Inspection on 31/07/07 for Millstream

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Millstream 31/07/09

Millstream 31/07/08

Millstream 09/01/07

Millstream 05/07/06

Millstream 12/01/06

Millstream 06/09/05

Millstream 23/11/04

Millstream 28/04/04

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

CARE HOME ADULTS 18-65 Millstream Mill Road Frindsbury Kent ME2 3BT Lead Inspector Anne Butts Key Unannounced Inspection 31st July 2007 10:00 Millstream DS0000057566.V344138.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 Millstream DS0000057566.V344138.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. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millstream Address Mill Road Frindsbury Kent ME2 3BT 01634 299970 01634 299971 millstream@evesleighcaregroup.co.uk 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) Evesleigh (Kent) Limited Post Vacant Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User accommodated will have a diagnosis of Huntington’s Disease. Service Users accommodated will have been assessed as having an acquired brain injury. 11th May 2007 Date of last inspection Brief Description of the Service: Millstream is a large care home situated on the outskirts of Strood. Local services are approximately 1½ miles away downhill. It is in keeping with the local area. The home caters specifically for adults with a diagnosis of Huntington’s Disease, and service users who have a diagnosis of an Acquired Brain Injury and whose individual needs they can meet. The home can accommodate and provide a service to twenty service users. The home is set over three floors. All bedrooms are en-suite and there is a range of shared spaces. There is a designated smoking lounge. There is a large rear garden which has terraced, paved and lawned areas and has good access for service users. There is some parking space to the front of the building. The home provides a range of information of prospective and current service users including a Statement of Purpose and Service Users Guide and CSCI reports are made available in the home. At the time of this visit fees ranged from £1,000 - £1,800. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out over one day by two inspectors, Anne Butts and Sue McGrath. The main focus of the visit was to review any improvements made since the last visit and the well-being of the service users. Time was spent touring the building, talking to a selection of people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit surveys had been sent out to service users, families and professionals to gain further feedback as to their opinion of the service. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The last key inspection in January and a random visit carried out in April had shown substantial shortfalls and areas of concern. This visit however has evidenced many improvements and a pro-active attitude to improving the services provided for the people living here. The Acting Manager had only been in post for three weeks at the time of this visit and where there are outstanding requirements remaining it is fully acknowledged that the home is in the process of fully meeting these and the overall judgement of the service has reflected this. What the service does well: The atmosphere within the home was relaxed and friendly – staff interacted well with service users and treated them with respect. Staff also demonstrated a good knowledge of individual service users and the overall impression was that staff are keen to promote the best interests of the service users. Care and consideration is taken with meals and there is a varied and nutritious menu. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 6 People have a good access to specific healthcare for Huntington’s Disease and other appropriate professionals. 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 Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 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 Millstream DS0000057566.V344138.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide need to be updated so people can make an informed decision about moving in. Service users are not benefiting from a pre-assessment process that ensures their needs can be fully met. A written statement of terms and conditions protects people. EVIDENCE: The information provided by the home within its Statement of Purpose and Service Users Guide had previously been inaccurate and not reflective of the service being provided. A requirement had been made at the last visit that these are revised; as yet this had not been fully completed. There has been some work carried out and the Home had employed an independent consultant to review these documents and several recommendations had been made. The Home is currently still in the process of updating these, therefore this requirement remains outstanding. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 10 There is a full needs assessment in place and the last visit had showed that the assessments were fairly sparse in detail. The records for a new service user were viewed and although there was a joint assessment in place from the placing authority and some personal information – the home’s internal assessment had not been completed at all and there was no care plan in place that had been generated from the joint assessment. There was no evidence to support the individuals’ diverse needs or any aspirations or care needs. A requirement is being made that there is a thorough assessment process in place that evidences that people’s individual needs have been fully assessed. It is acknowledged that people are carefully assessed for their compatibility with other service users in the home, in order to maintain a settled and homely atmosphere. Service users have now been issued with a contract. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users individual needs and goals and right to make decisions about their lives are not being reflected in their care plans. Their safety may be put at risk as these plans are not supported by risk assessments that address how to fully support service users in meeting their needs. EVIDENCE: A selection of service user plans was viewed, including the one for a new service user. A requirement was made at the last visit that the plans fully identify how to meet individual needs. Although it is acknowledged that some work has been carried out and that the new format has now been implemented – the actual information contained in many was still sparse and not detailed. The care plan had not been completed at all for the new service user and others may identify a need but not how to support the individual. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 12 The Acting Manager was able to produce one service user plan that he had written and this contained far more detail and identified individual support needs and how to support a person. He was aware that the plans still needed updating and re-written and had arranged for full reviews to be undertaken with all service users and as part of this process the service user plans and accompanying assessments would be updated to reflect actual need. Previous reviews of care plans had not evidenced that any changing needs had been reflected and updated into the plans. This requirement has been partially met but still remains outstanding. It is also being recommended that the home consider care-planning training for staff. Throughout the visit it was evident that people can choose where they want to spend their day and are supported to make daily decisions. Previously the staff had been restricted to the amount of support that they could provide to people as they were spending the majority of their time with daily care support needs. Their right to be supported in some decision-making is not fully reflected in the risk assessment process and this currently limits people’s choices and support with taking responsible risks. Where records identified a service user had made a decision that could possibly result in having an adverse effect on their personal safety – there was no evidence to show that the home had discussed this with the service user. Overall risk assessments are still not being completed to the required standard with outcomes for people and how they are supported being fully completed. Details of any risk assessments are not being incorporated into the care plans. Service users can sometimes display inappropriate or aggressive behaviours and this is linked to their conditions, guidelines for how staff should act in specific situations were not detailed and behavioural management should be considered within the risk assessment process. It is acknowledged as with the care plans that the Acting Manager has not yet been able to make sure that the assessments have been updated appropriately, but this requirement remains outstanding from the previous visit. Staff are completing daily notes in two separate places, and although this had been mentioned at the last visit – the inspector had been informed at that time that it was working and staff were happy to do this. The Acting Manager feels that it is not necessary and there is no need to duplicate records. Discussions were held around this at the time of the visit and the Acting Manager was advised to review the system that works best for the home and implement this. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The support for service users in promoting activities and choices has improved so benefiting people more in their daily lives. Family and friends are promoted in supporting service users and maintaining contact. Service users benefit from meals that support choice and offer a balanced and nutritious diet and meets their complex needs. EVIDENCE: The home has taken substantial steps in order to further support people with their activities. A member of staff has recently been allocated as an activities co-ordinator and part of her role is to support people with any choices or aspirations that they may have. Her plans for the future include more trips out Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 14 for people to places of their choice including theatre shows, visiting the cinema, pubs, lunches out and shopping. She is also planning to set up more activities in the home and is currently working with people to find out what there preferences and choices are. The aim is to make sure that the service becomes more tailored to individual needs and that people have improved opportunities for their own development or activities. The home has arranged for music therapy and a local organisation is supporting with arts and crafts. Service users are given the opportunity to take an annual holiday if they wish and there is a set amount included in the fees. People had chosen to go the Camber Sands this year and the allowance had covered the whole trip. It people do wish to take an actual break, the money can used for day trips. Time was spent talking to some people who live in the home and overall people were happy. Comments included “I like it here and I can usually do what I want” and “I enjoy reading and the staff spend time talking to me”. Staff also stated that they felt well motivated and the support they had been given by the Acting Manager was positive. They stated that they felt that things were starting to turn round now, and that having an activities coordinator in post and relieved them of a lot of pressure. The home does support service users in maintaining links with family and friends and their involvement is encouraged. There was some evidence with the assessment process that the home’s takes peoples religious preferences and cultural needs into account – however these were not being fully reflected into the service user plans and the home does need to make sure that people are supported with their preferences. Service users have unrestricted access within the home, dependent on their abilities, and are able to choose where they prefer to spend time. Staff were observed interacting and talking to service users and treating them with respect. The home does respect service users rights to keep pets if they wish. Menus and mealtimes are well catered for. The home clearly recognises the importance of a highly nutritious and high calorie diet for people with Huntington’s disease. Many people have swallow difficulties and much of the food needs to be liquidised, where this happens meals are presented in individual portions. The home recognises the importance of the consistency of food and drinks and monitors people’s intake. The home works closely with the Speech and Language Therapist to review peoples swallow abilities. Observations during the visit showed staff assisting with meal times sensitively. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 15 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 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of service users are well met, with the home accessing healthcare support for people. The management of medication has improved, although service users would be better protected when staff have received appropriate training. EVIDENCE: Discussions with staff evidenced that they respected people and are treated in a manner that promotes their privacy and dignity. Although information in care plans is still limited they do take into account peoples wishes for personal care and the amount of the support they require. A review of the care records for service users showed that the home does support service users with their healthcare needs and access a range of healthcare support. They are prioritising input from the Speech and Language Therapy team and making sure that all service users will benefit from a multiMillstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 16 agency review of their needs including taking into account palliative care. They are expanding their person centred care around individual current and ongoing healthcare needs and these will be reflective of all individual needs. They need to make sure that are able to monitor the individual health progress or deterioration of people. The home has now made arrangements for people to be above to access appropriate counselling or physiotherapy services and is also arranging training for staff in counselling skills. Feedback provided to the home from the people who live there have shown that they want people to listen to them and staff development in listening skills can only enhance and support this. As part of the review of the care planning process and the multi-agency approach the home is developing a palliative care programme for all service users. Huntington’s Disease is a progressive illness and when people move into the home, it is the intention that this should be their home for life – should they so wish. The home is adopting the Liverpool Care Pathway which will enable the home to respond quicker at the end of people’s lives. The home has always fully involved the service user and their families and supported people sensitively. Medication was reviewed and previous visit had shown shortfalls in the management of medication. At this visit, however, it was evidenced that the home had taken steps to make improvements in this area. There were no medication errors and the home has introduced a system whereby seniors check the medication twice daily. Medication was stored appropriately and there are protocols in place for PRN medication. The only area that remains outstanding is staff training; as yet the majority of staff have only been trained in the MDS system that is used in the home. A requirement is being made that staff are given appropriate recognised training in the administration of medication. Overall medication practices have significantly improved. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved Adult Protection procedures have ensured that service users will be safeguarded. Service users can be confident that they are able to make a complaint and that their views will be taken seriously. EVIDENCE: Following concerns raised earlier in the year, a random unannounced had been carried out in April – this had evidenced that service users were not being protected with regards to their money and belongings. At the time an Adult Protection alert was raised and the home was requested to carry out an investigation into its practices of managing peoples money and cigarettes. The home commissioned a fully independent audit of these practices and forwarded their findings to the Commission. They were able to evidence that it was poor practice and poor record keeping and maintenance that had resulted in many of the concerns that had been raised rather than actual theft. Where they were not able to reconcile receipts and records - they had committed to replace any money or cigarettes that could not be accounted for. This visit evidenced that practices had improved and service users are now being protected and supported with their finances and belongings and that any unaccounted for money and cigarettes had been reimbursed by the home. There are now clear lines of accountability and the home has held staff Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 18 meetings and updated policies and procedures around the protection of service users to re-affirm the safeguards for protecting service users. Where staff do not adhere to the organisations policies and procedures or working practices the home has robust internal procedures to deal with this. All allegations of abuse or possible abuse are taken seriously and acted upon. A large proportion of staff have now completed Adult Protection training. There is a complaints procedure in place and this is incorporated into the Statement of Purpose and Service Users Guide. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 19 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, 26, 27, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from having access to their own en-suite rooms with sufficient additional toilets and specialised bathrooms. The home provides a comfortable, homely and clean environment but service users would benefit from the refurbishment of some parts of the home. EVIDENCE: A brief tour of the home was undertaken with a selection of service users bedrooms being viewed. Millstream can accommodate up to twenty people. The home was overall comfortable, airy and clean. Many of the service users are wheelchair users and the home is accessible with lifts to all floors. There are four lounge areas, one of which is designated as a smoking lounge, and a separate dining area – there is also a patio area to the rear of the property that is used during the warmer months. There is adequate space in the home, although currently, the lounge on the second floor is not being used for service Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 20 users. Some areas of the home are in need of redecoration and the Acting Manager explained that a maintenance programme was in place that would be addressing these are part of the organisations improvement plan for the service. There is an additional area on the lower ground floor that is currently being renovated and there are plans to use this as an activities and recreational area that can be used by all people living in the home. There were plans for local students to visit to decorate some of the corridors with modern art – the Acting Manager confirmed that Service users would have a say in this and that it would be tasteful. Since the last visit the laundry area has now been improved and is now located in one part of the building with a separate rooms for washing drying and ironing. There aren’t any hand washing facilities in the actual washing room, but the home uses safe systems and there is a hand washbasin in the ironing room. They may want to consider putting a basin in the washing room if they feel the need arises. Bathrooms were clean and well maintained and all bedrooms are en-suite. There are suitable facilities and equipment for people with disabilities. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 21 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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefit from being cared for by staff who are familiar with their needs, however staff would benefit from receiving further training. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: Throughout the visit staff were observed to spend time with people and respond to their needs sensitively and with a caring manner. There was a relaxed atmosphere with staff demonstrating an awareness of individual needs. All staff were friendly and approachable. The home has a staff group who are familiar in their role and provide effective support to people. The culture of the staff group reflects those of the people living in the home. Staffing levels are currently at a minimum, with some bank staff being used to cover any shortfalls. Staff did state that the role of activity co-ordinator had taken some pressure off them, which enabled them to support people with Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 22 personal care and feeding. Staff also informed the inspectors that they felt more motivated and supported within the home. They confirmed that they had regular staff meetings and that they felt that they were listened to and that their opinions counted. There are clear levels of accountability with Senior Staff in post and a designated senior nominated for each shift. Staff have clearly defined job roles and are aware of their role within the home. There is additional ancillary staff including a cook on duty for all meal preparation, cleaning staff and a laundry assistant. There is also a maintenance manager, although his time is split between this home and others in the organisation. A review of the recruitment procedures evidenced that they had previously not been well managed. The last visit had shown that not always two references were being obtained and again at this visit there was a new member of staff who had started and did not have two references in place. Application forms had also not always been fully completed showing a full employment history – and there was no evidence to show that the interviewer at the time had explored any gaps in employment with the prospective member of staff. The home was also not following up with prospective members of staff if any information appeared on a Criminal Records Bureau (CRB) check that had not been declared at interview. It is acknowledged that these instances occurred before the Acting Manager took over his role and that the home had undertaken an audit of staff files that identified missing documentation. He agreed, however, to make sure that the procedures for recruitment are strengthened. The induction-training programme for the home was more in the form of a tick list and there was no evidence base to support it. There was also no evidence of any member of staff following an induction programme based on the Skills for Care programme, this had been discussed at previous inspections, but as yet there is no evidence to show that this has been addressed. Training has been addressed in some areas with some staff receiving training in movement and handling, first aid and adult protection. Some senior staff have also undertaken supervision training. A small proportion of staff have received training in Huntington’s although as yet there was no evidence to support people having undertaken training in the needs of people with Acquired Brain Injury. Training was a requirement at the last inspection and although it is acknowledged that there has been some progress in this area there is still a substantial amount of training required and therefore this requirement remains outstanding. As identified in under the standard for medication that staff have not received appropriate training in this area, and although a separate requirement has not been made the Registered Provider must make sure that this is included in the training schedule. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from an Acting Manager who is clearly committed to promoting the best outcomes for people living in the home. EVIDENCE: There is currently an Acting Manager in position, whose previous role was as the Deputy Manager. As such he has an understanding of the needs with people with Huntington’s Disease and Acquired Brain Injury. He has attended training in areas specific to the needs of the people living in the home and has a substantial amount of experience in the care sector. He is also receiving support from the Area Manager and larger organisation. In order to continue with the improvements within the home they will benefit from the ongoing support from the Registered Provider. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 24 As stated earlier in this report staff confirmed that they felt that they were being well supported and that the support meetings gave them an opportunity to participate in the running of the home with their views and opinions being listened to now. They stated that issues that had concerned them were now being resolved. The home has some quality assurance monitoring systems in place with regular monthly provider visits carried out. These have recently changed in format and are now more people based where they spend time talking to the people who receive the service and listen to their views. Staff also have the opportunity to feedback to these visits. The home had also employed the services of an independent care consultant who visited the home and made several recommendations that they are now acting upon. The home has rewritten and re-enforced some policies and procedures that had not allowed service users to be fully protected. Staff are now more aware of their accountabilities in these areas and these systems further serve to protect service users. There is still currently further work being carried out on other policies and procedures. The health and safety of service users is generally promoted with the maintenance of the environment and regular safety checks and servicing of appliances and equipment. There are still outstanding concerns with regards to risk assessments and some of the training for staff, but these have been addressed elsewhere within this report. Notifications of accidents and incidents are forwarded to the CSCI in accordance with requirements. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 25 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 Score 1 1 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 2 3 2 2 X 2 X Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 (1) (2) (3) Requirement The Statement of Purpose and Service Users Guide must reflect accurately the service provided by the home. This requirement remains outstanding with original timescales of 31/08/06 and 23/02/07. Once completed this must be forwarded to The Commission within the timescales stated. The pre-assessment needs documentation must be completed in a more detailed manner fully exploring as to how the home will meet the needs of the service user. All service users’ plans must set out in detail the full needs of the service user and how the home will meet these needs. This requirement remains outstanding with an original timescale of 05/04/07 The registered person must make that risk assessments identify any risks and hazards and the action to be taken to minimise these. The outcomes should be recorded in the DS0000057566.V344138.R01.S.doc Timescale for action 21/09/07 2 YA2 14 (1) 31/08/07 3 YA6 15 (1) 29/09/07 4 YA9 13 (4) 29/09/07 Millstream Version 5.2 Page 27 5 YA34 19 Sch 2. 6 YA35 18 (1) (c) (i) individual plan and reviewed with behavioural guidelines if applicable. Risk assessments must support people to take responsible risks. This requirement remains outstanding with an original timescale of 05/04/07. The Registered Person must 31/08/07 make sure that the recruitment procedures within the home are robust and are in line with the regulations and associated schedule. The registered person shall 29/09/07 make sure that training must be organised so that staff are appropriately trained in meeting the specific needs of the people living within the home and this training must be targeted and focussed on ensuring that staff can provide the best outcomes for service users. This has been partially met with an original timescale of 23/03/07. The home must continue to maintain an appropriate training programme. 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 YA7 YA12 Good Practice Recommendations It is recommended that as part of the training programme the Registered Provider considers care planning training for staff. It is strongly recommended that the home continue to develop the opportunities for service users to access appropriate activities or pastimes in accordance with their varying abilities. DS0000057566.V344138.R01.S.doc Version 5.2 Page 28 Millstream 3 YA35 It is strongly recommended that in house the induction programme is evidenced based and that new members of staff follow an induction programme in line with the Skills for Care induction programme. Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Millstream DS0000057566.V344138.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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