CARE HOME ADULTS 18-65
Mill House 102 Mill Road Mile End Colchester, Essex C04 5LJ Lead Inspector
Pauline Dean Unannounced Inspection 12th January 2006 09:25 Mill House DS0000017887.V277393.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 Mill House DS0000017887.V277393.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. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Mill House Address 102 Mill Road Mile End Colchester, Essex C04 5LJ 01206 845378 01206 843367 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) Broad Horizons Limited Miss Sarah Walsh-McKechnie Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 3 persons) 5th October 2005 Date of last inspection Brief Description of the Service: Mill House is an established, small care home for three younger adults with learning disabilities. The registered provider is Broad Horizons Ltd. The responsible person is Mrs Jean Revelle. The registered manager is Miss Sarah Walsh-McKechnie. Mill House is one of a group of three small care homes located in Mill Road, Colchester. The three homes work in close co-operation with each other. The home is found in a residential area of Colchester, located close to Colchester General Hospital. There are local shops and facilities nearby, with the main town centre offering shopping and leisure facilities a short bus ride away. Accommodation for the three service users is on the ground and first floor; each having a single room with a wash hand basin. There is a bathroom with bathing and shower facilities, and a toilet. An office/staff bedroom is also found on the first floor. On the ground floor there is a lounge/dining room and kitchen. The property is semi-detached and has gardens to the front and rear. There is some off the road parking. The rear garden is enclosed with a decking patio area, flowerbeds and lawns. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over one day in January 2006. This was the second inspection of the inspection year 2005 to 2006. Throughout the day there was discussion with the registered manager, Miss Sarah Walsh-McKechnie. All three service users were spoken with during this inspection. No visitors or relatives were present at this inspection. A tour of the premises was conducted at this inspection and some care and staff records were sampled. In addition some of the policies and procedures were sampled and inspected. Nineteen of the forty-three standards were inspected at this inspection; of these fifteen were met, with four standards nearly met. All of the twenty-two key standards were inspected over the two inspections of the year. As at the last inspection there is an improvement in meeting the requirements. The shortfalls found were as at the last inspection namely the development of a Service Users’ Guide in a format that would be readily understood by individual service users; the management of selfmedication by a service user; staff supervision and the quality assurance and quality monitoring processes. What the service does well: What has improved since the last inspection? Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 6 As noted above ongoing maintenance and decoration ensures that the premises are bright, clean and light. This is continually required with the wear and tear of the present service user group. The most recent admission into the home has settled well into the home and they were able to come and go from the home as they wished. Support and guidance is offered for this service user and the home currently has a settled resident group. Within all three of the Broad Horizons care homes, there is a flexible, established staff group and service users are encouraged to develop friendships between the residents of the other houses. This was evident on the day of inspection for two service users shared interests and adjoined to another room to play electronic games. Broad Horizons Ltd had undertaken a review of their policies and procedures in March 2005. These were in place with some revision and amendments made. All have been signed by the registered manager. 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. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 7 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 Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 8 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 & 3. Clear detailed information, by the way of the Statement of Purpose and the Service Users’ Guide, is provided to placing authorities, prospective service users and their families to enable them to make a choice of whether they wish to be admitted to the home. EVIDENCE: As detailed at the last inspection the home’s Statement of Purpose and Service Users’ Guide have been reviewed and revised and they meet requirements. There is, however, still a need for Broad Horizons Limited to further develop the Service Users’ Guide into a briefer and more accessible format for each individual service user within the home. Miss Walsh-McKechnie outlined ideas and thoughts that the company had had regarding this development and a concentrated effort is planned in Spring 2006. Prior to entering Mill House, prospective service users, their relatives and their representatives are invited to visit and stay at the home. Whilst this was not inspected in detail through record keeping, conversations with the registered manager and the most recent admission to the home confirmed this. Through a comprehensive and in-depth admission process, the home is able to ensure that service users, their families and representatives know that the home will meet their needs and aspirations. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 9 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): 10. Service users are confident and reassured that confidences and information about them are handled appropriately. EVIDENCE: From discussion with a service user and with Miss Walsh-McKechnie the inspector understands that all staff are aware of the need to respect information given by service users in confidence and to handle appropriately. Both staff files and service users files are kept in a locked office in the care home. Mill House DS0000017887.V277393.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): 14 & 17. Service users are supported and enabled to have opportunities to engage in appropriate leisure activities as they wish. The home offered a healthy, varied, planned menu, with consideration given to preferences and dietary requirements. EVIDENCE: As detailed in the last inspection report, service users are enabled and supported to participate in local community activities. One service user is supported and enabled to visit friends and access leisure activities and courses in the Colchester area. The only restriction to this is financial. They also have the services of an Occupational Therapist and a Community Psychiatric Nurse. The remaining two service users are supported and escorted to access local community activities. The inspector was informed that service users continue to have outings to Colchester town and the surrounding areas and they continue to enjoy shopping and socialising with the other service users in the two other Broad Horizons Limited care homes. Over the Christmas period the service users had attended Christmas parties and had seen a pantomime, which they had all enjoyed.
Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 11 On the day of inspection, lunch was served at Valmark House. Miss WalshMcKechnie said that service users often visit each other and have meals together. On this day it was more practical to have a meal at this home whilst the work in Mill House’s kitchen was ongoing. Menu planning is daily with service users selecting their own meals. Records are kept of these choices and details are recorded of how these choices are made. Miss Walsh-McKechnie said that advice and information is given to service users regarding a healthy diet and service users are encouraged to participate in the preparation of meals, the laying of the table and the serving of the meal. They are also supported to clear away after a meal and wash up the crockery. This is detailed in record keeping and care planning documents. One service user enjoys cooking meals in the home with assistance from their Occupational Therapist. Mill House DS0000017887.V277393.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): 20. The administration of medication for service users was found to be detailed and recorded to help ensure that service users’ health needs are met. Selfmedication practices and requirements need attention to help safeguard service users. EVIDENCE: Medication storage, administration and medicines entering and leaving the home were sampled and inspected for all three service users. The records were found to be in good order, with adequate secure storage found in the home’s office. Following the last inspection, the management and storage of medication held by a service user for self-medication, was reviewed and considered. Immediate action was taken by Broad Horizons Limited and a risk assessment was completed around the storage of this medication. A lockable storage container was provided and medication is dispensed in suitable packaging to enable dispensing and secure storage by the service user. These provisions have been brought into place. On the day of the inspection, however, both the bedroom and storage container were found to be unlocked. The need to review current arrangements, re-visiting the risk assessments in place regarding the storage and the ability of the service user to self-medicate needs
Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 13 to be reviewed and continually monitored to ensure that safe practices are followed at all times. Mill House DS0000017887.V277393.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 & 23. Appropriate practices were in place to help ensure that service users’ views are listened to, acted upon and their protection is promoted. Staff training, the awareness of management and staff, policies and procedures and staff recruitment practices help to safeguard this. EVIDENCE: From sampling policies and procedures, both the complaints procedure and the adult protection procedure were seen to be in place and they met requirements. A pictorial complaints procedure has been introduced into the home. Miss Walsh-McKechnie said that Broad Horizons Limited is looking to developing this further using additional symbols to fully detail both complaints and adult protection concerns. Recent links with a speech therapist and planned communication training should enable this work to progress within the home. Mill House DS0000017887.V277393.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): 25, 26, 27 & 28. Mill House provides a safe, homely and pleasant environment, which was clean and comfortable. EVIDENCE: Mill House continues to offer a bright, clean and a homely environment. The premises are of a domestic type and are in keeping with the local community in a residential area. Decoration and maintenance is ongoing. On the day of the inspection, new kitchen worktops and kitchen cupboard kickboards were being fitted. Miss Walsh-McKechnie said that this room would then be decorated. Bedroom accommodation remains as at previous inspections with planned decoration and maintenance ongoing. Each bedroom was personalised by the individual service user. Soft toys, CDs, DVDs and videos were seen in their rooms with televisions and sound systems evident. Within the home there is a bathroom comprising of a bath with a overhead shower, a toilet and wash hand basin. All of the current service user group are able to use these facilities without the use of any specialist equipment or environmental adaptations.
Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 16 The communal areas of the home are the lounge/dining room and the kitchen. Furnishings and furniture are of good quality appropriate to the needs of the three service users. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 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, 33 & 36. Staffing levels and skills are appropriate to the needs of service users. There is a need to introduce regular recorded supervision sessions for care staff to ensure that service users are supported and protected. EVIDENCE: As stated at the last inspection, Broad Horizons Limited have introduced Learning and Disabilities Framework (LADF) Training for all care staff. Staff have completed courses entitled the Safe Practitioner, Communication and Abuse Awareness training. National Vocational Qualifications (NVQ) training is also encouraged and progressed. Over 50 of care staff at Mill House have obtained a NVQ level 2 qualification in care, with one senior care staff member at the home about to commence NVQ level 2 in care in January 2006. Staffing rotas and staffing levels were inspected and these were found to meet requirements. Miss Walsh-McKechnie said that staffing levels are continually reviewed to ensure that service users needs are met as they access activities and appointments. Consideration is given to the Department of Health Residential Forum Guidance. Records evidenced that staff supervision had commenced. The need however to plan regular recorded supervision meetings was highlighted and discussed with Miss Walsh-McKechnie. New supervision record sheets have been
Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 18 introduced into the home. Discussion took place as to the record keeping currently used and to it’s composition and format. Miss Walsh-McKechnie was reminded of the need to ensure that topics as listed within the National Minimum Standards – Standard 36.4 need to be considered. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 19 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): 38, 39, 40 & 43. Staff and service users are well supported by the home’s manager, who is hands-on and part of the care team in the home. They benefit from competent and accountable management of the home. An effective quality assurance and quality monitoring system is still required. The home has reviewed and revised their policies and procedures to help safeguard service users’ rights and best interests. EVIDENCE: From discussion with Miss Walsh-McKechnie the management approach in the home was seen to be open and positive. Record keeping and management planning evidenced this. Whilst a quality assurance surveys have been used in the past, a new stakeholder survey is to be sent out to service users’ families and their social workers in the next two weeks. Following this, there would be a need to analyse the responses and implement an annual development plan for the home. Miss Walsh-McKechnie said that she hoped to have completed the analysis within three months.
Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 20 Policies and procedures were sampled and reviewed. Broad Horizons Limited have adopted policies and procedures produced by Mulberry House, a consultancy. Of those policies and procedures sampled, they were found to meet requirements. The care home however, is reminded of the need to ensure that in adopting these policies and procedures there is a need to guarantee that they are appropriate and applicable to the individual care home. The business and financial plan for the home were not inspected at this inspection. Insurance certification for Employers Liability was seen to be current, appropriate and on display. Miss Walsh-McKechnie said that insurance cover is in place to cover any loss or damage to the assets of the business. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 21 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 2 2 X 3 3 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 X 25 3 26 3 27 3 28 3 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X 2 3 X X 3 Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 22 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. Standard YA20 Regulation 13(2),Sch. 3(3)(i) Requirement The registered manager and staff must ensure that they encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the home’s policy and procedure for the receipt, recording, storage, handling, administration and disposal of medication. (This is a repeat requirement from the last inspection. Timescale of 28/10/05 not met.) The registered person must ensure that staff receive support and supervision to carry out the job as detailed in the National Minimum Standards for Care Homes for Adults (18 - 65). (This a repeat requirement. This standard was not inspected at the last inspection.) The registered person must ensure that there is an annual development plan for the
DS0000017887.V277393.R01.S.doc Timescale for action 03/03/06 2. YA36 12 (5), 18 (2) 03/02/06 3. YA39 24(1)(a)(b) (2)(3) 03/03/06 Mill House Version 5.1 Page 23 home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. . (This is a repeat requirement. Previous timescales of 07/02/05 and 25/11/05 were not met.) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Service Users’ Guide should be summarised in a clear and accessible format and addressed directly to service users in terms, which can be easily understood by them. Mill House DS0000017887.V277393.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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