Inspection on 08/03/06 for Milestones

This inspection was carried out on 8th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 27/06/07

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 Kath Houson Unannounced Inspection 8th March 2006 09:30 Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milestones Address 9 Commercial Street Cinderford Glos GL14 2RP 01594 825777 01452 760786 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 Mr John Evans Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 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 NMS required for living space the rooms are comfortably decorated and maintained. The accommodation provided 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. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place one day in March 2006. The acting manager, residents and a member of staff was available throughout the inspection and able to assist and provide all relevant documentation on request. Twenty-four core and non-core standards were assessed and included an examination of documentation; two care plans were case tracked, a tour of the environment and informal discussion took place with one of the residents whose care plan was case tracked. An informal discussion took place with a member of staff and a short succinct feedback was given to conclude the inspection visit. The inspector would like to extend her thanks to the staff and residents for their assistance with the inspection. What the service does well: 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. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 6 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.V285909.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Residents have their aspirations and needs assessed to ensure that the home can cater and meet those objectives. EVIDENCE: The home has a satisfactory admissions procedure involving additional healthcare professionals if necessary. Care plans are robust and include the resident’s aspirations. Other healthcare professionals have provided guidance and assessments that will assist in meeting potential resident’s objective. Alternative support is provided when required during the assessment process. The aim of the home is to assist potential service users to make an informed choice of their place of residence. By providing all the relevant information potential service users are able to sample the home. Each resident has an individual terms and conditions of the service in their file. The resident’s permission was sought and granted and was seen during the current inspection. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 8 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 The residents are aware that their needs are assessed and may change over time with support. Their progression is reflected in their care plans. EVIDENCE: Residents are aware that their assessed needs change due to their progression within the home this is reflected in their care plans. All resident’s needs are individualised and personalised. For instance one of the residents was able to apply for an assessment as part of the initial stages of learning to drive a car. One of his objectives is to be able to drive a car and increase his independence. This being such an important step and challenge, the resident was provided with support from a number of agencies. Resident’s goals can include woodwork or learning to drive a car and support is given to ensure that the residents aspire to their goals. The home uses the person centred planning framework when providing care and coordinating services. For instance, a resident requested that he wishes to learn to drive. An assessment package was put together with the home and the driving agency to assist the resident to fulfil his goal and aspirations. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 9 An example of how residents are able to make decisions and move forward with their development was seen with another resident who took on a more active role during the week and participated in the task of household shopping and cooking for that day. This is a transformation for this resident who says, “I help with cooking.” The home has been able to introduce a new day care programme with the assistance of the resident and the day centre. During the mid week the resident has a number of options and choices such as shopping, cooking the evening meal, he also attends the sauna and health club. This resident is happy with the change to his programme and has given a nickname to every event he attends. This shows a sense of humour and confidence compared to the previous inspection. The staff had commented on how this resident had become more outgoing. The care plans demonstrated how the residents are able to make decisions about their needs with the added assistance from their key worker who has a good understanding of residents care needs. All care needs are monitored and well documented with good observations made on the resident’s development. With such care and consideration there is a positive outcome for residents who will flourish and grow with support. The staff team enables the residents to take risks as part of promoting an independent life style. A risk assessments is in place with another resident who has the ability to work with complex machinery to produce wooden products. This resident continues to make these products to sell. Additionally this resident is able to use public transport and will go on long distances for pleasure and as part of a visit to the family home. The home has in place a missing persons policy. However one resident will phone the home to inform the staff of his whereabouts. The ultimate goal for this resident is to live on his own, in his own accommodation. The residents are informed at every stage of their development and their progress is regularly monitored. The continued progression of these residents is commendable. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 10 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, 15 and 16 Residents are able to participate in a wide and varied range of activities that aimed at increasing their independence. EVIDENCE: The staff team ensure that residents maintain appropriate and fulfilling lifestyles internal and external to the home. Regular participation in a wide variety of vast and complex activities ensures that residents have the opportunity for personal development and obtain the skills required for independent living. This was evident in the care plans and the progress seen during the current inspection. The staff team encourage the residents to take part in a wide range of activities that consists of both pleasure and educational topics. Residents will attend the day centre and take part in computers, sports activities swimming. Additionally, the residents regularly attended the adult opportunity centre and are able to participate in a wide variety of activities. These activities include life skills, budget planning, health and wellbeing topics. Pleasurable topics include treasure hunting. The resident said “ I ‘m going to the Forest of Dean Commission to ask permission to seek and find treasure and I like bike riding in warmer weather.” Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 11 The residents participate in further development of their skills. This would aim to enhance their independence. An expanded example is the resident who will go out on long distance travel, enjoys going to and will go on his own on a bus to Reading, Cardiff, Bath and Heathrow. This resident is able to work his way around a bus timetable and plan his final destination. The outcome is an increase in confidence. The residents are also encouraged to develop and maintain new and exiting friendships. For instance one resident said “ I like going to Greece with my friends” “I also go and see my mate” the outcome for these residents is to maintain friendships and promote links with their community in which they live. The home has daily routines that are centred on the residents. For instance, the staff team are aware that one of the residents likes to attend a church service and regularly takes part in playing the organ at the local church. Members of staff will listen and take on board requests made by residents. For instance one resident said “ I choose when I want to go to bed or the office (the spar club).” Additionally, the residents were treated with consideration, warmth and spoken to with respect during the current inspection by both members of staff. An activities coordinator has been employed for a few evenings. Their role involves being available to attend events with the residents. Residents are able to attend the swimming pool on Mondays. On Wednesday residents would attend bowling or cinema, and on Thursday go into Gloucester to a wine bar. All activities are rotational and subject to residents’ choice. The home has a people carrier used for transportation of the residents; staff said its ideal to drive the residents if they wish to go out. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 12 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 Residents discuss with the staff team how they would like to receive personal support. EVIDENCE: The residents at this home are extremely independent and with good support will continue to develop the staff team does this extremely well. The staff are aware of the pace of the resident’s progress. Thus handling with respect and dignity. For instance one resident was talking to the acting manger about wanting to attend his yoga class but it started to rain. The conclusion to the conversation was that the manager would give the resident a prompt when it was time to attend his yoga class and when the weather had improved. Another resident is aware of his health issues, for instance and says, “I got high blood pressure.” These examples demonstrate that the home operates for the benefit of the residents using the person centred approach to care planning. Care plan and daily reports provide evidence that the emotional health need and physical need are met and seen in the care plan and daily reports. The home has established a new medication procedure for residents away on weekend leave, to ensure that medication is taken appropriately. This review of medications was the result of a recent training day that the acting manger Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 13 had attended. New measures were implemented into the home’s procedures. As part of the new procedures the acting manager informs all trained members of staff to put the date of opening on medication. The home has had no drug errors. This is a reflection on the performance of the home. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 14 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 The home has a clear and effective complaints policy and procedure that will be used in matters arising. EVIDENCE: The home continues to receive compliments about the service. Feedback forms and questionnaires are sent on a rolling programme, in which Social workers and parents are sent questionnaires every six months. The residents questionnaires are completed every three months with the data sorted in house. The responses are kept in the residents file. The responses are positive and demonstrate that the residents are satisfied with the service. In addition there is the resident’s meeting. The minutes were seen on file. The Acting manager said however that she would like the residents to have the meetings more frequently to address any issues promptly. The acting manager would like to increase the frequency from 3-4 monthly to every eight weeks. The acting manager has in place a training matrix that shows when training is due. This is to ensure that residents continue to remain protected from abuse issues and that staff continue with their development. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 15 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 The residents live in a safe and comfortable environment with rooms that suit their lifestyle and tastes. EVIDENCE: The resident’s bedrooms are tastefully decorated and contain much of their own personal belongings. Each room has individual entertainment units and residents are expected to look after their rooms as part of promoting independence and self- reliance. The building is well maintained and has a regular maintenance programme. The home is clean and free from any offensive smells. The environment exceeds the national minimum standards and is kept in good order by residents and staff. The residents continue to tend to the garden and there are plans to plant new bulbs in the spring. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 16 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 Residents benefit from a staff team who have clarity of their roles and responsibilities. EVIDENCE: During the current inspection there was one member of staff and the acting manager present. The objective is to provide day care for one of the residents who are taking part in a new activities scheme that encourages the resident to become more active. The staff members are key workers and regularly monitor their named clients to discuss their care plans and risk assessments in relation to their lifestyle and potential hazards. These practical steps demonstrate that residents are given support, which are based on individualised care. The acting manager ensures that the residents are protected and has an effective recruitment procedure in process. These practices have been taken a step further and they are in the process of including the residents in the recruitment procedure. Residents are being offered training in this area. The home has a competent staff team who support the residents. During the current inspection, an informal discussion took place with a member of staff. This staff member has been with this service group for several years and is aware of their needs within the home. The acting manager ensures that the staff team are regularly kept up to date with new training and additional skills development. All members of staff have completed their mandatory training as seen in the training matrix. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 17 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, 39 and 40 Residents’ benefit from a home that is well-organised and managed to ensure that their place of residence is a safe and comfortable environment. The home fulfils its statement of purpose meeting its aims and objectives to meet the needs of residents. EVIDENCE: The acting manager fosters an open and inclusive approach within the home in which the residents are the prime focus in every aspect of the home. Residents and staff opinions are valued. This was evident during the inspection and feedback responses. The home has been compliant with the regulatory body and continues to operate at a high standard. This was seen during the current inspection and in comparison to the previous inspection in which the resident’s progress was very visible. The home has a self-monitoring system and shares the information with all staff members and residents. All policies and procedures documents were produced on request demonstrating the transparency of the home. The acting manager has future plans to improve the inclusion approaches even further Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 18 which would be of benefit to the residents, encouraging them to take more ownership of their home and to further develop staff skills. This will be monitored at the next inspection. The acting manger ensures that all safety checks for the home have been carried out to meeting the standard. Service check stickers were placed on each appliance and showed new dates for retesting. The delegated staff team weekly check water temperatures. All batteries for fire prevention equipment had been checked, changed and updated. The acting manager ensures the safe working practices within the home are carried out and very much a team responsibility. They work together to provide a home that is safe, regulatory compliant and meets the needs of the residents who live in the care home. Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 19 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 4 3 X 4 X 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 X 14 X 15 4 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 4 X Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 20 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. Refer to Standard Good Practice Recommendations Milestones DS0000016710.V285909.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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