CARE HOME ADULTS 18-65
Millenium Care (Fox Lane) 89 Fox Lane London N13 4RR Lead Inspector
Rebecca Bauers Unannounced Inspection 27th October 2005 13:00 Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 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 Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 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. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Millenium Care (Fox Lane) Address 89 Fox Lane London N13 4RR 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) 020 88828171 Millenium Care Mr Idwal Brian Evans Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd May 2005 Brief Description of the Service: Millenium Care (Fox Lane) is a registered care home, which provides residential service for seven adults who have a learning disability. The home is located in a quiet residential area within a few minutes walk from shopping and transport facilities of Palmers Green. The home is run by Millenium Care, a company that operates a similar residential home nearby. Facilities at the home include seven single bedrooms, a kitchen, a dining room, and a large lounge at the front of the house, a shower room, a bathroom and three toilets. Currently, the home does not have a vacancy. There is a space for car parking at front of the building. At the back of the building there is a garden, which is accessible through the kitchen. From 9.30 am to 3pm Monday to Friday all service users and staff are out of the premises. In the event of an emergency staff can be contacted via the sister home Old Park. Or the registered manager can be contacted via his mobile phone number. Both contact numbers have been given to the relevant day centres or colleges. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 27th of October 2005 as part of the annual inspection programme to identify progress with previous requirements and to check standards of care against the core standards. The inspection took two and three quarter hours to complete. A partial tour of the home took place; two service users were spoken to individually. No relatives visited the home during the inspection. Care records, quality assurance audits, staff records and health and safety records were examined. Two staff were spoken to and the inspector was accompanied by the registered manager. Further information was obtained through observations of staff interaction with service users What the service does well:
Service users continue to benefit from the experience of multidisciplinary working to ensure that their personal care, social and emotional health needs are met. Medication policies administration. and procedures protect service users from mis Service users are protected by the homes adult protection policies and procedures. The environmental conditions are homely and welcoming for service users to live in. All service users have a safe place to store valuables if they wish. The service users benefit from annual reviews of their assessed needs which are reflected in their detailed individual plans. This ensures that their needs are met and that staff support them in the way they prefer to promote independence. Service users continue to benefit from fulfilling activities to enhance their lives and meet their aspirations all within the guidelines of measured risk. The home ensures that service users, relatives and other professional’s views are listened to and addressed to improve service provision through quality assurance surveys and meetings. Service users benefit from a well-established staff team who understand their needs and are provided with the support and information to work with service
Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 6 users in a consistent way. All staff are competent and trained to at least NVQ level 2 in care. Robust policies and procedures are followed in the recruitment of staff to ensure service users are protected. The home is well managed and all health and safety checks are carried out to ensure the health welfare and safety of service users. Service users say that the staff are helpful and friendly. All service users said that they felt comfortable in the home and knew who their key workers were. Service users feel confidant that they are listened to and that any complaints will be taken seriously. What has improved since the last inspection? What they could do better:
The registered person and manager must be commended on their achievement of meeting most of the standards listed in the national minimum standards for care homes for adults (18-65). Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 7 One requirement was made at this inspection this was restated and concerned the need for staff to undertake practical training in the management of challenging behaviour for example ‘NAPPI’ training. 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. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: There have been no new admissions to the home. None of these standards were assessed at this inspection. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Service users know and continue to be involved in the review of their assessed needs and the development of their individual plans to ensure that their goals reflect their own desires and needs. Service users are actively involved in the participation and decision making in the home and are supported to take risks whilst at the same time promoting their independence. EVIDENCE: Two service users spoken to say that they had regular reviews where they are able to discuss their individual plans and make decisions with regard to their own personal goals. The home continues to keep excellent up-to-date review notes, which are held on the service users files. Some reviews are due this month; the home is in contact with the placing authority to arrange reviews for four service users. Daily records and an activities file for individual service users provided evidence of the decisions service users make with regard to their own lives on a daily basis. Two individual plans seen had been developed with the service user. Service users confirmed their involvement with the development of their individual plans. Following an assessment of need, these plans were comprehensive and clearly identified support needed from staff to enable
Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 11 service users to achieve specific goals and desired outcomes. These plans also stipulated what service users were able to do for themselves to ensure that their independence is promoted. Individual plans continue to be review monthly with the key worker and service users. Service users were seen interacting positively with staff that demonstrated a good knowledge of their individual needs. Each service user has a life history in place which includes childhood and family photographs, this provides valuable information for staff to enable a holistic view of each individual to be understood. The combination of this information has enabled a consistent approach in the care and support provided by staff to service users. Challenging behaviour guidelines were clear, appropriate and had been agreed using a multidisciplinary approach. Risk assessments continue to be reviewed and are comprehensive. There were appropriate risk assessments in place for all service users; they had been reviewed during the end of 2004 and January 2005. Further review dates had been clearly identified. The risk assessments clearly identified ways to minimise risk for service users whilst at the same time promoted their independence. Risk assessments included, absconding, the use of bedroom keys, bathing, kitchen appliances and access to the local community for example. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 Service users have opportunities for personal development through the attendance at college and activities within the home. Service users are able to access the community with or without staff support within the guidance of their risk assessments. Service users have regular contact with family and friends, which is promoted with the home. EVIDENCE: All seven service users continue to either attend a college, daycentre or pursue their chosen activities in the wider community during the week. Service users stated that they liked to go swimming, shopping, day trips or to the cinema. The activities record demonstrated a range of activities enjoyed by service users in the home such as cooking meals for themselves and others, activities in the local community, and across the UK. All service users have had an annual holiday. Some service users are planning to take an additional holiday with some friends in another home. Staff confirmed that service users go out every day to pursue their chosen group of individual activity. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 13 Communication is aided in the home through the use of makaton and speech and language therapy to ensure that service users with some communication difficulties are understood and that their wishes are met. The visitor’s book and individual plans demonstrated regular contact with family and friends. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19.20,21 Service users receive personal support in the way they need and prefer and their physical and emotional health needs are reviewed and monitored by a multidisciplinary team. Medication policies and procedures followed by the staff safeguard the service users. Documentation is in place to ensure that service users wishes are respected in the event of illness and death. EVIDENCE: Service users individual plans clearly detailed service users personal care and support need preferences. Service users commented ‘ I like the staff and they are caring.’ The service users physical and emotional health needs are met by the well informed staff in the home and the support they receive from a multidisciplinary team. Two service users files seen contained detailed health records of GP appointments, chiropodists, psychologist, speech and language therapy and psychiatry input. The home had robust procedures in place for the administration of medication to ensure the safety of service users. Medication records demonstrated accurate recording of the administration of medication. Staff spoken to explained the appropriate procedures for administering medication to
Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 15 safeguard service users. The pharmacist continues to visit the home on a monthly basis. All staff have received recent training in the administration of medication and the record of staff trained to administer medication held in the medication file has been updated. Staff have also received refresher training on the 27th of June from the CPN in epilepsy and the administration of rectal diazepam, which is relevant to safeguard some of the service users in the home. PRN guidelines had been agreed using a multidisciplinary approach and in place for all service users to safe guard them against over administration. Service users wishes in the event of terminal illness and death had been documented sensitively in their individual files to ensure their wishes are respected. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Service users do feel that their views are listened to and acted upon. Service users are protected by a well trained staff team and robust adult protection procedures. EVIDENCE: The homes adult protection policy and reporting procedure is clear and robust to protect service users. All staff have attended POVA training, this was evidenced in the staff files and through discussion with staff that were clear with regard to whom to report alleged incidences of abuse to. Each service user continue to have a copy of the homes pictorial complaints procedure in their bedrooms, service users have benefited from a stable staff team and feel relaxed enough to discuss any issues or concerns. There have been no complaints since the last inspection. Service users spoken to stated ‘yes I am very happy living hear.’ Service user meeting minutes demonstrated the homes ability to listen to service users views and act on them. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Service users continue to live in a homely, comfortable safe environment. The home is clean and hygienic. EVIDENCE: The home had been decorated last during May. The communal areas were bright and airy making the home welcoming and homely. Two of the service users had chosen and ordered new bedroom furniture for their rooms and were expecting a delivery in the next couple of months. The front of the house had been painted including the front door. The driveway had been paved and included a ramp to the front door making it more accessible. Other areas of the home were clean and hygienic. Fire doors in some areas had again been propped open by door wedges; this is not acceptable and is not in line with the homes fire risk assessment and emergency plan. The door wedges were removed immediately and all fire doors were shut effectively to ensure the safety of service users and staff. All fire doors must continue to be shut at all times. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 Service users are supported by a stable staff team and follow robust recruitment procedures. Service users benefit from a well supported and supervised staff. All staff have undertaken appropriate training to meet the individual and joint needs of service users. EVIDENCE: Service users benefit from a stable staff team who are well informed with regard to their needs through the use of the comprehensive individual plans, life histories and training. Staff records showed that all staff complete a TOPSS induction, receive regular two monthly supervision, some staff have monthly supervision. There has been one new staff recruited to work in the home since the last inspection. The file was examined and found to be complete and demonstrated robust recruitment procedures. The rota was seen and reflected the staff on duty at the time. Two staff spoken to were positive with regard to the support and training received within the home and stated that staff morale was good. Requirements made for staff to undertake mandatory training such as first aid and manual handling had been fully progressed. Staff have undertaken practical training in these areas during June 2005 to safeguard the service users and themselves. Certificates were seen to substantiate this. Staff had
Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 19 undertaken training in the management of challenging behaviour using a video, and practical training in epilepsy and the administration of rectal diazepam from the community nurse. Practical training in the management of challenging behaviour must be undertaken by the staff team for example ‘NAPPI’ training. Three staff have now completed NVQ level 2 in care one is still dong the course and three staff have started NVQ level 3 in care. Staff continue to have monthly team meetings, records showed clear direction and leadership with clear actions identified. Recent attendance at meetings have improved. Communication systems in the home are being reviewed to ensure that all significant information with regard to service users is appropriately handled and shared. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Service users benefit from a well run, organised home. Quality assurance monitoring systems ensure that service users views underpin self-monitoring and service development. Policies and procedures are reviewed and updated annually to safeguard service users and the health, safety and welfare of service is promoted. EVIDENCE: The registered manager is competent and continues to work within the ethos of person centred planning to ensure the service users needs and aspirations are a priority. The staff team are well informed and fully supported. Some staff will be undertaking training in PCP in the near future to promote this ethos. Service users benefit from regular resident meetings where there is good attendance. The summary quality assurance audits had been given to each service user. Service users views of the home are positive and areas for development have been formalised into an action plan to improve service provision. In addition, monthly unannounced visits are carried out by the
Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 21 registered person and copies of these reports are sent to the Commission and kept on file in the home to ensure constant monitoring of the service being provided. A recommendation made at the last inspection for the ‘evaluation file containing general information for staff to be reviewed and old information discarded had been fully progressed. All health and safety records were checked and were found to be up-to-date and appropriate to meet the health, safety and welfare of service users this included a work place risk assessment. The home has a fire risk assessment and an emergency plan in place to safeguard service users. Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 4 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Millenium Care (Fox Lane) Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 3 3 x DS0000010632.V251464.R01.S.doc Version 5.0 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 18(1)(c) (i) Requirement The registered person must ensure that all staff receive training in how to manage challenging behaviour, this must be approved training such as NAPPI. This requirement is amended and restated from the last inspection. Timescale for action was 1/9/05. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Millenium Care (Fox Lane) DS0000010632.V251464.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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