Inspection on 08/10/07 for Milestone House

This inspection was carried out on 8th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 25/07/06

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 Key Unannounced Inspection 8 &10th October 2007 10:00 th Milestone House DS0000023751.V348639.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.V348639.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.V348639.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 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.V348639.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th March 2007 Brief Description of the Service: Milestone House is registered to provide 24-hour residential care for up to 13 adults with learning difficulties/physical disabilities. At present there are 8 people living at the home. 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 twothirds of an acre of grounds. There is a large, secure car parking area to the front of the house. The accommodation is arranged over two floors and there are 12 en-suite bedrooms 10 of these being on the ground floor. The communal space includes a large lounge, dining room, a conservatory and quiet room. At the rear of the property there is a large secure garden, which is well maintained. Mr Nicholas Martine is the owner and the Registered Manager of Milestone House. The current fees for the service range from £949.76 to £1691.27 per week Information about the Home and the CSCI reports are available for prospective residents. Milestone House DS0000023751.V348639.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 on the 8th and 10th October ‘07. All the core standards were looked at during the visit and special attention was paid to the requirements and recommendation identified in the previous published report. In March ’07 a random inspection was carried out. The reason for this inspection was to check on the homes compliance with the statutory requirements and recommendations made at the Key Inspection held on 25th July 2006. The home had made progress in meeting the standards but there was still work to do. However, due to unforeseen circumstances the management has been not been able to continue to move the home in the right direction and there has been slippage in the progress. Milestone House is making slow progress in meeting the National Minimum Standards. The service does not always act on and change practises that have been identified as shortfalls in previous reports. Old ways of working keep resurfacing and affecting the standard of care delivered to the people living at the home. The following methods of inspection and information gathering were used: At the time of the site visit there was communication with residents, one-to-one discussion. care staff and management. Staff interactions with residents, care interventions and activities were observed. Individual support plans risk assessments were discussed. Selected policies, medication charts, training matrix and training programmes and financial arrangements were looked at. The service had filled out a quality assurance document prior to the site visit and information from this is used in the report. Information from the random inspection was also considered. Feed-back was received from visiting professionals. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Each of the residents now has a new contract, which tells them how much they pay to the service for the care they receive. Care plans and risk assessments are in place and have recently been reviewed by the registered manager. They now need to be used by the staff. The registered manager has accessed the assistant of an independent consultant who has visited the home on several occasions since the last inspection. She has offered assistance and advise to the registered manager and staff on how to move the service in the right direction. There are more in- house activities provided for residents. Staff said that they have received more training. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 7 What they could do better: There needs to be consistent, efficient and effective management within the home. The registered manager needs make sure that the residents/representatives know what is included in the fees and what will cost extra. All the contracts need to be signed. As previously mentioned all the care plans and risk assessments have been completed and reviewed. The registered manager now needs to ensure the staff are using them effectively on a daily basis. All the information on each resident needs to be brought together to enable staff to work with the residents in an individual and person centred way. The registered manager/provider needs to ensure that the systems involving the transfers of monies and finances of the residents are clearer and more transparent. There needs to be a break-down of the fees charged by the service stipulating what they pay for and how much e.g. if residents have to pay for the use of transport and what they pay. This issue has been referred to the local safeguarding adult co-ordinator. Since this issue was identified the registered manager/provider has sought the advice and assistance from a firm of accountants. More activities need to take place out side the home. All staff spoken said that they would like to do more with the residents but often there is not enough staff on duty or there was no driver for the mini bus. The home does need to evidence how it offers choice to the residents. There also need to be enough staff on duty at all times. Once again it was evidence that the home are not adhering to policies and procedure concerning recruitment of staff. The registered manager still needs to evidence 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 needs to develop and implement quality assurance systems and audits to ensure that the needs of the residents are being fully monitored and met. Systems also need to be in place to make sure that safety checks are undertaken at the required intervals. At the time of the inspection records pertaining to residents and the environment are being completed on an ad-hoc basis or not at all. This leaves residents at risk. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 8 A lot of the shortfalls identified in this report have been identified in the previous inspection reports Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milestone House DS0000023751.V348639.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.V348639.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People who use the service experience good outcomes in this area Prospective residents have access to adequate information about the home and there are assessments tools in place to assess any potential new residents. Residents/representatives need to know what they are paying for and what is not included in their fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service users guide, which contains the necessary information regarding Milestone House; it’s facilities and other aspects of the service. The guide aims to provide all the information that prospective clients/representatives would need to know before coming to the home. This now needs to be developed into a format, which is suitable for residents for whom the home was intended. There have been no new admissions to the home. Since the last key inspection the home has developed assessment procedures. They now have the tools in place to undertake full and comprehensive assessments when the need arises. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 11 The manager needs to ensure that someone with the necessary skills and knowledge will undertake any assessment. The registered manager has now reviewed all the contracts with the funding authorities and has negotiated new terms and conditions. The contracts are in place but now need to be signed by the residents/representative and the registered manager. The registered manager needs to ensure that there is a breakdown on what the fees cover when they must be paid and by whom and also the cost of any extras. e.g. what does the company charge individual residents for the use of the homes transport? Milestone House DS0000023751.V348639.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience adequate outcomes in this area Residents cannot be sure that the information on how to meet their needs is used on a daily basis. They need to be able to make more decisions about their own lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans were looked during the inspection. The care plans and risk assessments are of a good standard and had been reviewed by the registered manager in July ‘07. However, they had just been placed in the care file along with the old plans. It was evidenced the plans are not used as a daily working document. The care staff team confirmed this. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 13 Information about the care and support and the daily lives of the residents is kept in various files. There are separate folders for care plans, daily records and activities. The daily record file is limited to meeting basic needs. The activities records informs on the activity undertaken with no record on whether it was successful liked or disliked or what effect it had on the individual resident. They do not give a picture of what is happening residents throughout the day. There has been some steps made towards developing a person centred approach to care. Some residents now have a personal plan which has been done in conjunction with their key- worker and the ones seen contained good individual information. However, care staff are not the using the information. Due to lack of management guidance and training care staff are floundering on how to use the information effectively. Behaviours are not being recorded, and social interactions are not been recognised. The staff still need more direction, guidance and training on how to record daily events and use the care plans effectively. The home does need to continue to develop a more person centred approach to care. Key working needs to be further developed and promoted. Care needs are still being met in a fragmented and task orientated way. This was discussed with the registered manager at the visit. To achieve all of this there needs to be effective communication between all levels of staff working at the home. Risk assessments are now in place for all the residents and these have been reviewed. As with the care plans they need to be used by the staff to enable residents to take risks while keeping them as safe as possible. Staff need to realise that more emphasis is put on enabling people rather than restricting them. All the people living at the home have difficulty communicating. The care staff reported that they know the residents very well and are able to understand, interpret and anticipate many of their needs. The service recognises the right of individuals to make their own decisions and choices. This does not always happen in practice as staff have a limited understanding of how to do this effectively. There is some evidence that individuals are involved in some decision making about the home, such as day to day living and social activities. E.g. on when they get up when and how they go to bed, what they watch on T.V. However, areas where individuals can affect change are limited. The registered manager needs to be able to show why sometimes decisions are made by others and the reasons why. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, 16 and 17. People who use the service experience adequate outcomes in this area The home is providing the residents with more opportunities and facilities to enable them to develop and maintain an appropriate lifestyle in -side the home They do need to do more in the community. The quality of life is improving but more work needs to be done. The home needs to be able to demonstrate that residents are offered choices at meal times and that they are eating good and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at Milestone House have complex physical and learning needs. The level of activities that can be undertaken is varied and needs to be Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 15 individually tailored. At the time of the visit it was evidenced and observed that activities, leisure pursuits have improved and that there is more happening within the home on a regular basis. Feedback from visiting professionals and staff supported this view. The conservatory area is now being used for in house activities with smaller groups of people. The ‘rest’ room is being developed now being used for other activities like aromatherapy. More use is being made of the different areas of the house Each resident has an individual activities plan and the activities co-ordinator endeavours to ensure that planned activities do take place. However it was evidenced that at times this was restricted due to there not being enough staff on duty or because there was no –one available to drive the mini bus. It was also evidenced that some of the residents could not use the mini bus, as it did not have the appropriate safety harnesses in place. This was reported by visiting professionals and staff as an on-going problem, which needs to be rectified. There was also evidence to show that activities away from the home e.g. swimming sessions, attending day centres, day trips out were not happening because there are problems with the homes transport arrangements and problems booking taxis. The registered manager needs to address these issues. Activities are being recorded but there was no indication as to whether they were successful or enjoyed liked or disliked. As discussed earlier in the report all the information on residents need to be brought together so needs are being met in person centred way The home also needs to evidence that the residents 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 has started collecting evidence to ascertain the activities residents enjoy and benefit from. Some out-side agencies come to the home and offer aromatherapy sessions and arts and crafts. Residents have still not been offered the opportunity for a seven-day holiday out-side the home. 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 residents are encouraged to maintain contact with there families. One resident goes home for regular weekend visits. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 16 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 residents in conversations. The staff on duty at the time of the visit were respectful and caring Some residents do have private and quiet times throughout the day when they are alone in their rooms. The home has recently employed a new cook. She works 5 days a week and has become a valuable member of the team. There is a 4-week menu rota at the home. The meals provided are nutritious and healthy. There is also a weekend cook. The majority of meals now take place in the dining room. The residents require very varied and specific diets to meet their individual needs. Two of the residents are at risk of when eating meals and there are specific guidelines in place on how they should be fed. Since the last inspection there has been a visit from the local dietician. It was reported that her input was minimal and she made little changes to the diets of the residents. The diets of the residents do need to be kept under review. The service now has the documentation in place to keep a record of the dietary intake of residents. However, these are being used on an ad-hoc basis. Sometimes staff are filing them in and sometimes they are not. The registered manager needs to ensure that accurate records are kept. There needs to be systems in place to check that documentation is being completed and that staff are accountable. There is no evidence to demonstrate that residents are offered a choice of meals. It was reported and evidenced that all the residents at the home enjoy their meals and plates are always empty. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience adequate outcomes in this area. The residents receive adequate personal support but not all their health needs are monitored. The home’s procedures for dealing with medication do not adequately protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents are well dressed in clothing appropriate for the season and appear well kept. Staff were observed assisting residents in a flexible and supportive manner and were seen treating the residents 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.V348639.R01.S.doc Version 5.2 Page 18 The service operates a key worker system, which aims to provide sensitive and individual support to the people living at the home. Work has started on developing a more person centred approach to care. The registered manager needs to ensure that this work continues and is further developed. He then needs to make sure a person centred approach is fully implemented and that staff have the understanding and skills to do this successfully. Through observation and talking to staff it was evident that the home is moving towards making daily routines more flexible. The staff team need to continue to do this and identify preferred routines for all residents taking into account likes and dislikes, needs and preferences. The residents have the equipment they require to maximise independence and have additional specialist support. Some of the residents have specialist programmes, which have to be implemented by the staff. Feed- back from professionals and written evidence indicated that programmes are implemented. There was evidence to show that not all the health care needs of the residents are consistently met. There are residents who have specific needs regarding diet and weight. Records showed that weights were not being done at the planned intervals and records of dietary intake are not completed at times. A decision had been made by staff to give a resident a supplementary drink on a daily basis. Records showed that this had given inconsistently and there was no mention of this in the care plan or daily records. The service ensures the residents have access to healthcare facilities and routine checks are carried out frequently. Residents are referred to professionals when necessary. A member of staff accompanies residents 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’s procedures for dealing with medication do not adequately protect service users. The care staff stated that they have recently attended medication training. MDS were cross-referenced with MAR sheets and these tallied. The home still needs to develop ‘when required protocols’ for medication and topical creams. Creams are being kept in rooms with no guidance on when or where they need to be administered. Microlax enemas where also prescribed for residents. There was no directions or guidance in place on when these should be administered. A member of the care staff team gives the enemas to residents. The registered manager needs Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 19 refer to the Royal Pharmaceutical Guidelines and other specialist to see if this is acceptable practise. Staff would have to evidence training and competency if this practise is permitted. These issues were highlighted at the random inspection in March 2007. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience poor outcomes in this area. Concerns and complaints are acted on. Arrangements for protecting residents from most types of abuse are in place, however arrangements for protecting residents finances are not satisfactory and leave residents at risk This judgement has been made using available evidence including a visit to this service. 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. Due to the disabilities of the residents they would need representatives/advocates to undertake a complaint for them. The complaints procedure is now displayed in a more prominent position and in larger print. The home has not received any complaints since the last inspection. The registered manager and staff have an understanding of the safe guarding adult procedures and there is a whistle blowing policy in the home. The homes policies and practices do not adequately safeguard the resident’s money and financial affairs. The registered manager of the home is the appointee for the majority of the residents. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 21 Each individual has a building society book but the books are in the registered managers name on behalf of the resident. There have been no recent entries in the books. Some have not been used since 2005. There was no evidence to show that the residents receive bank statements. There is a lack of clear accountability and no audit trails in place. There is no clear information about what allowances the residents receive e.g. DLA and how much pocket money they should receive. Other visiting professionals also reported concerns about the resident’s finances On day-to-day bases the staff are given petty cash for the residents but this is all given in a lump sum and not individualised. There is no way of knowing what pocket money individual residents should have. The staff do keep records and receipts of what each individual then spends. Staff did report that at times the petty cash does run out and they are left without monies for the residents. At the time of the visit the above issue did cause concern. The safeguarding adults team was informed of the concern and they will be looking into the situation. The registered manager has responded by pro-actively seeking the services of an accountancy company to conduct an immediate audit and establish an improved system for the resident’s finances. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes in this area. The home is well maintained and decorated to a good standard providing residents with an attractive and homely place to live. The house is clean and hygienic. Procedures are in place to prevent the risk of cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation provided is sufficient in space to meet the needs of the 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 the ground floor is accessible to all the residents. Furnishings, fittings, adaptations and equipment are of good quality and suitable for their purpose. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 23 The conservatory is now being used for activities with small groups of residents. 2 new settees have been purchased fro the lounge. 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 night staff now do the laundry. The laundry room has all the facilities needed to wash soiled and infected linen. The home has 2 washing machines with sluicing facilities. Soiled linen is transported in red bags and put straight into the machine. The bags are 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.V348639.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 People who use the service experience adequate outcomes in this area. The staff have a good understanding of the residents 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 residents receiving care from staff who have not been properly vetted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been significant improvements made in defining the role and responsibilities of the care staff team. But the senior team leader has now had to take over some of the responsibilities of the deputy manager in her absence. This means she is trying to divide her time with care and managerial responsibilities. Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 25 The staff reported they have developed good relationships with the residents and are able to anticipate and meet the individual needs of the client group. The residents responded positively to staff. It was observed the staff are accessible and approachable to the residents 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. There are 15 care staff (including the activities co-ordinator) employed by the home plus a cook and a domestic. The home told us that over 50 of care staff have achieved NVQ level 2 or above. At the time of the inspection the registered manager was unable to locate the staffs’ training matrix but he did report that staff have received the necessary training and more was planned. Staff did say that they have received some up to date training. New staff had not received structured induction training. The staff team at the home has now remained stable for period of time, which has been beneficial for the residents. The registered manager does need to regularly review the staffing levels at the home to ensure that all the needs of the residents are meet at all times. The plan is to have 4 members of staff on duty in the morning and 4/5 in the afternoon to allow more activities to take place. From looking at the duty rota and from talking to staff it was evident that this does not always happen. There are several occasions when there are only 3 care staff available in the morning and 4 in the afternoon. Most of the service users need 2 staff members to meet their personal needs and to take them out. One staff member said, “ It was great yesterday. There were 5 of us on and we were able to take 3 residents out. That doesn’t happen very often.” Three staff files were looked at. The home has no system in place to check that all recruitment procedures have been followed. It was identified that 2 staff files contained no evidence of CRB checks. One file only had 1 written reference. Gaps in employment history had not been explored and there was no up-to date picture on file. The registered manager was going to immediately address these shortfalls. Formal supervision had started but was not being done on a regular basis. 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 to be undertaken by persons who have the competencies and skills to do so. Milestone House DS0000023751.V348639.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience poor outcomes in this area. The management of the home needs to be effective and consistent to ensure that the people in the home are safe and receive the care that they need. Quality assurance systems at the home do not yet ensure that the residents benefit from an improved service. Residents are at risk because the necessary safety checks had not been done. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to unforeseen circumstances the registered manager has had to spend considerable periods of time away from the home and for the past 7 weeks the deputy manager has been unavailable for work. This has left the home in a vulnerable position where there has been a lack of direction guidance. There Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 27 has been a slippage towards meeting the National Minimum Standards. The registered manager reported that he is becoming re- acquainted with the dayto-day management issues and shortfalls and states that he is getting the home back on track. The registered manager needs to ensure that communications and directions for the care staff are robust so they know what they are supposed to be doing to meet the homes aims and objectives. At the random inspection in March there was evidence to show the home had started to implement a quality assurance programme as required on the last report. Questionnaires had been circulated to residents, families and visiting professionals. There was no evidence that this had progressed. The information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service it provides for the residents. This will ensure that the aims and objective and statement of purpose of the home are being met. The registered manager also need to ensure that regular audits are done which will ensure that policies and procedures are being adhered to and staff competencies checked. Because this is not being done important things are being missed and overlooked. Staff did say, “that things start to improve and then they feel they are back to square one again”. The home needs to evidence that all staff have received the necessary mandatory training. Safety checks with regard to the servicing of hoists, electrical installation, gas boiler have been done. However checks on the fire equipment and fire procedures not been undertaken since the end of August ’07. This has left residents at risk. As soon as this shortfall was identified the registered manager did check the fire systems. The home have not implemented the new fire regulations and or carried out a full audit and risk assessment on the fire systems in the house. Water temperature checks had not been done for September ’07. The registered manager needs to make sure that there are systems in place to ensure that all safety checks are undertaken at the necessary intervals. He also needs to make sure that the staff are accountable for their designated duties. The registered manager must also make sure that all any product which may present a risk to residents are stored securely and correctly Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 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 3 2 2 X 2 1 1 X X 1 X Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Staff need to use the care plans as a working document to ensure all the needs of the residents are met. Daily records need to contain relevant information about the day of the residents. The home needs to continue to develop a person centred approach to care. (Outstanding requirement from the previous 2 inspections. Time scale of the 30/06/07 not met). Timescale for action 31/01/08 2. YA9 13(4) 3. YA12 16(2)(n) Staff need to ensure that risk assessments are adhered to and risks to residents are kept to a minimum. Outstanding requirement from the previous inspection. Time scale of the 30/06/07 not met. ) Activities out-side the home DS0000023751.V348639.R01.S.doc 31/01/08 31/12/07 Page 30 Milestone House Version 5.2 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 inspections. Timescale of 31/06/07 not met) 4. YA13 16(2)(m) All the residents need to have equal opportunities to engage in local, social and community activities. The service needs to make sure that all residents can use the mini-bus or other means of transport. There needs to be enough staff on duty to undertake activities. The registered manager needs to ensure there are robust guidelines in place for the administration of ‘when required medication’. Staff need to receive the required training when administering specific medications. (Outstanding requirement from the previous inspection timescale of the 30/04/07 not met.) The registered manager/ provider needs to ensure that the residents finanaces are safeguarded. There needs to be clear and transparent records in place for each indvidual residents. The registered manager DS0000023751.V348639.R01.S.doc 31/12/07 5. YA20 13(2) 30/11/07 6 YA23 16(2)(l), 20 30/11/07 7 YA34 19 Schedule 2 31/10/07 Page 31 Milestone House Version 5.2 8 YA37 9. YA39 needs to make sure that all checks are completed prior to staff working at the home. 10 (1) The registered provider/ manager needs to ensure that the home is effectiviely and effeciently managed. managed. He neeeds to be aware of issues and shortfalls within the home and and take the appropiate action to recify to ensure that the needs of the residents are met and risks are minimised 24(1)(a)(b)(2)(3) The registered manager needs to make sure that there are effective quality assurance and quality monitoring systems in place The views of residents /representatives, stakeholder need to be taken into consideration to improve and measure success in achieving the aims, objectives and statement of purpose of the home. (Out-standing requirement from previous inspections. Timescale of the 31/07/07not met) 30/11/07 31/01/08 10 YA42 23(4)(a)(c) 13(4)(a) The registered manager need to ensure that all fire checks and water temperatures are carried out at the necessary intervals. It must also be ensured that cleaning agents and other products, which may pose a risk to residents, are stored correctly. DS0000023751.V348639.R01.S.doc 08/10/07 Milestone House Version 5.2 Page 32 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 needs to make sure that the residents know what services are included in their fees and what is not. The registered manager needs to be able to evidence how residents make decisions and why others sometimes make decisions. The home needs to ensure that all residents have facilities for recreation and leisure. Each resident has the option of a 7-day annual holiday out-side the home. The home needs to be able to show the residents have a choice of meals. And an accurate record needs to be kept of meals eaten. A record also needs to be kept of when supplements are given to residents. Staff need to offer a person centred approach to meeting the needs of the residents and to maximise peoples independence and control over their lives. The service needs to make sure that monitoring of residents weight and diet is recorded at the necessary intervals. An up-to date photograph needs to be kept on each staff file. The registered person needs to ensure that there is a staff training and development programme. All staff need to receive a structured induction programme. All staff need to receive supervision at least 6 times in a year. 2 3. YA7 YA14 4. YA17 5. YA18 6. 7. 8 YA19 YA34 YA35 9 YA36 Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milestone House DS0000023751.V348639.R01.S.doc Version 5.2 Page 34 - 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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