Inspection on 27/06/07 for Milestones

This inspection was carried out on 27th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milestones 11/06/09

Milestones 08/03/06

Milestones 09/11/05

Milestones 13/03/05

Milestones 24/05/04

Milestones 11/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Milestones 9 Commercial Street Cinderford Glos GL14 2RP Lead Inspector Mr Tim Cotterell Unannounced Inspection 27th June 2007 09:30 Milestones DS0000016710.V344478.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 Milestones DS0000016710.V344478.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. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milestones Address 9 Commercial Street Cinderford Glos GL14 2RP 01594 825777 01452 760786 bev@steppingstonesru.co.uk 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) Stepping Stones Resettlement Unit Limited Mrs Julie Hall Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 8 March 2006 Brief Description of the Service: Milestones is a registered residential care home and provides care for adults with learning disabilities. The home is close to the town centre; there are local shops within walking distance of the home and all other amenities to promote integration into the surrounding community. The home is a domestic style house in a residential area of Cinderford in the Forest of Dean. The house consists of four levels, all the rooms exceed the National Minimum Standard required for living space, and the rooms are comfortably decorated and maintained. The accommodation can accommodate up to four adults who may have moderate learning disabilities and present various levels of challenging behaviour, mental disorders, communication difficulties and some emotional disturbances. Milestones is owned and operated by Stepping Stones resettlement and have a number of homes within its unit, for adults with learning difficulties and provide accommodation within the area of Gloucestershire. The weekly fees in the home are from £1075:00 to £1263:00. The reports produced by the Commission are available in the home. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 5 Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection was undertaken over two days by one inspector the total time in the home was 8 hours. During the inspection the inspector saw the Registered Manager, two support staff and three of the four residents. The inspection included looking at the accommodation, and the records of care planning, personal monies and medication. Surveys were also given to the residents to complete The Registered Manager was clearly anxious to provide a supportive and caring service and one in which individuality, choice and dignity were assured. What the service does well: Milestones provides a domestic type home where formal rules are kept to the minimum and everyone living in the home is able to contribute in respect of the day to day life. Staff support and offer guidance but residents are encouraged to develop independent skills through being involved in the daily running of the home. Residents seen individually said that they liked living in the home and that staff were supportive and good listeners. They felt they lived in a home where their views were sought and one in which individual needs were wherever possible met. The completed residents surveys which were returned to the Commission indicated that they were happy in the home and felt staff were helpful and provided good support when needed Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes a full assessment of need before any admission, which ensures individual needs are identified. EVIDENCE: There had not been any new admissions since the last inspection therefore the inspector discussed the procedure for the assessment of new residents with the registered manager. All new residents are assessed by staff at Stepping Stones and the Registered Manager of Milestones. The prospective resident is then able to visit and spend time in the home before any final decisions are made. The Registered Manager confirmed that admissions would only be made where it is clear that the home is able to meet the needs and that the resident are happy about the proposed move. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 10 Any staff transfers between the homes in the Company are subject to the same admission principles. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. 6, 7, 9. This judgement has been made using available evidence including a visit to this service. The residents needs and aspirations will be stated more clearly when the new system of care planning is in place. EVIDENCE: The home is in the process of introducing a model of care based on the “Person Centred Care Plan” and this will replace the “Person Centred Assessment”. One format was nearly completed and was seen as a comprehensive assessment of the needs and aspirations of the resident. It is anticipated that at the next inspection all new formats will be completed and available for inspection. The Registered Manager was clear about the need to identify problems/needs, the specific objectives and the methods to be used and finally regular evaluation to determine if the objectives are being met. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 12 In view of the changes it is difficult to offer any precise comment about the previous systems. However, there was some confusion about the frequency of any reviews of individual plans and in the absence of any formal procedure set by the Company the Registered Manager was undertaking reviews annually. Each resident also had an annual review with the sponsoring authority although some difficulties were experienced in receiving the documentation that followed a review. An example was a review held in September 2006 and at the time of this inspection the findings of the review had not been received by the home. Residents also have a “Pathways to Independence” assessment (based on abilities) and this is updated annually. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 ,16, 27 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents enjoy a varied and active lifestyle through appropriate activities and are supported by staff in the home to ensure contact with families, and the integration into the local community. The home provides a varied diet, choice and sufficient food for the residents EVIDENCE: Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 14 The residents needs are assessed and the majority are met through day facilities at Stepping Stones. The residents spoken to enjoyed the recreational/vocational activities at the centre and were happy to tell the inspector what they did. Residents are encouraged to integrate with the local community and this is developed through a written risk assessment. The range of involvement by residents ranges from complete independence in the community, to support from care staff and a gradual introduction based on individual needs. This is undertaken by use of the local shops and recreational facilities. Staff support and provide guidance in respect of leisure activities and the home provided written information for the residents. Family links are maintained and if necessary staff support provided. On the first day of the inspection a resident with staff support was arranging to visit their family and the travel details were being organised. Daily routines in the home promote independence and residents enjoy a flexible life style which enables them to exercise choice about how their time is spent. Residents told the inspector that they enjoyed the food provided and that they are able to contribute to the menu planning. They have access to the kitchen between meals and assist with the preparation of some meals. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 15 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 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health care needs of the residents are being met and where necessary appropriate support provided by staff. EVIDENCE: The support given to the residents is based on their needs and the respective plan of care. It was evident that the home treats residents as individuals and this is maintained through a personal and flexible service. All essential services e.g. doctor, dentist, optician and chiropodist are accessed through local services and there was a record of any appointments and treatments. Where specialist care is required the local Community Learning Disability Team is able to provide additional services. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 16 The home manages all medication but a resident would be able to self medicate subject to a satisfactory risk assessment. The home keeps a record of the receipt, administration and the disposal of all medication and the records were inspected. Staff who administer medicines have received training from the Training Officers of the Company who are based at Stepping Stones Care Home. The training officer also undertakes audits of the homes records. There are protocols for “as and when required” medication and these were available for all staff. It is recommended that the protocols are reviewed and the frequency discussed with the doctor. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 17 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 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an open and supportive environment where residents are protected from abuse and are able to contribute to their plan of care. EVIDENCE: The home has a written complaints procedure. The registered manager meets residents to discuss matters, which relate to the day-to-day running of the home. At the last meeting which was held on 10 May 2007 the group discussed the forthcoming residents holidays and the food in the home. There are also regular staff meetings. The inspector felt that the home operated in an inclusive manner and ensured everyone’s views were known. This environment was seen as one where concerns could be dealt with informally and the decisions based on a general agreement. Staff were seen as good listeners and had a positive relationship with residents. Staff have received training in the identification of abuse and Stepping Stones provide regular updates. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a pleasant and comfortable environment. EVIDENCE: The accommodation was inspected and found to be clean, in good decorative order and furnished with comfortable and domestic type furniture. The kitchen/diner was well organised and the dining furniture in good condition. The carpet must be cleaned/replaced as it was stained. The manager confirmed that this would be done. The lounge was furnished with a comfortable three-piece suite and later in the day the residents were enjoying the comfort and privacy provided. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 19 The lower ground floor is used by residents as an additional communal area and is furnished. It is normally used for playing music. There are four single bedrooms and three were seen. They had been personalised and reflected the individual interests of the residents. Each bedroom was in good decorative order and included the required items of furniture. There is a small garden at the rear and some help is provided to maintain this area. The home requested that some trees should be pruned. The request was made in December 2006; they still await the arrival of the maintenance person. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective staff team and the flexible service ensures individuality is maintained. EVIDENCE: The Registered Manager was seen as competent and having the required skills to manage the staff team. The style of management was clear and consistent and ensured that staff could be a part of the decision making process. Two of the staff team were seen, both of which had been transferred from other homes in the Company. Staff were seen as good listeners, supportive and having a good relationship with residents. The staff seen were aware of the disabilities and specific conditions of the residents. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 21 The recruitment process was discussed, however the last two appointments referred to staff who had been transferred from other homes in the Company. The Registered Manager hopes to involve residents in some part of the process of appointment as it was appreciated that their views are important. One staff record was inspected. Staff in the home have the benefit of a parent company, which has a Training Officer. The Inspector saw a record of the training staff had undertaken and details of when future updates would happen. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be organised and the needs of the residents seen as the most important. Residents live in an open environment and are able to comment and determine matters, which affect them. EVIDENCE: The registered manager has obtained a Higher National Certificate in Health and Social Care and has been in post just over twelve months. It was evident that she was making great efforts to provide a safe and supportive environment where individual needs are recognised and met. An example of Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 23 this would be the meetings held with staff and residents and the introduction of more comprehensive social histories and care plans. This objective has been hampered recently by staff absences and whilst it is accepted that any shortfalls have been covered by other staff or “bank” staff the organisation should consider ways of providing adequate cover from outside the home when long-term sickness/absence is experienced. Regulation 26 visits are being completed and the reports were seen as relevant and comprehensive. The organisation must consider the formal arrangements for the supervision of the registered manager. It is essential that the Registered Manager is involved with and consulted over all new staff appointments. Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 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 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 x Milestones DS0000016710.V344478.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA6 YA20 YA33 YA38 Good Practice Recommendations Review frequency of reviews of care plans. Review “as and when required” medication with GP. Consider other ways of covering long-term staff absence to reduce the reliance on the existing staff team. Consider mechanisms for involving the registered manager in the recruitment of staff for the home. 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