Inspection on 15/05/07 for Mill House

This inspection was carried out on 15th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mill House 06/02/06

Mill House 30/08/05

Mill House 17/12/04

Mill House 22/07/04

Mill House 22/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Mill House 3 Millpond Street Ross-on-Wye Herefordshire HR9 7AP Lead Inspector Jean Littler Key Unannounced Inspection 15th May 2007 1:00 Mill House DS0000024725.V333011.R01.S.doc Version 5.2 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 DS0000024725.V333011.R01.S.doc Version 5.2 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 DS0000024725.V333011.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House Address 3 Millpond Street Ross-on-Wye Herefordshire HR9 7AP 01989 765548 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) Mrs Anne Elizabeth Gray Mrs Anne Elizabeth Gray Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with a physical disability in addition to their learning disability can be accommodated. Date of last inspection Brief Description of the Service: The Home is managed as a sole concern by Mrs Anne Gray. The Home is registered to provide accommodation and personal care for five people with needs arising primarily from learning disabilities. Some of those accommodated also have physical care needs. The Home is a two storey terraced house in Ross-on-Wye, it consists of two single bedrooms and one double upstairs and one single bedroom on the ground floor that has a disabled access en-suite facility. There is a lounge, dining room, laundry and kitchen, and there is a good sized garden. The Home is located close to the town centre and has good access to local amenities. Information about the service is available from the Home. The fees are £425 per week. The residents pay a contribution towards the fees from benefits they receive. In addition to the basic fees the residents pay for their personal items such as toiletries and clothes, personal services such as chiropody and hairdressing and contributions towards holidays and transport costs. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over four hours on a week day afternoon. The owner was in and helped with the inspection process. The inspector looked around the house and spoke with one of the staff and three of the residents. One resident showed the inspector her bedroom and they talked in private about her views of the Home. Some records were looked at such as care plans. The manager sent information about the Home to the inspector before the inspection. What the service does well: The home only offers a place to someone if they can meet their needs. They can move in and try out the service before deciding if they want to live there. The residents are involved, where possible, in planning their support. The residents are supported to stay healthy and make decisions about their medical treatment where possible. There are enough staff to support the residents with their chosen lifestyle. The residents choose what activities, hobbies or college courses they want to do. The residents are supported to have friends and stay in touch with their families. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 6 The house is homely, comfortable and safe. The home is well run and the residents’ views are listened to. The staff team is small so staff know the residents very well. The staff are trained and supported to do a good job. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 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 DS0000024725.V333011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about moving into the Home. Their needs and aspirations are assessed and they have the opportunity to visit and try out the service. Each resident has a contract and a statement of Terms and Conditions of Residency. EVIDENCE: A Statement of Purpose is in place and this has been kept under review. There is a Service User’s Guide and each resident has a copy in a format that helps them understand the information. Each resident also has a copy of the Terms and Conditions of Residency that they or a representative have agreed to. No new residents have been admitted since 2005. The assessment and transition process for the newest resident was assessed at the last inspection. This had been carried out comprehensively and with the full involvement of the resident and her representatives. Procedures are in place for the assessment of any potential new resident. Placing Social Workers are always asked to provide Community Care needs assessments. The newest resident said she was given useful information about the service, which she keeps in her bedroom. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can be confident that their needs are reflected in their care plans and they are consulted about their care. They are supported to take reasonable risks as part of living independently and make decisions about their lives where possible. EVIDENCE: Each resident has a care plan that includes their strengths, needs and goals, along with practical care information and risk assessments. The plans are being kept up to date. Two residents have person centred care plans that they helped to develop and keep in their bedrooms. The newest resident’s plan was seen. This showed that some goals had been identified such as coin recognition and literacy skills. The plan is hand written and is not presented in an accessible format. The provider agreed this resident would benefit from developing her own person centred plan. She agreed to explore how other providers are using digital photography and computer images to make information more accessible. Key points about the resident’s needs that were highlighted in an assessment completed by an external professional could be Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 10 better reflected in the care plan e.g. the need to limit the number of choices offered. Two review meetings have been held with the newest resident and her representatives to confirm that the placement is meeting her needs. Annual meetings are held once a placement is established and residents representatives are involved where possible. The provider agreed to hold these at least six monthly in line with the National Minimum Standards. The provider agreed to consider developing a keyworking system and engaging care staff in the care planning and reviewing process. This and the developing staff supervision system should increase staffs’ skills and their awareness of the goals the residents are working towards. Each resident has very different needs and their routines and activity plans reflect this. Where possible the residents are enabled to take risks that benefit them e.g. one resident walks home from one of her activities when the evenings are light. One external professional reported that the residents are given plenty of choice and are all treated as individuals. Residents’ meetings are held regularly and they are consulted about things that affect their daily lives e.g. holidays, activities and meals. One resident goes food shopping as this is the best way to enable her to choose items she wants. One spoke in private to the inspector and said she was happy with the support she received and felt staff respected her choices. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are being given opportunities to try new experiences and develop personally. They are supported to make decisions about their lifestyle, activities and further education. Their rights are actively promoted and they are encouraged to take responsibility for themselves when possible. The residents’ personal relationships are valued and staff assist these to flourish. They enjoy their mealtimes and have influence over the food they eat. EVIDENCE: Each resident attends regular activities based on their interests and that they have indicated they enjoy e.g. gardening club, college, day centre sessions. Consideration is given to the residents age when planning as some are reaching retirement age. The new resident had not been attending any regular activities whilst with her family so her routine continues to be built up as she explores new options. One resident has chosen not to attend day services with people with a learning disability. The staff have supported her wish and she is accessing a local support group and is having personal literacy tuition. Risk Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 12 assessments have been carried out where needed e.g. for a resident to be left at an activity without staff support. The Home is close to local amenities and opposite a supermarket. Residents take part in shopping trips and use local resources such as cafes. A vehicle is provided for trips further a field. The residents can also use dial-a-ride or public transport. The residents mix with peers at the social events organised through the Ross Leisure Link. Residents are supported to have special days out or short breaks away e.g. to see films of their choice or to visit places of interest. Holidays are arranged each year and a week at the coast is booked for this summer. Two residents have applied for passports as they are going abroad for the first time to visit Euro Disney. The residents continue to be supported to stay in touch with their relatives and friends. Where needed staff provide transport to facilitate visits. Relatives and representatives are included in review meetings and other planning processes with the residents’ consent. One resident goes out each week with a friend and another has a friend who visits regularly. One resident has made links through a woman’s group but had not seen any of the members since it ended. The provider should consider supporting her to stay in touch with the women she liked. Relatives gave positive feedback in questionnaires about the homely atmosphere and the range of activities accessed. One reported that her relative has developed greater self-confidence since living at the Home. The residents reported in their questionnaires that they can choose how to spend their time and they enjoy their activities. All the residents are registered to vote and the newest resident explained that she had recently voted for the first time. The residents’ food preferences are well known. Some of these are not particularly healthy e.g. pie and sausages, so staff need to negotiate a wider variety of meals for the menu. A sample of menus showed a good range of healthy meals are being provided. Some of the residents assist staff to prepare meals and all help with tasks such as laying the table and washing up. The meals are relaxed and residents continue to report that they like the food. One resident was observed to make drinks for those at home and call up the stairs to find out peoples preferences. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are consistently provided with personalised support in a way they prefer. Their emotional and physical health needs are being met and their privacy and wishes respected. Medication is managed safely on the residents’ behalf. EVIDENCE: Some residents do not need staff support with personal care, however prompting is given if needed. The staff team is small and stable so staff know how the residents prefer routines. The staffing levels allow for each resident to be supported at their own pace. Details of how their personal and health needs are met are included in the care plans. The provider reported that some residents like pampering sessions e.g. having their nails done by staff. If able, the residents choose where to have their hair done and the style they want. All staff are female so same gender personal care is provided to the female residents but not for the male resident. The residents’ emotional needs are being met through strong relationships with the staff team and links with friends and family. Links with external professionals are in place for any complex emotional or physical needs. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 14 The residents’ health needs continue to be given a high priority. Regular preventative health checks are arranged e.g. dentals and well woman’s or man’s checks. One resident has benefited from attending a women’s group that was piloted locally, and it is hoped this will re-form soon. Healthy eating is promoted and weights are monitored if needed. The provider agreed to look at locally used Health Action Plans as a way of presenting health information in a more accessible and person centred way. If possible residents are supported to see health professionals in private unless they request staff support. Accidents are monitored and a matrix is available to look for trends. However none have occurred since the last inspection. Positive feedback about the service was received from the GPs, podiatrist and a dentist. One commented that the residents are always happy, busy, well dressed and have excellent personal hygiene. A visitor reported that her friend is always smart and well cared for. Medication was not inspected in depth on this occasion. The is a policy and procedure available for the management of medication that one of the Commission’s pharmacy inspectors has seen. Relatively little medication is currently being managed. The storage arrangements are suitable and the standard was met the last time it was inspected. The provider has actioned a recommendation to have a register in place in case any controlled medication is ever prescribed. All staff have completed a safe handling of medicines course. Some have done this in the past but the provider felt it important to refresh their knowledge. The supplying pharmacist audits the system and no recommendations were made at the most recent audit. The new quality assurance system includes an internal audit of medication. This was completed and action taken to make some improvements that were identified. The care plans contain details of the medication prescribed and the reason this is needed. Medication reviews are held regularly with the GP or consultant involved. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported to express their views and these are listened to. Good arrangements are in place to help protect the residents from abuse. EVIDENCE: No complaints or vulnerable adult concerns have been raised since the last inspection. The home has suitable policies in place for the management of any such issues. Staff have recently been provided with a refresher course on adult protection and they have been given information on how to respond appropriately to concerns and complaints. The professional guidance ‘Speaking Up’, is available and staff are expected to support the residents to express their views. The residents have a booklet about how to make a complaint, which has a form included. Not all the residents are able to understand and use this so there is also a poster with pictures to try to inform residents of their rights. The newest resident had shown a friend the complaints leaflet and explained it to her. This resident reported that she would tell the provided or her friend if she had any concerns. The feedback questionnaires received indicated that the residents and their represenatives feel their views are listened to and acted upon. Residents meetings are held regularly and one resident has enjoyed attending a self-advocacy group in recent years and she now plays an important part in promoting self-advocacy and disability rights locally. The other residents have either chosen not to attend this group or it would not be suitable for their needs. Staff recruitment procedures include robust checks on applicants’ backgrounds. Financial systems help protect the residents from financial Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 16 abuse. The care worker spoken with was confident that all members of staff would report any concerns or poor practice promptly. Three of the four residents would also be able to report any concerns themselves. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a homely, comfortable, clean and safe environment that meets their needs. The Home is being continually improved and the residents are consulted about any changes. EVIDENCE: The Home is in a central residential area of the town close to all amenities. There are four bedrooms with sinks. One is on the ground floor and this has an accessible en-suite shower facility. The communal areas consist of a kitchen, laundry, dining room, lounge, downstairs toilet and upstairs bathroom. The Home has always been found to be clean and homely. All areas were attractively decorated and comfortably furnished. The layout meets the residents’ needs, and suitable aides and adaptations had been provided. The Home is currently registered for five residents although only four have been accommodated in recent years. Some minor improvements were made to the spare single bedroom to make it warmer and recently one resident took up the option to move into it leaving the bedroom she had shared for many years. The provider reported that she is very proud of her new room and is enjoying Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 18 the increased privacy, choosing to spend more time in her room pursuing her interests. Now all residents have single rooms the provider is agreeable to the Commission reducing the registered places from five to four, as she would not expect residents to share in the future. This is positive, as the communal rooms are not very large. The bedrooms becoming single occupancy has facilitated a resident with some mobility problems to move into the downstairs bedroom and the newest resident, who is fully mobile, moving upstairs. All residents were consulted and consented to the changes, which seem to be beneficial to them all. One resident showed the inspector her bedroom, which she liked. She had her personal possessions around her and staff were seen to knock and wait for her permission before entering the room. The room is big enough so as she does have visitors a second armchair should be provided. The Home continues to be well maintained by the provider’s husband who deals with repairs, redecoration, the garden and routine testing such as fire equipment, and water temperatures. Following a visit by the fire authority in 2006 the fire prevention arrangements have been improved with door seals and the alarm extended into the bathroom where a gas water heater is stored. A system is in place for staff to report repairs that are needed and there is a rolling programme of redecoration and refurbishment. Recently two bedrooms have been decorated and flooring has been replaced in some parts of the Home. The laundry room is suitably equipped and it was clean and well organised. It is kept locked but residents can access it under supervision. Protective clothing is provided and infection control and hand washing information is displayed in staff areas. All staff have received training in infection control. Feedback from visitors to the Home confirmed that high standards of cleanliness and homeliness are always maintained. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from support from an established, competent and effective staff team. They are protected by the recruitment procedures. The staff are appropriately qualified and trained to meet the residents’ needs. The residents’ benefit from a well supported staff team, but outcomes may be further improved if some areas of the staffs’ role and management are further developed. EVIDENCE: The rotas showed that appropriate levels of support continue to be provided. At times only one worker is needed, however staffing is arranged flexibly to meet the person centred approach. For example an additional worker supports one resident to walk home from a day placement in fine weather or collects her by car. Additional staff are provided to facilitate health appointments, days out and activities specifically requested. One resident is looking forward to going to London with the provider to see all the tourist attractions, as she has never been, and two residents are looking forward to a trip to Disneyland in Paris. At night one worker sleeps-in and the provider is on call. The provider works regularly in the Home and will cover any gaps in the rota if needed. The team supports each other well and agency and bank staff are never used. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 20 One worker was interviewed, who has worked in the Home for many years. She reported that she continues to be well supported and that morale remains high. She feels she is offered appropriate training and she now holds an NVQ 2 and 3 in Care. She confirmed that the residents’ needs are being met and that there were no current concerns. The discussion showed she was aware of her role and of each residents’ needs and preference. She obviously respected their rights and wishes e.g. she gave an example of supporting one resident’s decision to occasionally opt out of her bowling activity. The feedback questionnaires received from the residents, professionals and visitors was positive about the staff team. The resident spoken with reported that she liked all the staff including the new one. Three residents were at home during part of the inspection. All appeared very relaxed and they related confidently with the provider and member of staff on duty. The provider has a training plan in place for each year and all staff have their own training file. Since the last inspection courses such as Adult Protection, Medication and Person Centred Planning have been accessed. Moving and Handling refresher training has been identified as the next training needed. Staff have been given a good practice guide on equality and diversity, consent to treatment, discriminiation and whistle blowing. NVQ awards continue to be promoted and over 50 of staff are now qualified. Some are now being supported to gain the level 3 award. The new member of staff has completed the Common Induction Standards. The provider did not expect the new worker to gain the Learning Disability Award Framework (LDAF) as she is only employed to sleep-in two nights a week, however she had attended core safe practice courses and the other training provided for the team. The provider agreed to explore how LDAF is delivered locally so she is fully informed for the future. The new quality assurance system gives staff the oportunity to give feedback e.g. on morale and training. It also includes a matrix for logging staff supervision sessions. Although the sample seen showed regular dates where guidence was given to the worker, one-to-one supervision meetings are not always being held six times a year. The provider is aware of this and it is an aim to develop this management approach further. Annual performance appraisals are carried out with staff. Staff meetings are not held very often and the most recent was October 06. The size of the Home and the small staff team allow information to be shared informally, however the provider recognises that formal staff management systems can bring benefits to the residents. As mentioned above the provider is going to consider introducing a keyworker system. Some staff are very experienced and are now well qualified. They should be able to take on some delegated responsibility for care delivery. One new worker has been recruited since the last inspection. The records showed that a robust recruitment procedure was followed. The CRB check and references were in place before the worker started and the provider had called the referrees to verify their authenticity. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, 43. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a well-run home and effective leadership that puts them at the heart of the service. They and their representatives can be confident their views are valued. The policies and record keeping systems in place help protect the residents’ best interests. The residents’ health, safety and welfare are actively promoted. EVIDENCE: The management arrangements continue unchanged with the provider working full time in the Home and providing direct care. She has relevant experience and has run the Home on a day-to-day basis since it was opened. She keeps up to date with professional changes through a network of local providers and by attending courses. Since the last inspection she has attended a managers fire awareness course to inform herself about the new fire safety regulations. She is due attend a seminar to ensure she is fully informed about the Skills of Care Council. Over many years the Commission has received feedback and Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 22 seen evidence of the provider’s positive attitude and commitment to ensuring the residents’ needs are fully met. The feedback received and the findings of this inspection confirmed that further progress has been made to ensuring high standards are achieved in all areas of the service. The required records are being maintained e.g. health and safety checks and a visitors book. The records sampled were well organised and these are stored securely. As detailed above the records seen were up to date and the level of recording in some areas e.g. quality checking systems, has been improved. The provider uses an external company to support the management of the Home e.g. for employment information and for draft policies and procedures. This is effective and the provider has adapted the information to reflect the Home. The policies and procedures have been kept under review. The provider has not become the financial appointee for the newest resident. It is positive that this responsibility has been taken on by a relative. The arrangements in place were suitable but could be made more person centred if the resident held all her own money in her room. A risk assessment may be needed in relation to where the key to the cash tin is held. The provider gave details to demonstrate that routine Health and Safety checks are being carried out e.g. electrical appliances had been tested in February 07. A risk assessment has been completed for each room and maintenance checks are being carried out every three months. A quality assurance system has been introduced during 2006 that is based around monthly audits linked to the National Minimum Standards. The provider has completed some of these and has taken action where improvements have been highlighted. The system includes feedback questionnaires for various stakeholders. A positive example was seen that had been returned by a visiting professional. The newest resident had been supported by a friend to complete two feedback forms during the initial stages of her placement. Both were very positive. The provider is aware that when a full quality review is completed the findings and any development aims should be shared with stakeholders and the Commission. A business plan has been developed for 2007 and this includes development aims for the service e.g. more staff gaining the NVQ 3 in Care. Evidence of appropriate insurance arrangements were seen and the provider is obviously competent at managing the Home’s finances for the benefit of the residents. She had recently amended staff contracts to reflect the changes in statutory annual leave entitlements. Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 23 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 1 2 3 4 5 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 4 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 4 3 3 3 3 4 Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 YA33 Good Practice Recommendations Introduce a Keyworking system to support the development of person centred care plans and to help staff implement the knowledge learned whilst gaining professional qualifications. Hold staff meetings more often to ensure the team is working consistently towards the residents’ agreed goals. Provide staff with more frequent formal supervision sessions to support their professional development and to monitor their ability to meet the residents’ needs. 2. YA36 Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 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 © 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 Mill House DS0000024725.V333011.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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