Inspection on 04/05/05 for Mill Green

This inspection was carried out on 4th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mill Green 09/03/07

Mill Green 06/09/06

Mill Green 15/09/05

Mill Green 21/07/04

Mill Green 13/04/04

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Thorndene

Insight - Eastchurch

Southfields

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

CARE HOME ADULTS 18-65 Mill Green Mill Lane Felbridge East Grinstead West Sussex RH19 2PF Lead Inspector Christine Bowman Unannounced 4 May 2005 13:30 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 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 Stationary 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. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mill Green Address Mill Lane Felbridge East Grinstead West Sussex RH19 2PF 01342 326105 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashcroft Care Services Acting Manager - Mrs N Kenny Care Home 6 Category(ies) of LD Learning Disability 6 registration, with number of places Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accommodation with both board and personal care is provided at any one time shall not exceed six (6) Date implemented 1 April 2002 2. The age/age range of the persons to be accommodated will be: 19-60 years Date implemented 1 April 2002 Date of last inspection 21 July 2004 Brief Description of the Service: Mill Green is a large detached house located in a quiet residential area of the village of Felbridge. The home is registered to provide personal care for six young adults with learning diasbilities and is owned by Ashcroft Care Services, who own a number of care homes in the South East. The Accommodation comprises of six single bedrooms, two sitting rooms, a kitchen/dining room, a utility room, toilets, and two bathrooms. The home has a large enclosed garden. There is a lake nearby and East Grinstead town centre, which provides a good range of shopping and leisure facilities. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, commencing at 1.30pm and took four hours to complete. All of the six residents were seen and spoken to. The shift leaders were interviewed and discussions were held with other staff on duty. A tour of the premises was included in the process as was the inspection of resident’s records. A meal was taken with the residents. The findings of this inspection were that the atmosphere of the home was friendly, that the residents were cared for by staff, who made every effort to ascertain their wishes and that the environment is homely, comfortable and welcoming. Improvements had been made since the last inspection in many areas, but there are other areas, which continue to require attention. What the service does well: The communal living spaces in this home are homely and comfortable, and the kitchen/ dining room provides a central gathering place when groups return from trips. The resident’s bedrooms promote their independence and individuality and are colourful and light. The home has a very good system of introducing the residents to people who do not know them. Each resident has a book, which explains who they are and the things, which are important in their lives. Throughout the inspection, the staff were attentive and intent upon promoting the independence of residents but also being mindful of their high needs and the risks this entails. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Ashcroft Care Services must ensure that the manager of this home is registered with the Commission for Social Care Inspection. The staff records could not be viewed on this occasion because the key to access the cabinet was not available. These records must be accessible to be inspected at all times. It was not possible to ascertain if the staff, who had moved from other Ashcroft homes, were intended to be the permanent staff team for this home as required by the previous two inspections. Although it may be good experience for staff to work with a range of needs in various homes, it is of utmost importance that this group of residents, four of which can only go out with staff they know well, and at least one of which must be accompanied by two members of staff, are provided with a permanent staff team. A requirement of the last inspection was that a regular and reliable means of collection of clinical waste be maintained. This was in order to limit the time the clinical waste bin was left in the drive because this had been the subject of a complaint from a neighbour. Staff stated that the bin is always in the drive Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 7 and that there is nowhere to store it. The management must find an alternative place to store the clinical waste bin. 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. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2and3 Sufficient information is available for a prospective resident to make an informed choice about the possibility of this home meeting their assessed needs and aspirations. EVIDENCE: A statement of purpose and service user’s guide were available at the home. A separate copy of the service user’s guide for each resident was kept in the office and a member of staff stated that staff read them to residents on request. The guide was in a pictorial format, which was accessible to the residents. Copies of both the statement of purpose and the service user guide were requested to be sent to the CSCI local office. All the residents of Mill Green have been living there from the time it was opened as a home seven years ago. There is evidence in the resident’s files that some preparation was made before admission and pre-admission assessments had taken place. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 10 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 standard(s) 6,7 and9 Care plans, and the outcomes of reviews are communicated to residents via their key workers, who encourage and enable them to make choices, which are risk assessed prior to involvement. EVIDENCE: All residents have a condensed version of their care plan in their individual booklets. Due to the fact that the majority of the residents do not use language to communicate, important information is recorded in these personal booklets. This includes communication (hints and tips), skills (dressing, use of knife, fork and spoon etc.), likes and dislikes in food, activities, objects and people etc. Resident’s files containing personal information were stored on an open shelf in the staff sleeping-in room/office. A lockable unit must be obtained for the safe storage of this information. The care plans viewed contained detailed information covering all aspects of personal support and healthcare, behaviour assessment and support and comprehensive risk assessments, which had been signed and dated by the Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 11 staff when they had been read. Evidence of six monthly reviews was also viewed in the resident’s files, and new goals were set. One resident was observed approaching a member of staff when she wanted something, she made eye contact and took the hand of the member of staff leading them and then pointing to what it was that she wanted. This was recorded in her care plan as her way of making her wishes known and choosing. Residents are involved in daily living skills and one resident likes to help with the shopping, a member of staff stated, he likes to push the trolley, select items and put them in the trolley, he also likes to help around the house and will sweep the kitchen floor, load the dishwasher and put items away. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 11,12,13,14,15and17 Opportunities for personal development, leisure and social activities and community involvement are available to residents. Meals are cooked from fresh ingredients and individuals are respected and enabled to make choices. EVIDENCE: One of the residents attends Crawley College for four days each week, he is escorted to the college and support is available to him on the site. His records show that he has participated in IT skills, communication through sign language, self advocacy, traffic awareness, personal safety, accessing the community and much more. Another resident has one to one education sessions with the home’s own staff every evening and she chooses the activity. Records show that she had chosen to do baking, colouring and painting and jigsaw puzzles. Music sessions are purchased by the home one day per week and a member of staff stated that these sessions were enjoyed by everyone and include using a keyboard and singing. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 13 Attending church is popular with one resident, who enjoys being a part of the local community. A member of staff said that everyone says’ hello’ to this resident when they see him on the way to church and this makes him really happy, he greets them with a smile and looks forward to the next church service. All residents have contact with members of their families, some only for birthdays and reviews and others more frequently, a member of staff stated, and this was also evidenced in the records. Whilst viewing a resident’s room accompanied by the resident and a member of staff, the resident suddenly started jumping up and down, as I was looking at his photographs, the member of staff explained that he was very happy and excited that I had asked about his family. The residents of Mill View have a large trampoline in their garden, a large bubble bath, a cat, which is jointly owned, and one of the residents owns a guinea pig. Some of the residents have riding sessions and others go carriage riding, a member of staff stated, they are also taken on seaside trips and walks in the country. One member of staff is preparing to take the resident she is the key worker for on a short holiday, but she has only been working at Mill Green for a short time, and will concentrate on getting to know the resident thoroughly, taking her on short trips first. In addition to socialising with other Ashcroft Homes, the residents attend music sessions at Surrey Oaklands and a friendship group in Caterham. Meals are prepared and cooked by staff members with assistance from residents, fresh ingredients are used and the residents thoroughly enjoyed the Indian dish, which was presented for tea on the day of the inspection. It was very quiet throughout the meal, the residents were concentrating on eating. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 18 and 19 Key workers give personal support and ensure that the physical and emotional needs of residents are met. EVIDENCE: One resident was looking rather displeased in the afternoon and came into the office to find the shift leader, she was intent upon taking the member of staff who happened to be her key worker away, she held onto her hand and was pulling her. As soon as she had achieved her aim and she was showing off her room and putting on her favourite music, her face had a beaming smile on it. Later in the day the same resident walked up to her key worker with a dissatisfied look on her face, pulling at her own clothes, when the member of staff returned she explained that the resident’s underclothing had become uncomfortable and she needed some help to untangle them. On the morning of the inspection a resident had attended his GP’s surgery and this had been promptly recorded in his case notes. Care plans inspected revealed that specialist help was sought when required and there was evidence that a number of specialists were involved with the residents, these included physiotherapists, art therapists and psychiatrists. Records also showed that residents made regular visits to the dentist and optician, and dates were set for future appointments. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22 and 23 Residents are able to communicate their feelings in a variety of ways to members of staff, who are attentive and responsive. The staff attend training on the Surrey County Council Vulnerable Adults Procedures and are aware of their responsibilities. EVIDENCE: Observations of interactions between the residents and the staff team showed that they were aware when the residents were attempting to communicate and made every effort to assist them to make their wishes known. Much use was made of pictorial systems enabling residents to point to whatever it was they wanted, or not, dependant on the situation. Detailed descriptions of behaviours and the triggers for these behaviours were contained in personal records and a shorter version in the resident’s own book. There was sufficient evidence to show that, despite the fact residents could not communicate verbally, the core group of permanent staff had really studied the reactions of the residents and produced advice to prepare new staff to gain an understanding of the residents prior to working with them. The staff, asked about VAP training, stated they had completed this and the list of completed training in the staff room supported this. Staff records could not be viewed. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24,25,26,27 and28 The home provides suitable homely, comfortable, and spacious accommodation, which meets the needs of the residents. EVIDENCE: The home has a number of communal rooms and this allows for different activities to take place at the same time, a piano and a computer are available, as well as a television, video and compact disc players. Both the kitchen/dining room and one of the sitting rooms have French windows, which lead onto the terraced area of the garden. The garden is large and enclosed. It is mostly covered by lawn and there is a small shed, where the guinea pig lives and also a large trampoline erected. Downstairs are two bedrooms, a laundry room and a toilet, which was being completely refurbished at the time of the inspection. Upstairs are four further residents’ bedrooms, two bathrooms one with a large bubble bath and a power shower, and a sleeping-in room for the staff. Except for one bedroom, where the resident had recently damaged the wall, the staff Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 17 sleeping in room, the hallway and the area at the top of the stairs, which are in need of redecoration, the home was tastefully decorated. Two of the residents were present when their bedrooms were being inspected, they both had things in their rooms which were special to them. One resident’s bedroom was very bright colours, which she had chosen herself, she had lots of cushions to match, a collection of soft toys and a music centre with a large collection of compact discs. Both had photographs of family members and suitable furnishings. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 The staff observed had a good understanding of the needs, likes and dislikes, interests and wishes of individuals, and worked cohesively as a team. EVIDENCE: Staff files could not be accessed therefore checks could not be made on relevant documentation, qualifications, training certificates or the frequency of supervision meetings. The staff interviewed stated that induction had taken place, that Ashcroft Homes offer plenty of training opportunities, and that they are well supported and supervised. Some staff stated that working in a variety of the Ashcroft Homes with residents with differing needs was good experience. The shift leader interviewed stated that the staff team is settled now, however, some of the staff interviewed are very new to Mill Green and a vacancy still exists. A requirement of the last two inspections was that the staffing levels be maintained with long term agency or permanent staff in this service, this is because some of the residents can only go out with people they know well. There were sufficient numbers of staff on duty. The role of the key worker was clearly defined on the residents’ care plans. A list of staff training was on the notice board in the staff sleeping in room, and Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 19 covered health and safety, first aid, food hygiene, epilepsy, fire safety, autism, bereavement, schizophrenia, bipolar disorder and report writing. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40 and42 Ashcroft Care is failing to comply with The Care Home Regulations 2001 by not applying to register the manager. There is clearly a regard for health and safety issues by management, however this is not always followed in practise. EVIDENCE: The acting manager of Mill Green has not made application to be considered for registration by the commission for social care inspection, despite being in post when the last inspection took place on 21st July 2004. Ashcroft Care must ensure that this application is made immediately, failure to comply may result in legal action being taken against Ashcroft Care by the CSCI. Policies sampled had been updated in 2004 and could be fully accessed by the staff. There was safe storage for hazardous substances, fire safety equipment had been checked in April 2005, electrical systems testing was taking place on the Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 21 day of the inspection and records showed that appropriate risk assessments had been carried out. There was a problem with the new coded exit system for the front door. This prevents the residents from rushing out and protects them from accessing the road. This must be connected to the fire alarm system so that it is disabled in case of an emergency because it is a fire exit. The practise of using wedges to prop open doors must stop, some doors were fitted with appropriate mechanisms, which ensure the closure of fire doors when the alarm is raised. The clinical waste bin, which has been the subject of a complaint, must not be left in the driveway continuously, suitable storage must be found. Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 22 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 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 4 Standard No 31 32 33 34 35 36 Score 3 x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mill Green Score 4 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x x 2 x 2 x H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 23 yes 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. 2. Standard YA30 YA32 Regulation 16(2)(k) 18(1) Requirement Suitable storage must be found for the clinical waste bin The registered person must confirm the measures it is taking to ensure the home is on target to meet the 2005 NVQ minimum training targets. The registered person must supply a copy of the Statement of Purpose and the Service User Guide to the CSCI Surrey local office. Staff files must be available for inspection at all times The acting manager must apply to the CSCI to be considered forregistration as a registered manager. The registered person must ensure that records containing personal data be stored securely Fire doors must not be wedged open. The registered person must ensure that the coded exit system on the front door is connected to the fire alarm system so that it is disabled when the alarm is sounded. Timescale for action 4/06/06 4/06/06 3. YA1 4(2) ( c ) 4/05/05 4. 5. YA34,35 & 36 YA37 7,9 & 19 8&9 4/05/05 4/05/05 6. 7. 8. YA8 YA 42.2 (ii) YA 42.2(ii) 17 (1)(b)(a) 23(4)(a) 23(4)(a) 4/05/05 4/05/05 4/05/05 Mill Green H58 H09 s13721 Mill Green V225244 040505 Stage 4.doc Version 1.30 Page 24 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. 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