Inspection on 30/08/05 for Mill House

This inspection was carried out on 30th August 2005.

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

The inspector 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 15/05/07

Mill House 06/02/06

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 Unannounced Inspection 30 August 2005 13.45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Mill House Address 3 Millpond Lane, Ross-on-Wye, Herefordshire, HR9 7AP 01989 765548 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs A E Gray Mrs A E Gray Care Home 5 Category(ies) of Learning Disability 5 registration, with number Learning Disability over 65 years of places 5 Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the information on the previous page a Condition has been placed on the homes reistration that allows for residents with a physical disability in addition to their learning disability to be accommodated. Date of last inspection 17 December 2004 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 and some are over the age of sixty-five. 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. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a week day afternoon between 1.45pm and 3.15pm. Two of the four service users were at Home and one spoke briefly to the inspector. The provider and a permanent full time support worker were on duty and assisted with the inspection process. A social worker was at the Home carrying out care need assessments and holding review meetings. The provider needed to be involved in this process so the inspection was kept brief. Information already known about the service, and correspondence between the service and the Commission since the last inspection were also considered as part of the inspection process. What the service does well: What has improved since the last inspection? The care plans were being developed into a more Person Centred format with the involvement of the residents. Daily records to provide evidence of the service being provided had been expanded and these clearly showed the personalised service being provided. The emergency admission of a new resident had been sensitively managed. She had been well supported during the transition into the service and fully consulted about her needs and wishes. Her room had been decorated along with other areas in the Home. More staff had gained NVQ qualifications and others had started work to achieve these. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 6 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 E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 standard(s) 2, 4. Suitable assessment and admission arrangements had been carried out for the admission of a new resident even though she was admitted under emergency circumstances. A trial period of three months had been arranged and the placement was being kept under review. EVIDENCE: A new resident had been admitted in an emergency situation. Information had been provided at short notice by the social worker involved and the provider had also completed an assessment with the resident shortly after the resident was admitted. The placement was still under review but was progressing positively. The provider reported that the resident had been provided with information about the Home and had this explained to her following her admission. She was aware that she had a three-month trial period to see if she liked living at the Home. The compatibility of the resident group was given serious consideration during the admission process as the other residents have lived together for many years. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9. Suitable arrangements were in place to plan and review support needs. Where possible residents were being involved in decisions about the service they received. The support plans were being developed into a more Person Centred format. Residents were being supported to take reasonable risks so they could lead fulfilling lives. EVIDENCE: Two care plans had been developed into a more Person Centred format and the provider was planning to develop the other plans in this way. No care plan had been developed for the new resident as information was still being collected about her needs and wishes. The provider was planning to develop the care plan if the placement became permanent. The diary showed that all residents were partaking in suitable activities and were being given the opportunity to be independent e.g. to go out alone. The new resident’s records showed detailed daily notes were also being kept. These showed the good efforts being made to help her settle and meet her needs. The information would also be important for assessing if the placement was appropriate, before it was made permanent. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 10 The two residents seen were not able to express their views on the service to the inspector, however they appeared very well presented and were relaxed and relating well to the provider and member of staff on duty. Efforts to consult residents had been further developed and resident meeting minutes showed each resident sticks a happy or sad sticker on the minutes after each short meeting to state if they agree or don’t agree with the decisions made. The funding authority was in the process of reviewing each residents care needs and a representative from Social Services was carrying out two needs assessment meetings at the Home on the afternoon of the inspection. An additional meeting had been held in August for one of these residents, as his family could not attend this later date. A friend of another resident was attending her meeting to help represent her wishes. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 14, 15, All residents were partaking in a good variety of suitable activities that they had shown an interest in. Residents were being supported to take reasonable risks and develop their life and independence skills. Good efforts were being made to promote positive relationships between residents and their friends and families. EVIDENCE: The two residents at Home in the afternoon had already been out at day care sessions. One had been at the recycling project and the other happily signing to indicate she had enjoyed winding cotton at the Autumn Circle group. All residents were attending regular activities and a summer holiday had been arranged. Recently everyone had enjoyed the Ross Regatta. The new resident had not been attending any regular activities whilst with her family so her activity timetable was being built up slowly as she became more settled and her confidence was growing. She was at a weekly bowling session, which she had recently joined. She had also chosen to learn to knit and this was going well. A risk assessment had been carried out regarding road safety and so staff were still supporting her when travelling to activities, however the Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 12 resident was getting used to staying at the bowling session alone. Daily records showed she was being encouraged to be as independent as possible with her own care and domestic needs, e.g. making her own breakfast. The new resident was being supported to visit her mother who was unwell and stay in contact with her brother. The friend of another resident was present in the Home as she was joining a care needs review meeting. The resident often visits her friend to take part in the family’s activities e.g. birthdays. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 21. The residents were being supported in a manner they preferred by staff they knew well and their physical and emotional needs were being met. Great efforts had been made to support and maintain the dignity of a resident whilst she was dying. EVIDENCE: The stable staff team know how the residents prefer to have their physical care needs met and the staffing levels allow for each resident to be supported at their own pace. Their emotional needs were being met through strong relationships with the staff team and links with friends and family. Links with external professionals were in place for any complex emotional or physical needs. Regular preventative health checks were taking place e.g. dentals and well womans/mans checks. The new resident had been registered with a GP and had agreed to have baseline tests done e.g. weight and blood pressure. Dental and other health needs were being set up as these links were not previously in place. A resident who had lived in the Home for many years had become unwell in April 05 and died in hospital in May. To ensure her dignity was maintained and her physical and emotional needs were met in the manner she preferred the provider and other staff supported her every day and provided her with company. The other residents had been kept informed and following discussions with the resident’s relatives the wake had been held at the Home. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 standard(s) 22, 23. Suitable arrangements are in place for responding to complaints and adult protection concerns. The provider has experience of reporting an adult protection issue and acted promptly in line with the procedure. 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 are provided with training about abuse issues and adult protection and these areas are covered in the NVQ awards. Following an incident at the day centre the provider did raise concerns that were dealt with under the local Vulnerable Adult procedures. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 30. The house was suited to its purpose, it was being well maintained and looked homely. Arrangements for cleaning, repairs and maintenance were proving effective. Residents were being supported to personalise their bedrooms. EVIDENCE: The Home was being well maintained and is being kept clean and well organised. All areas were attractively decorated and comfortably furnished. The layout was suitable to the residents’ needs, and suitable aides and adaptations had been provided. The new resident had had her bedroom re-decorated and arranged in a way she preferred. Furniture with a lockable draw had been provided and she had been encouraged to bring personal items with her from her family home to make the room personalised, comfortable and homely. One single room remained empty, as two residents still prefer to share a bedroom. The Home was clean, tidy and homely. A steam cleaner had recently been purchased to help keep carpets and upholstery looking its best. The fridge temperatures were being monitored and food in the fridge had been covered Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 16 and dated. The new boiler/water system reduced the risk of Legionella and water temperatures were being monitored daily to reduce the risk of scalding. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. Appropriate staffing levels were being maintained by a small and effective team of support workers. EVIDENCE: The rotas seen showed that a regular team of seven staff were providing suitable cover. Two staff are full time and five are part time. A part time maintenance worker is also employed. One worker was always on duty during the day and one was sleeping in overnight to be on-call. A second worker was working part of the day to assist with personal care and then with outings or health appointments etc. There were no vacancies and any gaps were being covered by the team being flexible so no agency staff were needed. No new staff had been recruited but the provider had confirmed in the past that she was aware of the recruitment requirements, POVA, CRB etc and the need for new staff to access LDAF induction and foundation units. The support worker on duty had worked at the Home for many years and she and the provider interacted well with the residents in a friendly and appropriate manner. She reported that staffing levels were sufficient and that the team felt well supported and morale was good. She felt that there were no current issues of concern. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 18 Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 41. Appropriate management arrangements were in place and the service was running smoothly. Records were being maintained and securely stored. The level of recording relating to the support provided to residents had been improved. EVIDENCE: The management arrangements were continuing unchanged with the provider working full time in the Home providing direct care. The Home had a relaxed and welcoming atmosphere and residents’ family and friends were being encouraged to visit and take part in residents’ lives and planning meetings. Appropriate records were being maintained and securely stored. The records relating to residents care needs and the service provided to them had been expanded and were more comprehensive and useful. Health and Safety arrangements were not fully assessed, however the member of staff reported that the fire alarm system was being tested regularly and that a fire drill had been held recently. The fire extinguishers had been serviced in November 04. The provider had reported one incident to the Commission as Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 20 required. No other serious incidents or accidents had occurred since the last inspection. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 4 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 x 4 4 x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mill House Score 3 3 x 4 Standard No 37 38 39 40 41 42 43 Score x 3 x x 3 x x E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 22 N/A 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 Regulation None. 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. 2. Refer to Standard YA39. YA6 Good Practice Recommendations Further develop the quality assurance system in line with regulation 24 and standard 39. (Brought forward, not assessed). Continue developing Person Centred Care Planning methods. Liaise with Carolyn Green the PCP Co-ordinator for the CTLD on 01432-268-258. Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill House E52 E02 S24725 Mill House V247615 300805 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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