Inspection on 25/07/06 for Milestone House

This inspection was carried out on 25th July 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 13 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 23/01/06

Milestone House 19/01/05

Milestone House 14/09/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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 25th July 2006 09:30 Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milestone House DS0000023751.V297324.R01.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 James Neil Martine Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 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 permanent service users and one respite service user 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 ensuite 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 well maintained. Milestone House is owned by Mr Nicholas Martine who is also the Registered Manager. There is a deputy manager, 17 care staff, a full time administrator, a cook, housekeeper and maintenance worker. The current fees for the service range from £661.33 to £1223.81. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. . Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over one day. All the key standards were looked at during the visit and the inspector gave special attention to the requirements and recommendation identified in the previous report. Some of the requirements and recommendations made at the last inspection remain out-standing. The home continues to improve the service offered to the residents, however there is still a way to go before all the National Minimum Standards are met. Since the last inspection the homes clinical director has left and also the administrator. The registered manager has employed a new administrator who has skills, knowledge and experience in the learning disability field. She will assist in developing the service and the care it provides. The care staff structure at the home has now been stable for some time and this has had a positive effect on the service users. The staff the inspector spoke to are very positive and optimistic about the future of the home. It was observed that the staff have a good relationship with the service users and they were seen to interact in away that was sensitive, caring and respectful. The service users are well kept and dressed appropriately in keeping with their personalities. The staff on duty at the time of the visit were helpful and co-operative. During the inspection the atmosphere in the home was calm and service users appeared content and relaxed. There has been one adult protection concern raised since the last inspection. The registered manager investigated this as directed by the adult protection co-ordinator. The following methods of inspection and information gathering were used: one-to-one discussion with staff, communicating with service users, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes. The pre-inspection questionnaire was returned and comments were received from professionals who have in-put into the service. What the service does well: The staff do meet the physical and healthcare needs of the service users, there is regular input from the local specialist team and G.P appointments are frequent. The care staff on duty were seen to interact with the service users in a respectful and caring way. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 6 The staff are good at providing basic care to the service users, e.g. preventing pressure areas developing, ensuring that service users are well kept at all times. 7 of the present 10 residents are wheelchair users. The home now has a consistent and stable team of care staff who know the service users very well and have the skills to anticipate and interpret their needs. Milestone House provides a pleasant, safe, and well-maintained environment for service users to live in. The home is clean and there are systems in place to control the spread of cross infection. What has improved since the last inspection? What they could do better: Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 7 The home still needs to evidence that they have the systems and procedures in place to undertaken a full and thorough 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. Work has started on this but it is yet to completed. As previously mentioned all the care plans and risk assessments have been completed and implemented. The registered manager now needs to ensure that these are kept up to date to reflect the changing needs of the service users. The registered manager also needs to ensure that the staff are using them as a daily working document. Each of the service users has an individual activities programme in place and reports from staff and other agencies say that the service users are now doing a lot more. However there does need to be further developments to ensure that staff meet the individual needs of the service users taking into account their capabilities, likes and dislikes. There was evidence to show that the programmes were not being adhered to and activities and leisure pursuits are not taking place. All staff spoken said that they would like to do more with the service users but often there was not enough staff on duty or there was no driver available or on occasions they were told not to take service users out because of the weather conditions. The care staff work in a very task orientated way and routines are adhered to. There needs to be more flexible working to ensure that the home develop a person centred approach to care. The home needs to evidence that they are providing a healthy and varied diet that meets the individual needs of the service users. A dietician has been contacted and staff are awaiting her visit to seek advice and support on how to undertake this task effectively. From looking at the duty rota and from speaking to staff there was evidence to show that there is not always enough staff on duty to meet the complex needs of all the service users. The home is now caring for an extra service user with complex physical, social and psychological needs however this was not reflected in the staffing numbers at the home. Once again it was evidence that the home are not adhering to policies and procedure concerning recruitment of staff. The registered manager still needs ensure that all staff have received the necessary training both mandatory and specialist so they have the competences and skills to work safely at the home. The staff also need to receive the necessary supervision and support to undertake their roles effectively. The registered manager also needs to ensure that the staff undertaking the role of supervising have the training and skills to do so. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 8 Quality assurance and monitoring systems need to be developed so the management can measure the homes success and identify weakness. This will ensure the on-going improvement of the service Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 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.V297324.R01.S.doc Version 5.2 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): 1,2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. 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: The home has a Statement of Purpose and Service User Guide. These documents have information about what facilities and services the home has to offer. The Service Users Guide is well written and informative. This now needs to be developed into a format which is suitable for whom the home was intended. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 11 As highlighted at the last inspection the registered manager does need to have policies and procedures in place to ensure that service users are only admitted following full and comprehensive assessment undertaken by people competent to do so. The registered manager needs to develop systems and tools that will assist in undertaking initial assessments in an efficient and effective way. This will ensure that the home can meet all the needs of the prospective service user. The staff will then be able to develop and implement a robust care plan. The registered manager continues to work towards completing contract/terms and conditions of residency for all the service users. He is still in the process of reviewing all the contracts with the funding authorities and is hoping to negotiate new contracts. The home is now able to provide a breakdown on the fees charged what they cover when they must be paid and by whom. The registered manager needs to gather 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.V297324.R01.S.doc Version 5.2 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care plans and risk assessments are of a good standard. However service users cannot be sure that all their changing needs will be identified and met and that all risks are identified and minimised. Service users need to be able to make more decisions about their own lives. EVIDENCE: Each of the residents has a care plan, the inspector looked at 5 plans. The care plans are written to a good standard and are easy to understand and follow. They contained all the relevant information to allow staff to meet the complex needs of the service users. The inspector was able to cross-reference the plans with other documentation to ensure that they are being used effectively. Some staff reported that they used the plans on a regular basis but other staff did not know what information was in the plans. Care staff also reported that they often are not kept up to date on events that had happened at the home on the previous shift. The registered manager needs to ensure that all staff understand and effectively use the care planning system. It was noted that relevant information is often logged in the staff communication book and this Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 13 information is not then transferred into the daily records. It was also evidenced that the care plans are not being up-dated on regular basis to reflect the changing needs of the service users. The care plans were compiled in February /March ’06 and have not been reviewed since, needs of some of the service users have changed in this time. The registered manager needs to make sure that care plans are up-dated on a regular basis. The staff are filling in daily records but the information being documented is the same every day. It does not give a true picture of what is happening with service user throughout the day. Behaviours are not being recorded, moods and social interactions are not been recognised. The staff need more direction, guidance and training on how to record daily events and use the care plans effectively. Risk assessments are now in place for all the service users. As with the care plans they need to be up-dated and reviewed when necessary. It was evidenced that some new risks had been identified for some service users. For one service user a robust risk assessment had been but in place to minimise the risk of bruising. However this was not consistent. Another service users had spent a few days in hospital following a physical problem but no risk assessment had been put in place to give the staff the information and guidance on what to do to reduce the risk of further hospitalisation. All service users at the home have communication difficulties. The care staff reported that they know the service users very well and are able to understand, interpret and anticipate many of their needs. The staff are able to explain how they assist and support service users in making decisions and know when they like things and when they don’t. Through observation and talking to staff it was seen that service users are given choices on when they get up, when they go to bed, what clothes they wear. The home is developing ways to show whether or not service users enjoyed an activity. This can be further developed to show how service users make decisions about the food they eat and other areas of daily living. The registered manager needs to be able to show why sometimes decisions are made by other and the reasons why. The home has now managed to engage independent advocacy services for a service user who has no other representation. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. The quality of life is improving but more work needs to be done. The home needs to be able to demonstrate that they have a varied menu and that service users are offered choices. . EVIDENCE: All the service users living at Milestone House have complex physical and learning needs. The level of activities that can be undertaken is varied and needs to be individually tailored. At the time of the visit it was evidenced and observed that activities, community presence, and leisure pursuits have improved since the last inspection. Feedback from visiting professionals Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 15 supported this view, as did reports from staff. However the home does have more work to do before this standard is completely met. Each of the service users at the home now has an individual activity programme. When these were cross-referenced with daily activity records it was evidenced that planned activities are regularly not taking place. Sessions at the specialist learning disability had not been attended; the inspector was informed that this was because they had not been booked. Staff reported that other activities and leisure pursuits had not taken place because there was not enough staff on duty or there was no driver available. The registered manager needs to address all these issues to ensure that activities and leisure pursuits are planned for well in advanced and that there are staff/drivers available. The registered manager needs to monitor that activities are happening. The inspector was surprised to find that an out-door activity was considered a walk around the garden. The day of the inspection was very warm and had been for some weeks. It was surprising to find that there was no indication that the garden was being used for out-door activities. When the inspector asked about out facilities such as umbrellas, out-door tables or a paddling pool the information given was that there are some somewhere but no one knew where. The staff need to evidence that they are encouraging and supporting the service users to participate in meaningful activities and leisure pursuits. The home also needs to evidence that the service users have a choice about what they do and if someone decides not to do an activity the staff need to be able to evidence how that decision was reached and what alternatives were offered. The home had just started collecting evidence to ascertain the activities service users enjoy and benefit from. The staff are completing 3 different sets of records around activities and leisure pursuits and this seems to have confused the issue. This was discussed at the time of the visit and will be addressed. The occupational therapist from the local learning disability team has been coming into the home to assist staff and service users in developing activities. There are plans to take some of the service users ice-skating in the not too distant future. The activities co-ordinator is organising for more out-side agencies to come into the house and provide activities and leisure programmes. One service user had recently attended the circus and really enjoyed the experience. Another service user reported that she enjoyed attended the local day centre. Service users have still not been offered the opportunity for a seven day holiday out-side the home. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 16 The registered manager needs to ensure that there is a consistent approach to assisting service users to undertake a fulfilling lifestyle in –side and out-side the home. The service users are encouraged to maintain contact with there families. One service user goes home for regular weekend visits. Members of staff were observed demonstrating good body language and communication skills. They were seen to talk and interact in a positive way; they involved and included service users in conversations. The staff on duty at the time of the visit were respectful and caring Service users do have private and quiet times throughout the day when they are alone in their rooms. The home has recently employed a new cook who has only been at the home for 10weeks. She works Monday –Friday 8-2pm and Saturdays 8-1pm. There is a 5-week menu rota a home. The meals provided are nutritious and healthy. The service users at the home require very varied and specific diets to meet their individual needs.2 of the service users are at risk of when eating meals and there are specific guidelines in place on how they should be fed. These do need to be reviewed as the inspector was informed that these are not the original ones devised by a specialist. It was noted that some service users are having ‘small potions’ at meal times in order to reduce their weight. This was done without consultation with a dietician. There is no record kept of the meals eaten by service users except for the snack offered at suppertime. There is no evidence to demonstrate that service users are offered a choice of meals. The home is awaiting a visit from the dietician who is going to review everyone’s dietary needs. This will resolve the above issues when the visit has taken place. It was reported and evidenced that all the service users at the home enjoy their meals and plates are always empty. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 home does need to ensure that routines are flexible and individual preferences are taken into account. The medication procedures and systems at the home have improved and are now well managed. EVIDENCE: The Home operates a key worker system to provide sensitive and individual support to service users. Service users are well dressed in clothing appropriate for the season and appear well kept. Staff were observed assisting service users in a flexible and supportive manner and were seen treating the service users with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 18 Through observation and talking to staff it was evident that daily routines are very task orientated. One service users does have a very individual routine and this has been developed because she is able to communicate her wishes to staff. Work needs to be done on developing preferred routines for all service users taking into account likes and dislikes needs and preferences. Service users at the home do have limited communication skills but staff have a good understanding and rapport with all the service users and with input from families/representatives/other professionals the home will be able a more person centred approach to care. The service users have the equipment they require to maximise independence and have additional specialist support and advise from physiotherapists, speech and language therapists and O.T’s. The service users are waiting for a visit from the dietician to review dietary intake eating and develop eating plans to suit the individual needs of the service users. Some of the service users have specialist programmes, which have to be implemented by the staff. Fed- back from professionals indicated that some of the programmes were implemented to high standard were as other were not adhered to. The registered manager needs to ensure that there is a consistent approach by the staff and that all programmes are implemented. The home ensures that the service users have access to healthcare facilities and routine checks are carried out frequently. Service users health care needs are monitored and they are promptly referred to professionals when necessary. A member of staff accompanies service users when they are attending appointments and visits from healthcare professionals are conducted in private. A medical report sheet is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments The home uses a Monitored Dosage System (MDS) from Boots and all staff that 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 crossreferenced with MAR sheets at the time of the visit and these tallied. As required protocols have been developed for oral medication this now needs to be extended topical creams. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. Service users are protected from harm and abuse EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home and staff are aware of how to make a complaint. There is a copy of the complaints procedure in the service users guide service. Due to the learning disabilities of the service users they would need representatives/advocates to undertake a complaint for them. The complaints procedure needs to be displayed in a more prominent place within the home and could do with being written in larger print. Its positioning at the moment is high up and difficult to read. This was discussed with the homes administrator and she is going to address this issue. The home have not received any complaints since the last inspection. The home has the appropriate Adult Abuse policies in place and also a Whistle Blowing Policy. The staff are aware of the policy, feel confident to use it if necessary and knew the appropriate action to take if they had to do so. Any incident pertaining to abuse or potential abuse would be followed up immediately and all action taken recorded. The registered manager is very aware of all adult protection policies and procedures. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 20 There has been 1 adult protection issue since the last visit which was brought to the attention of the adult protection co-ordinator. The registered manager was advised to undertake an investigation within the home. The registered manager has done this to a satisfactory conclusion. The staff have also used the adult protection issue and its outcome to improve practises within the home. All staff need to receive adult protection/POVA training. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and decorated to a good standard providing service users with an attractive and homely place to live. The service users are provided with a home that is clean and hygienic. Procedures are in place to prevent the risk of cross infection. 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. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 22 The home still has CCTV cameras in some of the communal areas. The inspector was once again informed that these cameras are no longer used. To evidence this cameras do need to be removed. The laundry room has all the facilities needed to wash soiled and infected linen. The home has 2 new washing machines with sluicing facilities. Soiled linen is transported in red bags and put straight into the machine. The bags are transported through the lounge area of the home. The deputy manager is going to other ways the laundry can be taken to the laundry room without intruding on the service users. Disposable gloves and aprons are available and worn and liquid soap and disposable towels are sited in the necessary areas. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 23 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the service users and positive relationships have been formed. The care staff group within the home is now stable. Not all service users needs are met due lack of staff training, numbers of staff and lack of support and supervision. Recruitment policies have not been consistently followed resulting in service users receiving care from staff who have not been properly vetted. EVIDENCE: The staff reported that they have developed good relationships with the service users and they were able to anticipate and meet the individual needs of the client group. Service users responded positively to staff. 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 registered manager needs to ensure that the staff work towards meeting the main aims and objectives of the home as documented in the statement of purpose. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 24 Since the last inspection the home has made good progress in meeting the standard, which requires 50 of the care staff to have achieved NVQ level 2 or above. There are 19 care staff (including the activities co-oridinator) employed by the home plus a cook and a domestic. 11members of the care staff now have NVQ level 2 or above. The staff team at the home has now remained stable for period of time, which has been beneficial for the service users. The registered manager does need to regularly review the staffing levels at the home to ensure that all the needs of the service users are meet at all times. There are 4 staff members on the a.m shift and usually 4/5 on the p.m shift. The staff reported and there was evidence to show that this is not enough staff to meet all the needs of the service users throughout the day. Most of the service users need 2 staff members to take them out which would then leave only 2/3 members of staff to tend to the remaining service users. Most of the service users at the home require 2 staff members to attend to any personal care need. The deputy manager is looking at bringing in extra staff at specific times during the day to ensure that activities and other pursuits are undertaken. This needs to be implemented. Milestone House presently has a service user on respite care. There is no indication that staffing levels were reviewed and increased to meet the specific and complex needs of this service user. Staff did report that at times they do not receive enough specific information about the service users. They said they are not given a proper handover when they arrive for duty so have little idea what happened on the previous shift and what the need to do on their shift. They feel that information is lost. The registered manager does need to improve the systems for cascading information to all staff. The inspector did note that there have been occasions when a female service user has been taken out in the minibus by 2 male carers. The home should consider the need for a gender mix when taking service users out. The staff are not having regular team meetings in which matters can be discussed and addressed. The last meeting was on the 23rd February ’06. The registered manager needs to ensure that these are implemented at least 6 times per year. A record needs to be kept and out-comes actioned. Recruitment procedures at the home are more robust but the registered manager still needs to ensure that all staff are fully vetted before they start work. 5 staff files were looked at. On 2 of the files there is only 1 reference and these are not from previous employers. There are also gaps in employment history, which had not been explored at interview. Staff file also needs to contain a photo of the staff member. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 25 The inspector was able to see a training matrix. There has been significant improvement in the training provided. However gaps were still identified in mandatory training. 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. Formal supervision has commenced. All staff need to have received a minimum of 6 supervisions within a year in addition to regular contact on day-to-day practise. Supervision also needs be undertaken by persons who have the competencies and skills to do so. The evidence indicated that staff giving supervision were unaware of the aims and objectives of supervision and had not received the appropriate training. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 26 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users cannot be sure that there is a consistent management systems and approaches in place to ensure that the home is meeting its aims and objectives. 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. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager of the home is also the registered provider. He has achieved the required NVQ level 4 award in management and care. Since the last inspection the clinical director has left the company and the registered manager/registered provider has employed a new assistant/administrator to help him keep the home moving in the right direction. She has only been at the home for a few weeks but already has a good understanding of what needs to achieved, however it will take some time before she can look at all the issues that need to be addressed. This lady also has a lot of experience, skills and knowledge in the field of learning disabilities and has been the registered manager of a home. The home is once again in the same position it was a year and there has been some slippage in maintaining standards. It was evidenced at the visit that deputy manager is struggling to undertake the task of care planning, risk assessments, the daily problems of the home and provide hands on care. The registered manager needs to ensure that she is given support and assistance she needs to undertake her role effectively. The registered manager needs to inform the management team of their role and responsibilities and also inform them of his role and responsibilities. Everyone will then know what they are supposed to be doing. Roles and responsibilities are blurred. Visiting professionals to Milestone House reported that the home is now more open and transparent. The home have started to develop quality assurance and quality monitoring systems. The views of the families had been sought by sending out questionnaires. 7 out of 10 questionnaires were returned and all these were positive. The registered manager also needs to seek the views of the service users /representatives/advocates staff and other professionals or services that have in-put into the home, so results can be acted upon and out-comes achieved. 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 necessary mandatory training. Safety checks with regard to the servicing of hoists, electrical installation, gas boiler and fire equipment are up to date. Fire checks have been done at the required intervals. The home are going to be visited by ‘Fire Co’ on the 31/07/06. They will be implementing the new fire regulations and carrying out a full audit and risk assessment on the fire systems in the house.. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 28 Water checks are now being undertaken at regular interval but temperatures were not being recorded so there was no way of evidencing the actual temperature. Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 3 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 3 33 1 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 3 1 X X 2 X Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 30 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. (Outstanding requirement from the last inspection. Time scale of the 28/02/06 not met) All care plans need to be reviewed and updated when necessary to reflect the changing needs of the service users Daily records need to contain relevant information about the day of the service users. The home needs to develop a person centred approach to care. Staff need to use the plans as a working document to ensure all the needs of the service users are met. DS0000023751.V297324.R01.S.doc Timescale for action 30/10/06 2. YA6 15 31/10/06 Milestone House Version 5.2 Page 31 3. YA9 13(4) Risk assessments need to be up dated when necessary Staff need to ensure that risk assessments are adhered to and risks to service users kept to a minimum. Activities in-side and outside the home need to continue to be developed for all the service users. Individual activities programmes need to be in consistently implemented. (Outstanding requirement from the previous 3 inspections. Timescale of 31/03/06 not met) To ensure that arrangements for all service users to engage in local, social and community activities are undertaken. (Outstanding requirement from the previous 3 inspections. Timescale of 30/11/05 not met) To ensure that the dietary needs of all the service users are met. To consult with the dietician to ensure that the correct balance of diet is been given in the safest possible way. Service users need to have choice and a record kept of food that is eaten. Staff need to offer a person centred approach to meeting the needs of the service users to maximise service users’ privacy, DS0000023751.V297324.R01.S.doc 31/10/06 4. YA12 16(2)(n) 31/08/06 5. YA13 16(2)(m) 31/08/06 6. YA17 16(2)(i) Sch.3 (3)(m) Sch4 (13) 31/08/06 7. YA18 12(2) 31/10/06 Milestone House Version 5.2 Page 32 8. YA33 18 dignity, independence and control over their lives. The home needs to ensure that it has sufficient numbers of staff on duty at 31/08/06 each shift to meet all the needs of the service users.Staffing levels need to be regularily reviewed to reflect the changing needs of the service users. Staff need to receive the relevant information to allow them to carry out their roles effectively from one shift to another in order to meet the needs of the service users. The staff need to have regular team meetings. (6 per year) All staff working at the home should have 2 references and ensure that full employment histories are obtained and any gaps in employment investigated and a record kept. 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) 9. YA34 19 31/08/06 10. YA35 18(1)(c) 31/10/06 11. YA36 18(2) All staff need to receive 30/09/06 supervision (a minimum of 6 times per year) Staff who DS0000023751.V297324.R01.S.doc Version 5.2 Page 33 Milestone House 12. YA39 supervise colleagues need to have received appropriate training 24(1)(a)(b)(2)(3) Effective quality assurance 30/11/06 and 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. (Outstanding requirement from previous inspections. Timescale of the 30/06/06 not met) 18(1)(c) The registered person needs to ensure that all staff have received the required mandatory training within the required timescales and that it is up-dated when necessary. (Out-standing requirement from previous inspections. Timescale of the 30/04/06 not met) 31/10/06 13. YA42 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 registered manager needs to be able to evidence why decisions are sometimes made by others and the reasons DS0000023751.V297324.R01.S.doc Version 5.2 Page 34 2 YA7 Milestone House 3. YA14 why. The home needs to ensure that all service users have facilities for recreation and leisure. Each service users has the option of a 7-day annual holiday out-side the home. Staff need to offer a person centred approach to meeting the needs of the service users to maximise service users’ privacy, dignity, independence and control over their lives. To consistently implement specialist programmes. The registered manager needs to develop protocols for the administration of topical creams that need to be administered on a when required basis. To ensure that the service users have a gender mix of staff attending to their needs. The registered manager needs to ensure that the home is well run by informing the management team of their roles and responsibilities and the role and responsibility of the registered manager. 4 5. 6 YA18 YA18 YA20 7. 8. YA33 YA37 Milestone House DS0000023751.V297324.R01.S.doc Version 5.2 Page 35 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.V297324.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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