Inspection on 14/01/09 for Mill House

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mill House 18/12/06

Mill House 12/01/06

Mill House 05/10/05

Mill House 14/12/04

Mill House 16/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mill House 102 Mill Road Mile End Colchester, Essex CO4 5LJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Kerr     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Mill House 102 Mill Road Mile End Colchester, Essex CO4 5LJ 01206845378 01206843367 broadhorizons@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broad Horizons Limited Name of registered manager (if applicable) Miss Sarah Walsh-McKechnie Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4 The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both whose primary needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Mill House is a small care home for four younger adults with learning disabilities. The registered provider is Broad Horizons Ltd. The responsible person is Mrs Jean Revelle and Miss Sarah Walsh-McKechnie is the registered manager. Mill House is one of a group of three small care homes owned by Broad Horizons, located in Mill Road, Colchester. The three homes work in close co-operation with each other. The home is in a residential area, located close to Colchester General Hospital. There are local shops and facilities nearby, with the main town centre offering shopping and Care Homes for Adults (18-65 years) Page 4 of 32 care home 4 Over 65 0 4 Brief description of the care home leisure facilities, a short bus ride away. Mill House provides accomodation for four people. Rooms are located on the ground, first and second floor; each having a single room with a hand wash basin. There is also a bathroom with bathing and shower facilities, and a toilet. An office and staff bedroom is also found on the first floor. On the ground floor there is a lounge/dining room and kitchen. The property is semidetached and has gardens to the front and rear. There is some off road parking. The rear garden is enclosed with a decking patio area, flowerbeds and lawns. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to adults aged 18-65. The inspection was unannounced on a weekday, which lasted five and three quarter hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in two staff Have Your Say surveys and the Annual Quality Assurance Assessment (AQAA) issued by the Commission for Social Care Inspection (CSCI). This document gives the provider the opportunity to inform CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. The manager was present during Care Homes for Adults (18-65 years) Page 6 of 32 the inspection and fully contributed to the inspection process. At the time of this inspection, there were three people living in Mill House. The current fees are between 550 - 575 pounds per week. Hairdressing, papers, magazines, clothing and personal activities are not covered by the fees and are charged at cost. What the care home does well: What has improved since the last inspection? What they could do better: More could be done to provide people using the service with information in formats that meet their individuals needs. This includes the service users guide and quality assurance questionnaires. These could be further developed using makaton symbols and pictures like the complaints procedure and photographs and quotes from people who already live in the home, giving their comments and experiences about using the service. Medication Administration Records (MAR) charts received into the home must contain accurate information and which clearly reflects when medication is to be taken. This will ensure people receive their correct medication as prescribed by their general practitioner. To provide better security and protect service users from the risk of financial abuse their personal bank cards and individual pin numbers must be kept separate and in a Care Homes for Adults (18-65 years) Page 8 of 32 secure place. It is recommend a current photograph of the individual should be attached to their missing persons profile for identification purposes. To protect the health, welfare and safety of the people living in the home the manager must complete risk assessments for hot water outlets and hot surfaces. An assessment needs to be completed for each person living in the home in respect of the individuals capability of bathing and showering alone, without scolding themselves, with water that is too hot and scolding themselves on hot surfaces such as pipework and radiators in their own rooms and in the dining room. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Broad Horizons have detailed information and admission policies and procedures in place to support people that may consider using this service and which ensures they can meet the individuals needs. Evidence: A comprehensive statement of purpose and service users guide was provided at the inspection, which clearly tells prospective clients about the service, the fees and facilities. This could be further developed using makaton symbols and pictures like the complaints procedure with photographs and quotes from people who already live in the home, giving their comments and experiences about using the service. Each person is provided with a copy of the service users guide, which forms their terms and conditions of living in the home. This is reviewed annually and states the individuals current fees. There have been no new admissions since the last inspection. Two peoples care plans Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: looked at as part of the inspection process showed both people had moved to the home in 1997. A copy of the funding authoritys needs assessment had been obtained for both individuals, which formed the basis of the individuals care plan. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service know they will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. Evidence: Care plans are well organised person centered and agreed with the individual. These are easy to understand and look at all areas of the individual’s life. The care plans record peoples preferred language and method of communication. Plans contained all relevant information from previous placements, preliminary and Community Care Assessments, which covered all aspects of the individuals health, personal and social care needs. These included a description of the support and interventions required by staff to maximise the individuals independence and to keep them safe. A previous requirement from the key inspection in 2006 was made for the manager to ensure that staff enable people using the service to take responsible risks Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: and that they are provided with information on which to base decisions within the individuals care plan, risk assessment and risk management strategies. The individuals needs assessment has formed the basis of the individuals plan with identified aims and defined objectives. These were listed 1 to 9 providing a good description of daily living support required and the individuals own abilities to achieve the outcome. These include supporting people using the service to develop their self help skills, such as washing, bathing, literacy, money, communication, use of community resources, such as post office, restaurants, pubs, leisure activities and interpersonal skills, such as appropriate behaviour, personal hygiene, health education and emotional well being. Each aim listed was supported by a detailed risk assessment providing staff with information of how best to support the individual, to do what they want to do and to be as independent as they can be, whilst minimising the risks to them. These are reviewed monthly. Each of the residents care plans contained a missing persons profile with a brief description and information about the individual and contact numbers should they go missing when out in the community. It is recommend a current photograph of the individual should be attached for identification purposes. Plans included supporting people whose behaviours can be challenging to others or them selves as a result of self neglect, self injury or physical and verbal aggression. Aim 9 in the plan of one individual has been developed to support them to manage their beahviour, which relates to destructive and obsessive behaviours around food, personal possessions and to their environment. The plan gives good descriptors of trigger points and guidance for staff if inappropriate behaviour occurs. This is supported by a detailed risk assessment, which reflects the individuals history of violence and self harm with actions for staff to take to reduce the risks. Recording of incidents that have occurred showed that staff focus on positive behaviours, as well as recording the negative behaviour. Staff confirmed people using the service are encouraged to make choices and decisions and whilst they may have limited language they were able to communicate their feelings and wishes through non-verbal language and gestures and using objects of reference. An example of this is by taking different items of food out of the fridge and freezers and letting the residents chose what they want to eat. This was also evidence through observation of the residents moving freely about their home and choosing what they wanted to do. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are supported to live meaningful lives, both in the home and in the community, enjoying a full and stimulating lifestyle with a variety of options to chose from. Evidence: Observation and discussion with people living in the home confirmed they are supported to follow their interests and be integrated into community life. Time was spent talking with all three residents. One person was tired and decide to go to their room of their own accord to rest, whilst the other two residents decided to go to their rooms to listen to music and were supported by staff to make them self a cup of tea. The people living in all three Broad Horizon homes know each other and meet and socialise together regularly. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Staff encourage and support the residents to be as independent as they can be taking part in the cleaning and running of the home. Although the plans show that residents have limited independent living skills they do take part in drying the dishes, loading the washing machine and folding their own clothes, cleaning their own rooms, planning and shopping for meals. People using the service are supported to take part in various activities in the home and in the community, such as going to the pub, bowling, aqua springs, going to the cinema, visits to the company caravan in St Osyths for days and holidays, listening to music, dancing, puzzles, games and helping in the garden. The home also has a trampoline in the garden for people to use. The manager stated they have tried in the past to support the residents to attend college but none of the people currently living at the home are able to take part in these activities. All three people living in the home are supported to maintain family links and friendships. Residents told us they spent time at home at Christmas with their families and one person said, I go to their parents home very other weekend. A previous recommendation by the Environmental Health Officer was for the home to to obtain and implement the food Safety management system. A policy is in place, which includes the guidance and reminders for staff with regards to food hygiene and hand washing and procedures for assisting people to eat and refusal to eat. Menus have been designed to ensure meals are balanced with a nutritional basis. The weekly menus are used as a guide only, people are offered choices. Nutrition charts seen reflect this. Residents confirmed they assist staff in food shopping and picking out foods in their local supermarket. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is based on their individual needs and preferences. Evidence: People living in the home are supported to have access to health care services. Care plans contained individual health plans, which provided clear information about the individual’s health, physical and mental health needs and how these were to be met. Health charts were seen, which monitored peoples health and where potential complications or problems were identified these were dealt with. One persons review and diet plan identified there are some concerns about the individuals weight. The individuals relatives had raised concerns about their considerable weight loss over the last few years. When they moved into the home they were 13 stone but now weighed 8 stone 4lbs. This was discussed with the manager who confirmed the individual has a heart condition and the General Practitioner (GP) had recommend the individual followed a low fat diet, after recurrent chest infections. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Their weight loss has helped with their mobility and heart condition, however their relatives have expressed concern they would like to see an increase in their weight and feel 9 stone would be a healthier weight. This has been set as an objective following the last review and is being monitored. The manager confirmed the individual is not following a diet anymore and has not been for a couple of years. They have stayed a steady weight and that the increased activity has helped. Nutrition records are being kept. Their weight record shows they have maintained an average weight throughout the year. The principles of respect, dignity and privacy are put into practice, delivery of personal care is responsive to the needs and preferences of the individual. The majority of the people living in the home are able to manage their own personal care with staff support. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each persons health and well being. The practice of administering medication is generally well managed. Medication Administration Records (MAR) were inspected for all three people living in the home. Individual photographs were attached to the records to avoid mistakes with the persons identity. The MAR charts were found to be completed correctly, with no gaps. Staff had made good use of the reverse of the MAR chart to reflect when PRN (as required)medication had been given or if medication had been refused. However one persons MAR chart had inaccurate instructions printed relating to a PRN medication. Chlorpromazine 100mg was recorded as well as 50mg. The 100mg medication had not been signed for. Instructions on the MAR chart stated this was to be taken up to three times a day. The manager confirmed this was a PRN medication and had not been used for a long time. They were advised to talk to the pharmacist about this and either state that the drug is PRN or remove it from the chart as this could lead to confusion. Medication is locked securely in a cupboard in the kitchen. None of the people living in the home are currently prescribed controlled drugs, however the manager was advised if anyone in the home is prescribed these in the future it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall with either rawl or rag bolts. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a complaints procedure, which is in a format they understand and which enables them to make their views known and are protected from abuse or being placed at risk of harm or abuse. Evidence: The complaints procedure has been developed in easy read format using makaton symbols and pictures and photographs of individual staff and other relevant people to the people using the service. Each person has been issued with their own copy of the complaints procedure and these were seen in their care plans. A previous requirement was made at the key inspection in 2006 for the complaints procedure to be amended. This made reference to incorrect information about raising complaints with the registered director of the Commission for Social Care Inspection (CSCI). The manager was informed that the Commission is not a complaints agency and does not have statutory powers to investigate complaints, but can use powers of inspection to undertake enquiry so that we can make a judgment as to whether the provider is complying with the regulations. The registered manager was advised of the need to review this procedure for these inaccuracies. The complaints procedure seen had been reviewed and amended and now directs people to raise any concerns they may have with manager and provides timescales for Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: complaints to be investigated and to refer to CSCI if remain unhappy with outcome. Neither the Commission or the home have received any complaints against this service, since the last key inspection. This was confirmed in the complaints log. The manager stated they have built up a trusting relationship with the people using the service and their relatives and tend to deal with any issues as they arise, which care openly discussed and monitored. Broad Horizons have a robust adult protection policy and procedure in place to promote and protect the health, safety and welfare of the people using the service. The procedure provides information about the various forms of abuse and the procedure staff must follow if they suspect or observe any kind of abuse. Staff spoken with were clear about their role in the reporting of incidents of poor practice and suspected situations of abuse. They were also familiar with the whistle blowing policy and procedures and their duty of care to raise any concerns they may have about other members of staff conduct. People who use the service are supported to obtain, secure and spend their own personal money. The manager confirmed that each person living in the home has their own bank card, this is being kept in their individual money tins with a record of the pin number. This was discussed with the manager who was advised the pin number should be kept in a separate place to protect the individual from the risk of financial abuse. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout and design of Mill House provides people who live there with a safe and comfortable home. Evidence: Mill House provides the people who live there with homely, welcoming safe and comfortable accommodation. It is nicely decorated and maintained to a good standard. The building is fully in keeping with neighbouring properties and has a medium sized garden, which is accessible to all people who live there. Communal rooms are spacious and well furnished with modern equipment and domestic style furniture, carpets and curtains. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. The lounge has recently been redecorated making the home look bright and cheerful. Peoples rooms are decorated to reflect their individual personalities, hobbies and interests, with personal effects. The conversion in the attic is now complete with en suite facilities, however there is no one occupying the room at present. The home has a communal shower and bathroom. The bathroom is starting to look a little shabby and outdated with the rest of the home and could do with refurbishment. Tiles are missing off the end of bath surround. The manager confirmed there are plans in place Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: to redecorate peoples bedrooms bathroom and the hallway. The bath has been fitted with thermostatic valve to regulate the hot water temperature, however a member of staff informed the shower does not have a valve fitted. Radiators in peoples rooms and in particular the radiator in the dining room was very hot to touch, other radiators in the hallways had already been covered. A risk assessment for each person in the home needs to be completed in respect of bath and shower temperatures and the risk of them burning or scolding themselves on radiators. Issues around the privacy for an individual who occupies a bedroom on the ground floor were discussed. This was raised at the previous inspection with regards to opaque perspex added to their bedroom window. The manager was advised to reconsider the action taken and look to more appropriate window dressings to ensure privacy. The manager explained the individual kept pulling down the net curtains. The window has a covering on the glass, which looks like etching. This retains the individuals privacy but still allows for light to enter the room. The main curtains are secured in place to the curtain track by Velcro, which allows for these to be re hung easily when the individual pulls them off. Appropriate domestic laundering facilities are sited in the kitchen area, which is accessible to the people living in the home. There are procedures in place to ensure dirty linen does not come into contact with food being prepared in the kitchen. Liquid soap and paper towels are provided for handwashing in all en-suite and toilet facilities where staff may be required to provide assistance with personal care. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People currently using this service are protected by the homes recruitment procedures and are supported by a staff team that are trained, skilled and in sufficient numbers to meet their assessed needs. Evidence: Four requirements were made at the previous inspection in 2006 for clear records to be kept to show there are sufficient numbers of staff to support service users assessed needs at all times, improve staff recruitment practices and record keeping in the home, to develop a staff training and development programme and ensure that regular recorded staff supervision sessions are held. The duty roster reflected there is two staff on duty during the daytime hours of 8am to 9pm, with one staff on sleep in duty at night. The provider has calculated the assessed needs of the three people currently living in the home using the Residential Forum Guidance, which reflects a total of 152.95 staffing hours, are required. This works out at 3 .82 full time equivalent staff. The home employs four staff, which does currently meet the needs of the people living in the home. These figures may need to be reviewed if a fourth person moves into the home. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Staff are allocated to specific houses, but do mix and match among the other Broad Horizon homes, to provide continuity rather than using agency staff to cover sickness and annual leave. The people using all three services and staff all know each other well and regularly undertake activities and trips together. Two staff files were examined, both had a current photograph of the employee for identification purposes, terms and conditions of employment and all the relevant documents and recruitment checks, required by regulations to determine the fitness of the worker, which had been obtained prior to them commencing employment. Comments received in two staff Have Your Say surveys and discussion with a staff member during the inspection, confirmed that all recruitment checks are carried out prior to appointment. Staff also told us they are kept informed about changes to peoples health and welfare and about changes within the service. They confirmed they had completed induction training and have access to other training including a National Vocational Qualification (NVQ), which covered what they needed to know to do their job and to meet the needs of the people using the service. They also confirmed there are sufficient staff available to meet the needs of the people living in the home and stated, staff are always willing and able to help, we aim for our clients to have a normal life and be as independent as possible. Staff files contained an individual development plan, which reflects training completed and planned. Most recent training has included food hygiene, safeguarding vulnerable adults, fire safety and health and safety. They have also accessed deprivation of liberty training via the Internet. The manager confirmed that staff had previously completed the Learning Disabilities Award Framework (LDAF) as part of the induction process to ensure they had a basic knowledge of working with people with learning disabilities. The manager identified they had been experiencing problems accessing training and have established contact with a company to provide food hygiene and moving and handling training and are awaiting to confirm dates. The manager and provider are currently undertaking a teacher training course and assessor awards. This will enable them to deliver their own training in the future, including their own induction training and verification. Information in both staff files confirmed that new employees had completed their induction training, within the first six weeks of their employment, which included completion of induction workbooks in line with the Skills For Care requirements. Both staff had completed an induction questionnaire to ascertain their understanding of topics covered in the induction. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Staff files had records to confirm that regular supervision is now taking place, this was also confirmed in discussion with staff. The documentation reflects that these sessions include discussion of what went well, what worked less well, discussion of practice issues linked to supporting the people using the service and policies and procedures. Good practice discussions included what to do in an emergency, accompanying service users to appointments and in the community, about learning disabilities, care practice and service users monies and petty cash responsibilities. Policies and procedures discussed covered medication administration, recognise and respond to abuse, fire safety and the complaints procedure. Staff felt the manager is very supportive and is always available if issues or problems arise. Broad Horizons provide staff with the opportunity to complete NVQs The home employs a total of four staff, three have completed NVQ level 2 or above. These figures reflect the service has met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect and is run in the best interests of the people living there, by a competent and qualified manager. Evidence: Sarah Walsh McKechnie has been the registered manager for this service for eight years. They have previous experience of working with people who have a learning disability, palliative care and nursing care of the elderly, as well as being a qualified registered nurse. They have completed their Assessors Award and National Vocational Qualification (NVQ) level 4 in management. Observation of the interactions between the manager staff and the people living in the home, reflects a domestic, non working environment with a homely atmosphere. The most recent annual quality assurance stakeholder survey was completed in November 2008. Feedback obtained from surveys received was positive about the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: service provided. People living in the home had also been provided with questionnaires, however the manager stated it was not possible to get an accurate response from one of the residents and staff had supported the other residents to complete the questionnaires. These reflected they were happy with the service they were receiving. However, more could be done to obtain the service users own views, particularly for people with limited reading skills and understanding, by further developing the questionnaires, in a similar format as the complaints procedure using symbols pictures and photographs. Additionally where possible people using the service should be supported to complete these with support from an independent advocate. Essex County Council completed a contracts monitoring and compliance visit of the home in September 2008. The report for this visit was seen and outcome was that the home continues to provide a good service. Recommendations were made to to improve supervision, training and weight monitoring in care plans. Evidence that the home are achieving this was seen during this inspection. People who use the service are supported to obtain, secure and spend their own personal money. Records of two people tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. The home has a detailed procedure for handling clients cash, which states clients who can must sign individual spending sheets when drawing their personal allowance. Those unable to sign require two staff signatures a senior and staff member. All monies must be accounted for on clients personal spending sheets and receipts must be kept, which show the date amount what and where items are purchased and the change accounted for. Receipt numbers are recorded on the spending sheet. Cash balances are checked at each handover and signed as correct by the seniors. Broad Horizons employ the services of a company who visit all three homes to assess health and safety. They undertake unannounced inspections and last visited Mill House in December 2008. The manager stated they are awaiting their findings and will be issued with a report. The company provide staff with a handbook, containing all health and safety policies and procedures and will provide training. The health and safety handbook is also used during supervision to discuss health and safety. As previously mentioned in the environment section of this report the manager needs to complete a risk assessment for hot water outlets and hot surfaces for each of the people living in the home to ensure their safety when bathing showering and from uncovered radiators. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Records examined confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The homes maintenance folder contained appropriate procedures and provided evidence that routine monitoring of systems, such as monitoring hot water temperatures are completed to ensure compliance with health and safety requirements. The fire logbook showed that the fire alarm is serviced regularly and tested weekly. Regular fire training and drills take place. The homes fire risk assessment was seen which is up to date and complies with current legislation. Care plans contained detailed incident and accident report forms. There were only two incidents recorded, one for each of the residents. The recording on the forms provided good detail about the accidents, what led to them occurring and the actions taken. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 11 Service users bank cards 12/03/2009 and personal individual numbers (PIN) must be kept seperate. This will provide better security and protect service users from the risk of finacial abuse. 2 42 13 A risk assessment for hot 12/03/2009 water outlets and hot surfaces must be completed for each person in the home, in respect of bath and showers temperatures and the individuals capability to use the shower alone without scolding themselves, with water that is to hot and scolding them selves on hot surfaces such as pipework and radiators. This will protect the health, welfare and safety of the people living in the home. Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 More could be done to provide people using the service with information in formats that meet their individuals needs. This includes the service users guide and quality assurance questionnaires. These could be further developed using makaton symbols and pictures like the complaints procedure and photographs and quotes from people who already live in the home giving their comments and experiences about using the service. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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