in safeguarding vulnerable adults. What could be better and how the home has improved is blank on the AQAA. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience good outcomes. The home is well maintained and decorated to a good standard providing clients with an attractive and homely place to live. Restrictions to a person’s drinking water facilities need to be reviewed, making sure they remain the least restrictive. The house is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation provided is sufficient in space to meet the needs of the clients. The premises are safe, comfortable, airy and clean and provide sufficient light heat and ventilation. The premises are in keeping with the local community and the ground floor is accessible to all the clients. Furnishings, fittings, adaptations and equipment are of good quality and suitable for their purpose. Bedrooms are personalised making it feel like home. A cleaner is employed and the home was clean on both days of the visit. There is a large garden, which has some paved and seating areas for people to use. No client has a key to the home or bedroom. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 21 We found the home still has CCTV cameras in some of the communal areas. This means the home like feel is spoilt and clients may feel that their privacy is not respected. The inspector was informed that these cameras are no longer used. To evidence this and make the home feel more homely cameras need to be removed. The laundry room has all the facilities needed to wash soiled and infected linen. The home has 2 washing machines with sluicing facilities. Soiled linen is transported in red bags and put straight into the machine. The bags are still transported through the lounge area of the home. This means clients space is intruded on. Disposable gloves and aprons are available and worn and liquid soap and disposable towels are sited in the necessary areas. Cleaning products are now stored safely. Some restrictions have been imposed without assessments being carried out and agreement from clients. For example the water supply to a person’s bedroom taps has been cut off and access to the kitchen and laundry is restricted. All imposed restrictions should be reviewed in consultation with clients to ensure that they are the least restrictive option and are in people’s best interests. An improvement was noted on the AQAA, namely, staff have had infection control training. They plan to improve by disinfecting bedrooms on a weekly basis. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 22 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 and 36 People who use the service experience adequate outcomes. Specific training relating to peoples’ needs, such as autism and / or learning disability would benefit staff to support clients more knowledgably. Regular staff supervision needs to improve. Checks are carried out before people start in post, which protects clients from risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found from the rota and observations that there are three staff on duty from 7am to support seven clients. Most of the clients require the support of two staff. There is usually a fourth member on staff on duty from 10am till 6pm. There are two waking staff at night. Agency staff are used to cover some waking night shifts due to staff vacancies. There has been a high turnover in staff over the past few months. This means that people who use the service may have to wait a short time for support and do not have continuity in night staff. One staff said ‘it is nice when we have extra staff, more people can go out’ Some of the staff are longstanding so they know the clients well. There has been some staff sickness lately, which has meant less staff on duty at times. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 23 Most staff were observed talking to and interacting with clients in a positive respectful manner. One staff was observed talking quite curtly to and seemed impatient with a client who was anxious. This did not help the client’s anxiety. This was discussed with the manager who agreed he would look into the issue through supervision and training. Four staff files were sampled and we found that training relating to clients needs is limited. For example some people have had none or little training in, for example, learning disabilities, person centred planning or alternative communication. This means they may not have the full range of skills to work developmentally with people who have complex needs. We found gaps in mandatory and other training including fire awareness and safeguarding vulnerable adults. This means they may not have the full range of skills to keep people safe. Competency assessments to check ongoing competency are not carried out. We shared information about local social service training providers, and the manager took note of the website information straight away. The current induction is very basic and not all staff have had a proper induction. The manager obtained the skills for care induction from the internet and has advised this is now being used. Four staff supervision records were checked and we found the same as at the last inspection that staff are not supervised in line with the Minimum Standard. One staff had no recorded supervisions for 2007; one had one recorded supervision for 2007 and two staff and two recorded for 2007. We found that staff meetings are not held regularly and no staff meeting has been held for some time. Staff did not know if and when a staff meeting was planned. This means that they do not get support, opportunity to discuss issues like training and reflect over their practice as often as they should. The AQAA says that over 50 of the staff team have a National Vocational Qualification and that they could be better at using staff more effectively. They plan to improve by integrating new staff into the team and building on team spirit. They do not say how they plan to do this. The AQAA says that nearly half of the staff team have left the home in the last 12 months, this included people within their 3 month probation period. Staff files for three new staff and an existing staff member were sampled to look at recruitment procedures. We found that the necessary checks are carried out before a person starts in post, which protects clients. The manager said that clients meet prospective staff when they look around the home. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 24 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 and 42 People who use the service experience adequate outcomes. The management of the home needs to be effective and consistent to ensure that the people in the home are safe and receive the care that they need. Quality assurance systems at the home do not yet demonstrate that clients benefit from an improved service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered manager is now at the home on a daily basis managing the day-to-day running of the service. The Registered manager has owned and run the home for eighteen years. There is no deputy but team leaders run the shifts and direct support workers. The manager said he feels the home is more stable after a period of instability when the manager was not at the home very much and there was a succession of managers. During this time, the clients and home were placed in a Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 25 vulnerable position leading to a decline in the quality of the service. The registered manager accepts that although the situation is stabilised with his return to full time post, he acknowledges that there is further room for the service to improve. The staff have had inconsistencies in supervision, training and development, which the registered manager is endeavouring to put right. We found that the current quality assurance systems do not meet the Minimum Standard. Opportunities and support for clients to air their views are limited. This means that clients views are not sought in a meaningful way then improvements made based on these views. The Registered manager said he has employed the services of a consultant to carry out a quality audit in the near future. We found that water temperatures are now checked at all outlets as required at the previous inspection. Although checks are carried out of fire equipment like emergency lighting, alarm bell and extinguishers no drills have been held. There was no record of when a fire drill was last held and some staff have not had any fire training. New staff including waking night staff have not been involved in a practice fire drill, which places clients at risk as staff do not know how to evacuate in the event of a fire. There is no fire risk assessment of the home as required. The manager said he would hold a fire drill straight away. The AQAA said improvements in the above areas have been the provision of new hoist slings. They plan to improve by senior staff training other staff in how to hoist clients into chairs. The manager must be certain that the senior staff have had the right training to be trainers themselves. There is also poor understanding of real barriers to improvement around actively engaging clients who have profound disabilities in decision making. The AQAA identification of improvement barriers is the delay of police checks, resulting in the use of agency staff. Clients pay a weekly fee of between £950 to £1730 per week. Improvements around quality reviewing the care and support plans are needed to demonstrate the provision of value for money. Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 1 X X 2 X Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA9 Regulation 13 Requirement To ensure that clients are moved and handled safely, they must have clear, thorough guidelines in place for staff to follow. Where systems of communication and choice making already exist from speech and language assessment, these must be used to aid client opportunities. Timescale for action 30/06/08 2. YA7 12, 13 31/10/08 3. YA32 YA42 18 Where the need for speech and language support appears evident, referrals should be made for support. To ensure that staff have the 31/12/08 skills to support clients they must have mandatory training as required by the Minimum Standards. Infection control First Aid Food Hygiene Fire and Health and Safety Training related to clients’ specific needs. Epilepsy awareness Learning disabilities Communication skills DS0000023751.V361123.R02.S.doc Version 5.2 Page 28 Milestone House 4. YA23 13 5. YA42 23 All staff must have the skills and knowledge through training and competency assessment to recognise and respond to the potential for abuse. To ensure that staff know how to evacuate the home in the event of a fire, regular drills must be held and recorded with all staff. To ensure that clients are safe the home must have an up to date fire risk assessment. 31/07/08 25/05/08 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 YA18 YA17 Good Practice Recommendations Staff need to offer a person centred approach to meeting the needs of the clients and to maximise peoples independence and control over their lives. The home needs to be able to show the clients have a choice of meals. And an accurate record needs to be kept of meals eaten. A record also needs to be kept of when supplements are given to clients. All staff need to receive supervision at least 6 times in a year. 3. YA36 Milestone House DS0000023751.V361123.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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