Inspection on 09/11/05 for Milestones

This inspection was carried out on 9th November 2005.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestones 11/06/09

Milestones 27/06/07

Milestones 08/03/06

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 9th November 2005 10:30 Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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.V260079.R01.S.doc Version 5.0 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.V260079.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Milestones Address 9 Commercial Street Cinderford Glos GL14 2RP 01594 825777 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.V260079.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 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.V260079.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place one morning in November 2005. The acting manager was available throughout the inspection and able to assist and provide all relevant documentation on request. Twenty-four of the core standards were assessed and included an examination of the documentation provided; one resident’s record was case tracked, a short and informal discussion was conducted with acting manager and a tour of the environment formed the inspection. One of the residents was sleeping, and the others were out a short succinct feedback was given to conclude the inspection visit. The inspector would like to extend her thanks to the service users staff and acting manager for their assistance. 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.V260079.R01.S.doc Version 5.0 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.V260079.R01.S.doc Version 5.0 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): 1; 2 and 3 Residents have the information they need to make an informed choice about their place of residence EVIDENCE: Service users have the relevant information to make positive and informed choice about the different styles of accommodation available. Milestones is a residential home that supports independent living. The culture of the home is to provide support to the service users’ and encourage service users to take responsible for their own welfare. The facilities at the home provide a challenge for service users’ to enable them to try out their acquired independent life skills and who will be ready to take the next step into fully leading an independent un-supported lifestyle. An example would be to go out shopping at the local shops and managing their budget. The home adopts an inclusive type approach in which service users and staff are very much equal. There has been a transformation in the staff structure, which needs to be included in the service user guide and statement of purpose to reflect this change. This will be made a requirement, as there are staff changes within the home. The home has an admission procedure in which potential residents will be able to sample the home before making an informed choice. Information about the home is discussed and initial assessments are made with other members of the professional team. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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 Residents are aware of their assessed and changing needs with personal goals and aspirations are reflected in care plans. EVIDENCE: One care plan was examined and it was found that all documentation was organised in a clear format there was evidence of regular reviews. The care plan additionally included a report from the key worker. The documentation process for care plans, highlighted the need to monitor service users progress to ensure that aspirations were being met, which was completed to a high standard and included all relevant individualised information. An example of an individual example of a risk assessment for one service user was examined, documentation was clear with guidelines to inform, how staff observes the wellbeing of a service user whilst operating a complex piece of machinery. There is an approach ‘pathway to independence’ that will assist the service users’ to increase their skills and confidence while in supported living. The goals and aspirations of the service users are discussed and detailed in the individual care plans. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 9 Service users have regular review and reports that are included in the care plans the signed documentation is organised and provides a clear picture of development and improvement of service users’. The day centre is to produce a daily account of progress of the service users’ in order to monitor improvement that is external to the home. This is seen as good practice and support for the service user additionally provide information for the home. The acting manager said that they were in the process of updating the service user file; this will be monitored at the next inspection. Residents exercise their choice, one service user decided that he would stay in bed and “recharge his batteries because he was very tired.” This service user has a full activities programme and likes to spend one day in the week in bed. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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): 11; 13, 15, 16 and 17 Residents have the opportunity for personal development and monitoring of their aspirations EVIDENCE: Management of the home 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 service users have opportunity for personal development and obtain the skills required for independent living. The activities programme include working with computers; sports activities swimming, recreational course that will involve local acting groups. The residents regularly attended adult opportunity centre, service users are able to participate in a wide variety of activities, such as life skills; budget planning, health and wellbeing topics, isolation and inclusion subjects which signpost individuals with learning disabilities to join relevant groups within the community. Positive links have been developed with the day centre with the aim to monitor progress of the service users to promote partnership working, and to ensure that service users integrate into community life. The residents are independent and have access to a wide range of services and activities. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 11 Service users are encouraged to lead a full relationship with their peers and other members’ external to the home. One service user spends time with his girlfriend and regularly meets up and goes out for meals. Communication sheets are available in a number of formats to ensure that exchange of ideas can be shared. Service users contribute to of the daily routines within the house to promote independence. Participation in mealtimes and other household chores are performed with support from staff would demonstrate the inclusive nature of the home. The residents are encouraged to cook meals with the support of staff mealtimes is very much a family type manner in which tasks around mealtimes are shared equally between residents and staff. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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 and 20 Residents’ benefit from staff support that will enhance their personal well-being EVIDENCE: Residents express how they wish to be supported for example a service user was risked assessed when using a complex piece of equipment. Staff would regularly check on the service user to ensure that he was wearing protective garments and that the workstation was safe. Additionally service users’ will say when they wish to retire for the night thus exercising their choice and freedom. The risk taking measure is good practice thus promoting service users to apply their skills in a variety of ways. Service users receive support in their individualised way that would encourage freedom of choice. The acting manager stated that we discreetly check on service user without invading his space but to make sure that he is safe. There have been no errors with medication and all staff is trained to administer medication. The medication section of the care plan is documented and demonstrate that the residents’ care plan include a list of prescribed medication and protocols which is personalised to meet the needs of each service user. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 13 The acting manager would also involve other healthcare professionals with the need to assess specialist input when progression on to the next stage of independent living is required thus personal choices are planned with support from staff team. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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 Service users are protected by clear and effective policies procedures within the home. EVIDENCE: There was a dispute between two service users, which was dealt with in-house, and apologies were submitted from both service users. The acting manager listened to and acted on the views and feelings of both service users and encouraged a discussion to take place. The necessary steps were taken and the named inspector was informed. The home has clear and effective policies and procedures in place to deal with any complaints. Apart from the recent incident there has been no problems or complaints with the home and its service. Both the public, family advocates and representatives have been content with the service thus far. The home has good community links and the residents are part of the community in Cinderford that can be seen as a positive step to promoting independent living. Documentation for the adult at risk policy and procedure is in place in which staff has been trained to safeguard residents from maltreatment. For instance funds were being allocated to a service user who requested a small sum for the purpose of shopping, various documents were signed and dated and stated the sum of funds given this is evident of good practice. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 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; 25, 26, 27, 28, 30 Residents live in an environment that is appropriate for their lifestyle and is accessible to relevant community facilities. EVIDENCE: The residents live in a comfortably decorated homely and safe environment that is well maintained clean and free from any offensive smells. Fixtures and fittings are of good quality and has its own organised laundry room which residents are encouraged to use. The home has a garden that is looked after by the residents. The kitchen has been risked assessed and all sharp implements are locked away. The home additionally has a workshop in which one of the residents was making wooden eggcups using complex machinery. The basement in the home is utilised as another lounge/games area and music room is attractively decorated. The basement door that is a fire exit has been repaired and completed to standard. The premises are suitable for it’s stated purpose and provides a safe and pleasant environment. All the bedrooms exceed NMS for living space and are individualised and suit their needs and life style. One of the rooms was vacant however there is the possibility of a potential admission to occur shortly. The home has clean bathrooms and toilets all with safety/privacy locks. Communal areas are clean Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 16 and attractively decorated to a high standard and a maintenance programme is in place to ensure the upkeep of the house is kept at a high standard. The garden is kept tidy and is regularly used by the residents. All water temperature are checked and documented. Respect and privacy is fundamentally adhered to with the freedom to come and go was observed. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 17 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; 34, 35 and 36 Residents’ benefit from qualified staff, which are accessible and supportive. EVIDENCE: The staff team are qualified competent and have completed their basic mandatory training. A training matrix was seen with information of new training and updates when required for staff team. The training matrix additionally included supervision session that occurs every two months. Another manager supervises the acting manger with several years experience in the care industry. The home has a recruitment policy and procedure in place the acting manager operates a thorough recruitment procedure based on equal opportunities to ensure the protection of service users. Newly recruited staff files were examined; references, CRBs and full employment histories were discussed. The acting manager is aware that POVA first and the limitations of tasks relating to personal care and the new employee was understood. It was evident via documentation and observation that the staff knows and has developed a relationship with service users that they support. All staff members’ key work the clients and offer support to enhance an independent lifestyle thus demonstrating commitment and consistency to service users within the home. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37; 38, 41 and 43 Residents’ benefit from a home that is well-organised and managed to ensure that their place of residence is safe and comfortable environment. EVIDENCE: The acting manager has been in this role since August 2005, has been in the care industry for a number of years. An application to become a registered manager for Milestones has been put forward and is currently being processed. The home currently demonstrates compliance with the National Minimum Standards regulatory body and is operating at a high standard. All documentation was produced on request backed up with evidence. The service users appear content and safe with support given from all staff members who address the residents’ with respect and consideration to their needs. The home appears to have an open and inclusive atmosphere with the acting manager communicating a clear sense of direction and accountability. The service users are aware of whom to approach when necessary. Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 19 Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 4 4 4 4 4 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milestones Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 X 3 DS0000016710.V260079.R01.S.doc Version 5.0 Page 21 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. 1 Standard YA1 Regulation 4(1)(b) Requirement To update Statement of Purpose and to supply the CSCI with a copy. Timescale for action 28/02/06 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.V260079.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Milestones DS0000016710.V260079.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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