Inspection on 31/07/08 for Millstream

This inspection was carried out on 31st July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but 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 31/07/07

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 08/11/2008.

CARE HOME ADULTS 18-65 Millstream Mill Road Frindsbury Kent ME2 3BT Lead Inspector Anne Butts Unannounced Inspection 31st July 2008 09:30 Millstream DS0000057566.V367591.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.V367591.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.V367591.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 springmeadow@ilg.co.uk Evesleigh (Kent) Ltd 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) Manager post vacant Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Millstream DS0000057566.V367591.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. 31st July 2007 Date of last inspection Brief Description of the Service: Millstream is 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.V367591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection that took place on 31st July 2008 and lasted for one day. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people receiving the service. Time was spent touring the building, talking to 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. 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. Homes have twenty-eight days to complete and return the AQAA. The AQAA was not returned in the specified time and a reminder letter had to be sent. 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 in relation to KLORA’s and AQAA’s. The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the commission, but will be referred to as ‘the manager’ within this report. What the service does well: Staff interact well with the people living in the home and demonstrated a good knowledge of their individual needs. The people who live in the home indicated that they found the staff helpful. There is a varied and nutritious menu that meets the individual complex needs of the people living in the home. People have a good access to specific healthcare for Huntington’s disease and other appropriate professionals. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 6 End of life issues are treated in a sensitive manner that respects peoples choices. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service User Guide provide prospective service users with the information they need to make an informed choice about moving into the home. People can be confident that they will have an assessment of need prior to moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated. These documents are now more detailed and give a clearer view of the services that are provided at Millstream. The Statement of Purpose gives information specific to the services provided in the home and acknowledges the specialist needs of the people living in the home. The Service Users Guide is in a userfriendlier format. There is a copy of latest inspection report available in the reception area of the home. There was a requirement made at the last inspection in relation to the preassessment process. At this visit we viewed the records for three people living in the home and saw that they now contained more detail. There is still some Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 9 lack of detail in relation to people’s life histories Admissions to the home are only made when an assessment of need has been undertaken. Either the manager or deputy manager carries out assessments and the home will only provide accommodation to people whose needs they have assessed as being able to meet. The home considers prospective service users compatibility with the people currently living in the home in order to maintain a settled and homely atmosphere. Further information is also sought from relevant health professionals. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 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. 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. People are now benefiting from improved care plans and being supported by staff who are aware of their individual needs. People cannot be confident that their wishes and feelings are always listened to and acted upon. EVIDENCE: We looked at the care plans for three people living in the home. A requirement was made at the last inspection for the care plans to set out in detail the individual needs of the person and how they will be met. We saw at this visit that care plans had improved. They now contain more detail and information about how to support the individual with their care. For example there is information about how to help people with their communication needs and were written in a sensitive manner that gave clear guidance to care staff on how to understand and listen to the individual. Care plans also reflect how to Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 11 support people with their physical and emotional needs. Care plans would continue to benefit from peoples individual likes and dislikes being expanded upon. We spoke to five members of care staff and we found that they were aware of the individual needs of the people they were supporting. This means that they are using the care plans and have an awareness of people’s needs. Care plans we viewed showed that they are now being reviewed and updated in line with the National Minimum Standards. At the last visit there was a requirement to make sure that risk assessments identify risks and hazards to people and that there were clear guidelines on how people are supported. We looked at the risk assessments for three people and saw that these had now improved with more information that is now linked into the care plans. They give clearer guidelines on how to support people in their environment and with individual needs. Some of the risk assessments would benefit from giving clearer information as to why boundaries are imposed especially with regards to behavioural management but when we spoke to staff they were able to demonstrate a clear and informed knowledge of the individual needs of the people living in the home. A recommendation is being made in this report that risk assessments continue to be developed. Daily notes are completed and are linked to the care plans, although there is some confusion with these as they are not always being written in chronological order and staff are making entries in the wrong place. For example a daily record for 19 July 2008 had been entered underneath the entry for 4 July 2008. This does not ensure a consistent approach and support the individual with the monitoring of their care and is not in keeping with good record keeping practices. The manager stated that there are now regular monthly key worker meetings and the Statement of Purpose also identifies this. The records we viewed, however, did not support this with any evidence of regular meetings taking place. Where a key worker meeting had taken place there was no evidence of any action that had been taken to follow up any issues that may have been raised. For example one person had said that they did not like living in the home, but there was no further information or exploration of what the problem was. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 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. Service users are well supported by staff in meeting their daily needs, but staffing arrangements limit their opportunities to access a range of recreational and community activities or pastimes. People benefit from receiving well-prepared nutritious meals that offer choice and meet individual specialist and complex needs. EVIDENCE: We looked at how people spend their day and are supported by the staff working in the home. We spoke to three people who live in the home and five members of staff. There was evidence to show that people are supported with some activities and that there are choices of pastimes available. There is an activities co-ordinator Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 13 who is available during the week. We saw examples of different arts and crafts that people had undertaken including making posters for a garden party that had been arranged. Records of activities also evidenced that people were supported with different pastimes such as games afternoons, film nights and quizzes. Magic moments visit and staff stated that when they have time they would read the newspaper with people. There was some evidence to say that people were able to go out and about with records showing a trip out for a pub lunch or a trip to the shop. However discussions with staff, a service user and records viewed evidenced that social support was dependent upon staffing levels. For example a service user said, “There is not much chance to go out”. Staff confirmed this saying that where there were shortages of staff then time arranged to be spent with people had to be cancelled as a care need or an appointment would take priority. For example on the day of our visit one person had their shopping trip cancelled as someone else needed to be escorted to the dentist. We looked at activities records for two people and saw that there was times when activities were did not take place as staff were busy elsewhere. Written records stated that this was because they ‘were short on care staff’, carrying out ‘kitchen duties’ or ‘out on an appointment’. Records also evidenced that there was little time spent with people at the weekends. People 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. People are supported in maintaining links with family and friends and their involvement is encouraged. Menus and mealtimes are well catered for. People with Huntington’s disease need a high calorie diet and many people suffer with swallowing difficulties. The home clearly recognises the importance of a highly nutritious diet and there is a varied menu that caters for individual needs. This includes food being prepared which needs to be pureed or liquidised and 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 with food supplements available for those people who need this. Individual tastes and choices are catered for and the cook was knowledgeable about the individual needs of the people living in the home. Hot and cold drinks and snacks are available throughout the day. People we spoke to on the day of our visit all confirmed that they liked the food. Records in the kitchen are well maintained with temperature readings of fridges, freezers being regularly monitored. Where there are any fluctuations in temperatures, records showed that action was taken to address this. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of how to support people with their personal care in a manner that supports their privacy and dignity, but some systems for recording do not support people with this. People are not protected by the Home’s administration and recording of medication. People can be confident that they are supported with their healthcare needs and that their wishes with regards to end of life issues is handled with respect and sensitivity EVIDENCE: The information in care plans on how people are supported with their personal care has improved, with clearer guidance given in the care plans viewed. There is some improved guidance on people’s individual preferences, although the manager stated that this was currently being improved upon. We spoke to five members of staff who were all able describe how they supported people Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 15 and actions they would take to maintain their dignity. There are some practices within the home that do not, however, support people with maintaining their privacy and dignity. For example in two of the lounges and outside some of the bedrooms there were check sheets. These were used to record that a check had been carried out on either the individual or the room. These were seen to contain information of a personal nature that named people and identified a specific personal care matter. For example one sheet left in a lounge area stated ‘X watching TV – pad dry’. Another check sheet that was left outside a bedroom stated ‘full personal care given’. Records maintained within the care plans demonstrated that people’s healthcare needs are monitored and that people have access to a G.P. and other healthcare professionals as needed. The home works closely with the Primary Care Trust and works closely with the Huntington’s disease society is supporting people with their medical and healthcare needs. We looked at medication. There are four medication ‘rounds’ a day. The senior in charge on the day of our visit stated that this took about an hour. She confirmed that she had training in medication. The storage of medication in the trolley was not maintained in an orderly fashion with different boxes for people in different parts of the trolley. For example the same medication that had been prescribed for different people were in the same shelf – increasing the risk of giving out the wrong medication. We spot checked some of the boxes and found that the amount of tablets left in the boxes did not correspond with the Medication Administration Record (MAR) sheets. For example in one box there were 23 tablets where there should have been 21. Another box had 4 tablets missing and another box had 2 tablets more than it should have done. There were no gaps in the MAR sheet to explain these differences. Where people go out for the day or go home on social leave records were not robust for the signing in and signing out of medication. Medication was signed out but when people returned to the home with any medication it was not signed back in. When new medication was delivered any remaining medication was not always being carried over so the home was not able to audit exactly how many tablets there should be at any one time in all cases. Handwritten MAR sheets are not countersigned by a second member of staff so as to reduce the risk of recording errors. Regulation 13 (2) of the Care Homes Regulations identifies the importance of the recording and safekeeping of medicines in the care home and requirements have been made in relation to this. The home has adopted the Liverpool Care Pathway which supports people with an end of life plan. The home has always fully involved the service user and their families and supported people sensitively and end of life issues are respected. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure in place that is accessible to people living in the home and their relatives / representatives. People’s concerns are not always acted upon appropriately. Additional training in adult protection procedures has served to help safeguard the people living in the home. EVIDENCE: There is a complaints procedure in place and this is available for all people living in the home. We spoke to two people who both confirmed that if they had any problems they could always speak to the manager or a member of staff. We did identify through other records where people who live in the home voiced dissatisfaction with the service that appropriate action was not always taken. The National Minimum Standards clearly state that people feel that their views and concerns are listened to and acted upon and we have made a requirement about this under Standard 7. There are policies and procedures in place for adult protection and appropriate action was taken by the home when an adult protection alert was raised earlier in the year and the matter was investigated and closed. Staff have been trained in Adult Protection and this is ongoing for new members of staff and those people who are in need of updating. We spoke to Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 17 five members of staff and they were all clear about action they should take if they suspected any incidents of abuse. Staff records showed that new members of staff have a Criminal Records Bureau (CRB) check in place. There are clear systems for whistle blowing but we (The Commission) have received some concerns since the last inspection. When we spoke to staff there were also some concerns about a lack of confidence in raising matters with the management team or the larger organisation. A review of staff meetings did evidence that some issues had been brought to the attention of the management team and been dealt with at the staff meetings. People would benefit, however, from improved strategies enabling staff, people living in the home and other stakeholders to be confident that any concerns they raised were acted upon appropriately. There are policies and procedures in place for protecting peoples finances and personal possessions. Staff stated that these worked and records of staff meetings identified that if there were any concerns these were raised at the meeting and action was taken. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 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. People benefit from living in a well maintained home and with single en-suite rooms that suit their individual needs. EVIDENCE: A tour of the environment was undertaken with communal areas and a selection of bedrooms being viewed. Millstream can accommodate up to twenty people. 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. Since our last visit there has been some redecoration including the smoking lounge and an activity room. People are able to choose which communal area they prefer to use. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 19 All bedrooms are en-suite and there are no shared rooms. Bedrooms have been individualised with people having their own possessions. Personal space demonstrated that people’s rooms were their own and were comfortable. There are sufficient number of toilets and bathrooms situated around the home. As the home provides accommodation to people with physical disabilities they have specialist equipment in place. This includes lifts to all floors; aids and adaptations are provided such as lifting hoists, grab rails and toilet riser seats. There are Parker baths in the bathrooms. A staff call system is available in individual bedrooms and communal areas. These were seen to be maintained appropriately with regular checks carried out. There is a designated laundry area that is suitably equipped with systems in place to reduce the risks of cross infection including industrial strength machines. There are sluicing facilities on each floor. The home was overall comfortable, airy and generally clean. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 20 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): 32, 33, 34 and 25. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that they are cared for by staff who have a good understanding of their needs. The deployment and number of staff available at different times of the day and night is not sufficient to meet the different needs of the people living in the home. EVIDENCE: When we visited we observed members of staff interacting well with the people living in the home and responded to their needs sensitively and in a caring manner. Three people we spoke to confirmed that they liked the staff. Comments included ”they are very good” and “staff are great here”. Another person said, “They are all very helpful”. We spoke to five members of staff and they were aware of the individual and complex needs of the people living in the home. They were clear about their role in supporting people. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 21 There are, however, concerns about the level of staffing. As stated elsewhere in this report there are times when there are not enough staff to support people. We saw at the time of our visit that staff were busy in various parts of the building and this left people in other areas without any supervision or staff availability. For example when we arrived one person asked if they could be escorted into the lift so that they could to the smoking room, but there were no members of staff available to help with this at the time. Staff meetings also identify that there are staff shortages. We were told that due to staff shortages there was not a driver available to take a person to an appointment. Concerns were raised over staffing levels at night. Staff duties include some domestic duties during the night as well as caring for the people living in the home. Due to the nature of people’s conditions there are times when people want to get up in the middle of the night and need additional support. We looked at staff rotas for July 2008 and the night rotas indicated that there were usually three staff on duty, although occasionally only two people were identified and on other occasions there were four members of staff. We saw that one person had buzzed to get up in the middle of the night and staff had asked her to wait as they were due to do a 4 am check, this resulted in the person trying to get out of bed to go to the lounge area and sustaining a fall. At our last visit we identified that staffing levels were at a minimum and there has been no improvement in this. The Care Homes Regulations state that staffing should be in such numbers as are appropriate for the health and welfare of service users and a requirement is being made with regards to this. Staff recruitment procedures have improved and records viewed evidenced that the information was in place as stated in the National Minimum Standards and associated Regulations. At the last visit a requirement was made in relation to training. We spoke to members of staff who confirmed different training they had undertaken. We were shown evidence of training records including a training matrix that identified that training had been undertaken in movement and handling, adult protection, health and safety, infection control and first aid. We were informed that only senior staff who have been trained in medication undertake this role. There has been some specialist training given in relation to Huntington’s disease, acquired brain injury and basic counselling. Although we have deemed this requirement as being met, it is being strongly recommended that the training development programme be maintained. The manager informed us that there is an ongoing induction programme that ensures that new staff undergo induction training. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 22 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, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that they are living in a home where managers and staff are committed to looking after their best interests. The health, safety and welfare of service users and staff are mainly promoted and protected. Improved recording procedures would further support people with the monitoring of their care. EVIDENCE: The manager has now been in post for a year. He is aware of the specialised needs of the people living in the home and has worked towards making Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 23 improvements in the home. He has not yet applied to be registered with us (The Commission). Prior to our visit we asked for the Annual Quality Assurance Assessment (AQAA) to be completed and returned. This was not done within timescales and a reminder letter was sent. On receipt of the AQAA we identified that it had not been fully completed, with large sections of it being blank. We discussed this with the manager at the time of our visit. He stated that he had completed it electronically and that he had completed the full document. He also stated that he had a copy of this. We asked him to forward it to us within 48 hours of our visit. This did not happen. At this visit we also identified that there was some staff unrest within the home with staff feeling undervalued and reluctant to talk to management or the larger organisation about problems that arose. We did see some evidence in staff meetings that staff issues raised were listened to. Regular monthly visits are carried out by a senior member of the management team and this includes reviewing of health and safety around the home, reviewing records and talking to staff and people living in the home. 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 systems in place for recording and monitoring of incidents, although the systems for recording these are not always robust. For example where new documentation has been introduced this is not always being used and the information is being entered elsewhere which means that it is not always being acted upon in a timely manner. There were some gaps in the record keeping for example where a particular behaviour had been identified then the follow up behavioural chart was not always being completed. Another example is where there are regular checks being carried out the records for these were not being completed. Clear and robust records need to be maintained. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 3 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 3 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 3 2 X 2 X 2 2 X Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 YA7 Regulation 12 (3) Requirement Timescale for action 30/09/08 2. YA18 12 (4) (a) 3. YA20 13 (2) “The registered person shall for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings” In that appropriate action should be taken when service users express concerns. 15/09/08 “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users.” In that personal details about care or observations made about service users are not left in public places and are retained in a confidential and secure manner. “The registered person shall 15/09/08 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home”. In that robust records are kept of all medicines received DS0000057566.V367591.R01.S.doc Version 5.2 Millstream Page 26 4. YA20 13 (2) 5. YA33 18 (1) (a) 6. YA37 8 into or leaving the home. This includes social leave. “The registered person shall 15/09/08 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home”. In that medication must be administered in accordance with the prescription instructions. “The registered person shall, 30/09/08 having regard to the size of the care home, the Statement of Purpose and the number and needs of service users; ensure that at all times suitably, qualified, competent and experienced persons are working at the care home in such as are appropriate for the health and welfare for the health and welfare of service users” In that there are sufficient staff on duty at all times to meet the needs of the people living in the home. Any person who carried on or 30/11/08 manages an establishment or agency of any description without being registered under this part in respect of its (as an establishment or, as the case may be, agency of that description) shall be guilty of an offence. Care Standards Act 2000 (11 (1)) In that an application be made for a registered manager by date set. Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 27 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. 3 Refer to Standard YA7 YA20 YA35 Good Practice Recommendations That care plans and risk assessments continue to be developed in agreement with the individual. That where Mar sheets need to be handwritten then they are countersigned by two members of staff to reduce the risk of recording errors. That the training development programme for staff is maintained so that all staff benefit from being trained in being able to meet the specific needs of the people living in the home including developing challenging behaviour training for staff. That records maintained in the home for the protection of service users and for the effective and efficient running of the business are kept up to date and accurate. 4 YA41 Millstream DS0000057566.V367591.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone 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. 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