Inspection on 03/05/05 for Millenium Care (Fox Lane)

This inspection was carried out on 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Millenium Care (Fox Lane) 24/07/06

Millenium Care (Fox Lane) 27/10/05

Millenium Care (Fox Lane) 15/09/04

Millenium Care (Fox Lane) 04/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Millenium Care 89 Fox Lane Palmers Green London N13 4AP Lead Inspector Rebecca Bauers Announced 3 May 2005 at 10.00am 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. Millenium Care Version 1.10 Page 3 SERVICE INFORMATION Name of service Millenium Care 89 Fox Lane Address 89 Fox Lane, Palmers Green, London N13 4AP 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) 020 8882 8171 Mrs A D Fernando of Millenium Care Mr Idwal Brian Evans PC Care Home only 7 Category(ies) of LD Learning Disability registration, with number of places Millenium Care Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15 October 2004 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on the 3rd of May 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 five hours to complete. A full tour of the home took place; three service users were spoken to in a group. No relatives requested to speak to the inspector. Care records, quality assurance audits, staff records and health and safety records were examined. Three staff were spoken to and the inspector spoke briefly to the registered person. Further information was obtained from the pre-inspection questionnaire and comment cards. Seven comment cards were received in total, three from health care professionals including GPs and two from care managers and three from relatives. Positive comments were given with regard to the care received and the caring enthusiastic attitude of the staff team to meet the needs of the service users. Comments had been made with regard to the need to make the home more ‘homely,’ these requests have been listened to and acted on prior to the inspection. What the service does well: The service users benefit from annual reviews of their assessed needs that are reflected in their individual plans ensuring that their needs are met and that staff are supporting them in the way they prefer to promote independence. Service users benefit from fulfilling activities to enhance their lives and meet their aspirations all within the guidelines of measured risk. Service users benefit from the experience of multidisciplinary working to ensure that their personal care, social and emotional health needs are met. The environmental conditions are homely and welcoming and the home ensures that service users, relatives and other professional’s views are listened to and addressed to improve service provision. Millenium Care Version 1.10 Page 6 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 users in a consistent way. 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 enjoyed the food and activities. What has improved since the last inspection? Four requirements and two recommendations were made at the last inspection. All had been met by the registered manager who must be commended. All service users have now been provided with a lockable storage space for personal belongings in their own bedroom. Medication administration sheets demonstrated clear recording of when medication is administered to safe guard service users. The homes adult protection policy and procedure has been amended to ensure that the procedure clearly identifies the ‘host authority’ as the first point of contact in the allegation of abuse. Thus ensuring that the correct procedures are followed to protect the service users. The fire doors are now shut at all times and not propped open. This has been stipulated in the homes fire risk assessment and emergency plan to protect service users and staff in the event of a fire. Staff have regular breaks whilst working longer shifts to ensure that they are always fully alert and able to continue to meet the needs of the service users. The décor in the home has improved considerably, however a requirement had not been made for this at the last inspection. Service users confirmed that Millenium Care Version 1.10 Page 7 they liked the changes and that they had been involved in choosing colours schemes. The home carries out annual quality assurance surveys involving service users to ensure that the development of the service is a priority and to improve service provision for service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Millenium Care Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Millenium Care Version 1.10 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 standard(s) 1,2,5 Service users are well informed about the service provided in the home prior to admission, their needs are assessed fully ensuring individual needs and aspirations are identified. Each service user has been given a copy of the terms and conditions of the home. EVIDENCE: There have been no new admissions to the home since the last inspection. The four service users files seen all contained pre-admission information including an assessment of need to ensure that the home was able to assess whether or not they could meet the needs of the service users prior to admission. Two of the service users spoken to said that the staff were aware of their individual needs and had always been very supportive. Each service user has a written, costed, and signed contract in place. This contract clearly specifies the terms and conditions of the home including the notice period. Each service user has a copy of their own contract in their room including a copy of the statement of purpose and service user guide. Millenium Care Version 1.10 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 standard(s) 6,7,8,9 Service users know and are 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: Three 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. Excellent up-to-date review notes were held on the service users files examined. These demonstrated multi-disciplinary working. 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. Three individual plans seen had been developed with the service user following an assessment of need, these plans were comprehensive and clearly identified support needed from staff to enable 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 Millenium Care Version 1.10 Page 11 promoted. Individual plans are reviewed monthly with the key worker and service users. Service users were seen interacting positively with staff who 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 were good. 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 Version 1.10 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 standard(s) 11,12,13,15,16,17 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. The food provided in the home is good and enjoyed by service users. EVIDENCE: All seven service users attend either a college, daycentre or pursue their chosen activities in the wider community during the week. One service user stated that he regularly goes to the pub independently to watch the football on the big screen. Others said that they liked to go swimming or to the cinema. The activities record demonstrated a range of activities enjoyed by service users in the local community, and across the UK. Service users had recently returned from a holiday in Great Yarmouth. One service users said that he is in the process of arranging to go on another holiday with some friends in another home. Millenium Care Version 1.10 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. Relative’s feedback from comment cards stated that ‘we always feel most welcome when we visit.’ The menus seen corresponded with the food stored in the fridge and freezer, menus are varied and balanced. Service users said ‘ the food is good, we can help ourselves to food in the kitchen, sometimes I cook breakfast on a weekend’. Menus are revised on a three monthly basis with service users. Millenium Care Version 1.10 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 standard(s) 18,19,20 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. EVIDENCE: Service users individual plans clearly stated service users personal care and support need preferences. Service users commented ‘ staff are caring and respectful.’ 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. Three service users files seen contained detailed health records of GP appointments, chiropodists, psychologist, speech and language therapy and psychiatry input. A requirement made at the last inspection for the administration of medication to be recorded accurately on the Mar sheet had been met. Mar sheets for all service users were examined and found to have been completed appropriately. The home had robust procedures in place for the administration of medication to ensure the safety of service users. All staff have received training in the Millenium Care Version 1.10 Page 15 administration of medication. The record of staff trained to administer medication held in the medication file was dated 2001. It is recommended that the list of staff authorised to administer medication be updated to reflect recent training. PRN guidelines had been agreed using a multidisciplinary approach and in place for all service users to safe guard them against over administration. Millenium Care Version 1.10 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 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: A requirement made at the last inspection for the homes adult protection policy and procedure to be amended to include, in the first instance to contact the ‘host’ authority had been met. 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. Each service user has 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. Comment cards from relatives indicated that they were happy with the service and were able to complain. Three service users money tins and records were checked and were found to be accurate with a clear audit trail of expenditure. Millenium Care Version 1.10 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 standard(s) 24,25,27,30 Service users live in a homely, comfortable, safe environment. Bedrooms are individualised, bright and airy, service users are provided with good toilet and bathroom facilities to meet their needs. The home is very clean. EVIDENCE: A requirement made at the last inspection for all service users to have lockable storage space in their bedrooms had been progressed. During a tour of the home the inspector found that each service user now had a lockable space with a key. Service users had personalised their own bedrooms and new items of furniture had been purchased such as chairs and wardrobes. A requirement made for all fire doors to be kept shut at all times had been met. All doors were shut during the tour of the home. The fire risk assessment and emergency plan state ‘to reduce the risk of fire, keep fire doors shut,’ for the safety of service users. The décor in the home had been generously improved since the last inspection making it bright, welcoming and homely. All communal areas had been repainted in neutral colours giving a sense of more space, three service users bedrooms had been decorated and the dining area had been redecorated with Millenium Care Version 1.10 Page 18 a new dining table and chairs purchased. Service users had been consulted with regard to colour schemes. New pictures and mirrors had been purchased for the bedrooms and communal areas. The downstairs shower room has been completely modernised with the installation of a new high-powered shower unit and the bathroom upstairs had been fitted with new attachments. The home was clean and hygienic throughout. Redecoration plans are in progress for the front of the house which include the replacement of the front door, complete the paving on the drive way and painting of the exterior of the house. Millenium Care Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,36 Service users are supported by a stable staff team and robust recruitment procedures are in place to protect service users. Service users benefit from a well supported and supervised staff. New staff have not been trained fully to meet the individual and joint needs of service users. EVIDENCE: Five staff files were examined; two staff had been recruited since the last inspection. The staff files were very well organised and contained all documents required for the protection of service users demonstrating that the home has and follows robust recruitment procedures. 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 new staff have monthly supervision. Feedback from care managers was positive stating ‘ staff are keen to work in partnership to achieve actions set in reviews.’ Millenium Care Version 1.10 Page 20 The training records demonstrated staff had received a wide range of training. However some of the mandatory training such as first aid and manual handling had been carried out using videos, staff must have practical training in these areas to safeguard the service users and themselves. The training records also demonstrated additional training gaps and the need for staff to undertake training in the management of challenging behaviour, epilepsy and the administration of rectal diazepam. These must be undertaken to meet the specific needs of some of the service users. Staff have monthly team meetings, records showed clear direction and leaderships with clear actions identified. A recommendation made for staff who work longer shifts to have breaks had been complied with and had been discussed during the staff meetings. The rota reflected the staff on duty and the needs of the service users. Millenium Care Version 1.10 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 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) 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 safe guard service users and the health, safety and welfare of service is promoted. EVIDENCE: The registered manager is competent and works 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. Service users benefit from resident meetings and recent quality assurance surveys where their views about the home and the support they receive are obtained and summarised. The summary from this quality assurance audit 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 Millenium Care Version 1.10 Page 22 improve service provision. In addition monthly unannounced visits are carried out by the registered person. The homes policies and procedures are reviewed annually by the registered manager and any amendments made are signed and dated. One of the records held in the locked cupboard in the dining room called the ‘evaluation file contained general information for staff which did contain some out of date information. It is recommended that this file is reviewed and old information discarded. 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. Since the last inspection the home has revised its fire risk assessment and developed an emergency plan to safeguard service users. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 Standard No 24 Version 1.10 Score 3 Page 23 Millenium Care INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 x Score 25 26 27 28 29 30 STAFFING 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 3 3 x Millenium Care Version 1.10 Page 24 no 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 35 Regulation 13(4)(5) Requirement The registered person must ensure that the new staff receive training in practical first aid and manual handling. The registered person must ensure that all staff receive training in how to manage challenging behaviour, epilepsy and the administration of rectal diazepam. Timescale for action 1/7/05 2. 35 18(1)( c)(i) 1/9/05 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 20 41 Good Practice Recommendations It is recommended that the list of staff trained to administer medication is updated to reflect the most recent medication training received. It is recommended that the evaluation file that contains inforamtion for staff is reviewed, any old documentation that does not relate to current polices and prcedures and general practice should be removed. Millenium Care Version 1.10 Page 25 Commission for Social Care Inspection 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 © 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 Millenium Care Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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