Inspection on 23/01/06 for Milestone House

This inspection was carried out on 23rd January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestone House 23/04/08

Milestone House 08/10/07

Milestone House 25/07/06

Milestone House 19/01/05

Milestone House 14/09/04

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Insight - Eastchurch

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

CARE HOME ADULTS 18-65 Milestone House 188 London Road Deal Kent CT14 9PW Lead Inspector Mary Cochrane Unannounced Inspection 23rd January 2006 10.00a. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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.V267449.R01.S.doc Version 5.1 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.V267449.R01.S.doc Version 5.1 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 Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2005 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 9 Service Users in residence. The Home is located in a quiet residential area on the outskirts 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 ample and secure parking facilities 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. The communal space includes a large lounge, dining room, a conservatory and snoozelam. At the rear of the property there is a large secure garden, which is very well maintained for service users to enjoy in the better weather. Milestone House is owned by Mr Nicholas Martine who is also the Registered Manager. He is supported by a clinical director, a home manager,19 care staff who cover day and night shifts, 1 administrator who works full time a weekday cook and a weekend cook, house keeper and maintenance worker. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd inspection at Milestone House this year. This visit was unannounced and lasted from 9.50a.m until 5.00 p.m. on the 23/01/06 and 9.15a.m till 11.30am on the 26/01/06. The majority of the key standards were inspected at the previous visit, so the inspector focused on the requirements and recommendation identified in the previous report and any outstanding key standards. The home did experience an unsettled period last year when adult protection issues were investigated. The registered manager and staff have worked hard to comply to recommendations and action plans have been developed. Investigations and interventions have now been completed and the adult protection investigation has been concluded and closed. The home has made a lot of positive changes in the past months, which have improved the standard of holistic care given to the service users. At the time of the visit there were 9 service users in residence. The home had accepted another service user for 2 periods of respite care in October and December ’05. All the service users at Milestone House have complex physical and learning disability needs, which require skilful management and care. Communication is very specialised for most residents and interaction is by their facial expressions, eye contact and behaviour. The home was calm and relaxed and staff were communicating with residents in a respectful, inclusive and caring manner The registered manager, administrator and care staff where helpful and cooperative throughout the first day. The inspector returned to the home 2 days later to look at the work being undertaken by the new clinical director and to discuss the homes progress. Some of the requirements made at the last inspection remain out-standing. This was discussed with the clinical director at the time of the inspection and new timescales will be negotiated. The pre inspection questionnaire had been completed to a good standard and contained all the necessary information. Comment cards had been received from relatives. The following methods of inspection and information gathering were used: one-to-one discussion with staff, communicating with the service users observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication protocols, staff files and training programmes. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection there have been significant improvements in working towards meeting the National Minimum Standards and although there is still some way to go the home is heading in the right direction. The registered manager has been pro-active in actioning requirements and recommendations made following recent inspections and adult protection procedures. The registered manager has now employed a new clinical director who has a great amount of knowledge, skills and experience in the field of learning disabilities. She is undertaking a great amount of work to develop systems and practises within the home, which ensure that all the needs of the service users are met. She was available on the second day of the inspection and was able to discuss and evidence the work she been doing since arriving at Milestone House. All the care plans and risk assessments have been re-developed, some are now completed. This is a large piece of work which the clinical director is undertaking thoroughly before the plans are implemented. There home now has enough care staff on each shift to ensure that the needs of the service users are met at all times. Formal supervision has started some Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 7 of the staff spoken to had received supervision and found it helpful and positive others are yet to receive supervision. The amount of activities provided by the home continues to develop and improve. Work has been started on developing individual activities programmes for each of the service users and staff are in the process of finding out what service users enjoy and what is successful. The home now has input from many of the local specialist services. Visiting professionals reported that there has been improvements in the standard of care at the home. Advocacy services have also been secured for one service user who has no relatives/representative. The home has also acquired a new vehicle, which allows service users to be transported safely to activities, appointments, outings etc. What they could do better: The staff need to ensure that they can evidence that they have undertaken a full assessment on any new prospective service users prior to their admission to the home. All the service users at the home require up-dated contracts/terms and conditions of residency so they or their representatives know how much they are paying to the home and the cost of any extras. All the care plans and risk assessments need to be completed and implemented so staff are able to use them as a working document. Each of the service users needs an individual activities programme, developed to meet their individual needs capabilities, likes and dislikes. The registered manager needs to ensure that all staff follow procedures for the administration of medication. The home needs to ensure that all the required checks and references are in place prior to any member of staff commencing work at the home. The home needs to ensure that all staff have received the necessary training so they have the competences and skills to work safely at the home. Quality assurance and monitoring systems need to be developed so the management can measure success its aims and objectives. Please contact the provider for advice of actions taken in response to this Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 9 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.V267449.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Prospective service users require a full and comprehensive assessment to ensure that that Milestone House is suitable and will be able to meet all their needs. The home needs to provide the service users with an up-dated costed contracts/terms and conditions of residency so the service users/representatives know how much they are paying to the home for the services they receive. EVIDENCE: During the past 4 months Milestone House has accepted a service user for respite care on 2 occasions the first being in October and the second over the Christmas period. The inspector was informed that prior to coming to the home the service user was visited and assessed by the registered manager and the clinical director in her present environment. There was no evidence available to show how the service user was assessed and what methods had been used. There was no details available about who was present and how the information was obtained or what criteria had used during the assessment to show that Milestone House would be able to meet her needs. The care manager had forwarded information on how best to care for the service user but the home had not used this information or details from the Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 11 assessment to develop an individual care plan for the service user. This was discussed with the registered manager and the clinical director. They need to ensure that an assessment tool is in place and care plans developed for any new service user. Each of the service users has a contract/terms and conditions of residency in place. The registered manager is in the process of reviewing all the contracts with the funding authorities and is hoping to negotiate new contracts. The new contracts will need to include the information about the fees charged what they cover when they must be paid and by whom. The contracts must also state the cost of facilities or services not covered by the fees. This is with particular reference to transport costs. The contracts need to indicate how much service users pay to use the homes vehicles. The registered manager needs to access all this information and include it in the contracts. All contracts also need to be signed by the service users/representative and the registered manager. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care plans and risk assessments are being developed. They now need to be implemented to ensure that all the needs of the service users are being met and risks are kept to a minimum. Service users are encouraged to make decisions about their own lives pending on their limitations and abilities. EVIDENCE: Since joining Milestone House the new clinical director has spent a lot of her time developing the care plans and risk assessments of the service users. At the inspection 5 of the care plans were looked at. All of these contained the necessary information to ensure the needs of the service users are met. The plans are easy to understand and follow. They contain clear directions and guidelines on how staff are to meet the individual needs of the service users. The plans will also incorporate specialist instructions on how to deliver simple physiotherapy exercises and procedures, speech therapy, dietary and O.T interventions devised for individual service users. The daily records are now more informative and personal. Planned reviews with care managers and other professionals are being undertaken at 6 monthly intervals. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 13 The clinical director and the care staff are now encouraging and supporting the service users to live an independent and active lifestyle as their abilities allow. Risk assessments have been developed, which are individualised and provide information on how to minimise identified risks, they are of a good standard. In the previous report identified risks were inaccurate these have now been reviewed and accurate risk assessments are ready to be implemented. Within the next couple of weeks the clinical director plans to hold a meeting with all of the staff to explain how the care plans and risk assessments are to be implemented. She wants to ensure that the care plans and risk assessments are used as a working document by all the staff. Key-workers will be developing responsibilities to ensure that care plans and risk assessments are implemented, up-dated and reviewed when necessary. By the next visit the inspector envisages these standards will be fully met. The service users at the home all have communication difficulties. During the visit the staff were observed encouraging the service users to be independent as their abilities allow. They were seen to offer choices, with regards to their daily lives and activities. The care staff reported that they know the service users very well and are able to understand, interpret and anticipate many of their needs. It was evidenced that service users are given choices on when they get up, when they go to bed what clothes they wear and if they want to participate in activities or not. The home has now managed to engage independent advocacy services for a service user who has no other representation. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 &, 14. The home is providing the service users with more opportunities and facilities to enable them to develop and maintain an appropriate lifestyle in and out-side the home. Their quality of life is therefore improving. EVIDENCE: Significant progress has been made towards meeting this section of standards. There is still work to do but the home is moving in the right direction. Milestone House continues to develop and improve its activities for the service users both in-side and out-side the home. The increase in the numbers of care staff means that the service users now have more opportunities to go out into the community and use the facilities that are available. Service users go shopping more frequently, go for walks and visit local cafes/pubs. Over the Christmas periods service users went the pantomimes in Canterbury and Folkestone. The staff are recording when service users go out and a record is kept of all activities undertaken. Staff aim to take one service user out on a daily basis as this has been identified as a specific need. The clinical director is aiming for the majority of the service users go out at least twice per week. This has yet to be Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 15 achieved but the staff are working towards this goal. It was evidenced that some of the service users have only been out a few times since the new documentation was commenced. The senior staff need to ensure that time is allocated on a daily basis to allow service users the opportunity to go into the local community and experience different environments and activities. Arrangements have been made for service users to go to a specialist swimming pool once a week. Only one service user can go at a time but the staff hope this increases in the future. Some service users have now started to attend the local disco and local day centre. 2 of the service users attend the local learning disability team day centre and 3 more are waiting to be assessed. The local O.T is also organising for staff from the local disability team to come to Milestone House for 1 morning per week for 8 weeks to work with the activities co-ordinator and other staff and develop individual and group activities. The plan is that these activities will then be maintained, further developed and enhanced. The activities co-ordinator is providing activities in the home and this input will offer support guidance and direction to service users and staff. Staff reported that the service users are now doing a lot more. They said that the service users and the staff are finding the increase in activities and other pursuits beneficial and enjoyable. The staff spoken to are motivated and keen to develop this further and continue to improve the life’s of the service users. The home has now acquired a new vehicle which allows service users to get out and about safely on a regular basis. The clinical director aims to identify at least 4 activities, which each service users enjoys and is able to participate in. These will then form the basis of the service users individual activities programs. Individual programmes have yet to be developed and implemented. The registered manager needs to ensure that service users have the option of a 7 day annual holiday out-side of the home. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 The home provides good personal and healthcare facilities for the service users to ensure the health and welfare of the service users is maximise. The medication procedures and systems at the home have improved. All staff need to ensure that procedures are adhered to. This will reduce the potential risk to service users EVIDENCE: The Home operates a key worker system to provide sensitive and individual support to service users. Personal care, life skills and dignity are promoted. Staff are encouraged to promote a more flexible approach to daily living activities e.g. getting up, bed times, bath and mealtimes. Staff were seen to approach service users in a caring and nurturing manner. It was observed that the service users privacy and dignity was maximised allowing them independence and control of their own lives as their abilities allow. The service users have the equipment they require to maximise independence and have additional specialist support and advise from physiotherapists, Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 17 speech and language therapists O.T’s and others. The equipment problems that were identified at the previous inspection have now been resolved. There is regular input from the G.P.’s and the service users are accessing all the required healthcare facilities from the G.Ps surgery. Annual health checks have been undertaken and medication is reviewed at regular intervals. The home uses a Monitored Dosage System (MDS) from Boots and all staff who administer medication to Service Users have received appropriate training. A list of staff competent to administer medication is kept. Sample signatures are also available. The medication is stored in a drugs trolley and the keys to this are kept on the person who is in charge of the shift. MDS were cross-referenced with MAR sheets and at the time of the visit. It was noted that there were gaps on the MAR sheet for a complete drug round. This indicates the homes policies and procedures were not adhered to during this drug round. This places service users at risk. The issue was discussed with the registered manager at the time of the visit and he is going to address it. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are now protected from all forms of abuse. EVIDENCE: The adult protection investigation at the home has now concluded and the investigation has closed. The adult protection co-ordinator has written to the registered manager to explain the out-comes of the investigations and the action that is required of the home to ensure that it keeps moving in the right direction. All of the funding authorities are aware of the investigation and its conclusion. Care managers will continue to review their service users at 6 monthly intervals to ensure that all the needs of their clients are being met. The local learning disability team now has regular input and contact with the home. On discussion with the care staff it was ascertained that they now have more knowledge on adult protection and adult abuse issues. Some staff have now received adult protection training. The registered manager needs to ensure that all staff are aware of what constitutes forms of abuse and what procedure they must follow. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home is well maintained and decorated to a good standard providing service users with an attractive and homely place to live. EVIDENCE: The accommodation provided is sufficient in space to meet the needs of the service users. 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 accessible to all the service users. Furnishings, fittings, adaptations and equipment are of good quality and suitable for their purpose. The home still has CCTV cameras in some of the communal areas. The registered manager informed the inspector that these cameras are no longer used. To evidence this the cameras do need to be removed. The issue identified at the last inspection concerning the laundry of the service users being gathered in one basket has now been addressed. Service users laundry is now collected in their own individual containers and taken to the laundry room. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 20 This is another aspect, which evidences that the care of the service users is individualised and a person centred approach is being adopted. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 The staff have a good understanding of the service users and positive relationships have been formed. Staff are beginning to receive the supervision and support that they need. An effective staff team now supports the service users. The homes recruitment procedures need to be more thorough to ensure that service users are protected at all times. The home needs to ensure the safety of the service users by providing the required training for the staff. EVIDENCE: The care staff reported that they have developed good relationships with the service users and they are able to anticipate and meet the individual needs of the client group. There are no volunteers going into the home at the present time. It was observed that the staff are accessible and approachable to the service users and are able to exhibit good listening and communication skills. The staff have a good relationship with the homes G.P and positive relationships are being developed with other professionals who are now involved with the service users. The home now employs 18 care staff. 5 have achieved NVQ level2 or above and 9 have commenced training. By the next Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 22 inspection the home should have 50 of the staff trained to NVQ level 2 or above. There has been a significant improvement in the number of staff employed at the home There are now 18 care staff to cover the day and night shifts. The number of staff on each shift depends on the needs of the service users. The manager needs to ensure that the duty rota reflects the actual number of staff working. At the time of the visit the off duty stated that there 4 members of staff on duty when there was 6 staff on duty. 2 members of staff who had taken a service user out had not been included on the duty rota. This gives a false picture and the home are doing themselves a mis-service by not indicating the actual amount of staff on duty. This was discussed with the home manager and the duty rota will be amended to give a more accurate picture. The clinical director is proposing a change in the shift pattern so that a more robust staff hand over can take place. This will hopefully be implemented soon. The staff levels at the home are now regularly reviewed to reflect the service users changing needs. The home no longer uses agency staff. The activities coordinator works between 9.30-5.00 p.m. Monday to Friday. The home also employs a weekend cook. The staff reported that there are now enough staff on duty to meet all the needs of the service users and they are able to ensure that risks are now kept to a minimum. The home has now engaged the services of relevant professionals to assess and support the specialist needs of the service users. Staff meetings have been commenced and it needs to be ensured that these happen at least 6 times per year and are recorded and actioned. The inspector looked at a sample of staff files. It was evidenced that 2 of the care staff team had been employed by the home before a POVA first check had been received. References had not been obtained for another staff member. To ensure that the service users are protected the registered manager needs to have robust recruitment procedures in place that are adhered to at all times. This has been highlighted in the past. Before the inspection was completed on the 26/01/06 the out-standing POVA checks had been obtained and the inspector was able to see them. The homes administrator is going to chase the out-standing references. The registered manager also needs to make sure that no member of staff is working unsupervised prior to a full CRB check. The inspector was able to see a training matrix. Gaps were identified in mandatory training especially infection control and first aid. Dates had been booked for health and safety. The registered manager needs to ensure that all training is up-to date and on-going. Staff also need specialist training that is specific to the needs of the service user in their care. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 23 Formal supervision has commenced. Not all staff have received supervision to date. The aim is that all staff will have received a minimum of 6 supervisions within a year in addition to regular contact on day-to-day practise. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 & 42. The management structure at the home now ensures that there is leadership, guidance and direction to ensure the service users receive a consistent and good quality of care. Quality assurance and monitoring needs to be further developed to ensure the aims and objectives of the home are being met and the views of the service users/representative are acted on. The home on the whole now provides a safe environment for residents, however the gaps in mandatory training and does put residents and staff at risk. EVIDENCE: Since the last inspection the registered manager/registered provider has employed a new clinical director. The new clinical director has a wealth of knowledge, skills and experience in the field of learning disabilities. She is making good progress in introducing new structures and systems into the home to ensure that all the individual complex needs of the service users are Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 25 met. These are inline with the recommendations made following the adult protection investigation and action plan. The majority of her time so far has been spent developing individual care plans and risk assessments. Engaging services for specialist interventions, introducing a more robust system to ensure that activities and other pursuits are developed and implemented. Developing and educating the care staff team so that they are effectively meeting the individual needs of the service users and are working towards a person centred approach. The inspector does recognise that a lot of progress has been made in a few months and recognises the challenges of this position. The management team of Milestone House are now working towards meeting the aims and objectives as set out in their statement of purpose and are making progress in meeting all the National Minimum Standards. The registered manager needs to ensure that this work continues. The registered person needs to develop systems, which provide a measure on the effectiveness of the service. The home needs to be able to identify whether they are meetings their aims and objectives and develop systems for continuous self monitoring of the services they provide. The home had started to develop quality assurance and quality monitoring systems. The views of the families had been sought by sending out questionnaires. The home needs to make sure that this is followed up. The registered manager also needs to seek the views of the service users /representatives/advocates and other professionals or services that have input into the home, so results can be acted upon and out-comes achieved. . The registered person needs to develop systems, which provide a measure on the effectiveness of the service. The home needs to be able to identify whether they are meetings their aims and objectives and develop systems for continuous self-monitoring of the services they provide. The home needs to update and provide all staff with mandatory training. Safety checks with regard to the servicing of hoists, electrical installation, gas boiler and fire equipment are up to date. A fire drill was due. The registered manager needs to ensure that water temperatures are checked on a regular basis. This will evidence that the thermostats, which are in place, are working effectively. The home and environment is well maintained. Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 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 X 2 1 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 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 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 1 X X 2 X Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 27 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 YA2 Regulation 14(1) Requirement New service users are admitted only on the basis of a full comprehensive assessment. A copy of the assessment needs to be kept on the service users file and should be used to develop an individual care plan. Evidence of the assessment needs to be available. All care plans need to be completed and implemented. Staff need to use the plans as a working document to ensure all the needs of the service users are met. Risk assessments need to be completed and implemented. Staff need to ensure that risk assessments are adhered to and risks to service users kept to a minimum. (Outstanding requirement from the previous 2 inspections. Timescale of 30/11/05 not met) Activities in the home need to continue to develop for all the service users. Individual activities programmes need to be in place and implemented. (Outstanding requirement from DS0000023751.V267449.R01.S.doc Timescale for action 28/02/06 2 YA6 15 31/03/06 3 YA9 13(4) 31/03/06 4 YA12 16(2)(n) 31/03/06 Milestone House Version 5.1 Page 28 5 YA13 6 7 YA32 YA34 8 YA35YA42 9 YA39 the previous 2 inspections. Timescale of 30/11/05 not met) 16(2)(m) To make arrangements for all service users to engage in local, social and community activities. (Outstanding requirement from the previous 2 inspections. Timescale of 30/11/05 not met) 18(1)(a) 50 of staff need to be trained Sch.2 (4) to NVQ level 2 and above. 19 No care staff should be working at the home until the required CRB/POVA checks and references have been received. 18(1)(c) The registered person needs to ensure that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’. (Out-standing requirement from the previous inspection Timescale of the 30/09/05 not met) 24(1)(a)(b) Effective quality assurance and (2)(3) quality monitoring systems, based on seeking the views of service users/representatives, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 31/03/06 30/06/06 31/01/06 30/04/06 30/06/06 Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA5 Good Practice Recommendations The registered manager develops and agrees with each prospective service user an up-dated written and costed contract/statement of terms and conditions between the home and the service user. The home needs to ensure that service users have facilities for recreation and leisure. Each service users has the option of a 7-day annual holiday out-side the home. The registered manager needs to ensure that all staff adhered to the homes procedures when administering medication. 2 3 YA14 YA20 Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milestone House DS0000023751.V267449.R01.S.doc Version 5.1 Page 31 - 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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