Inspection on 31/07/09 for Millstream

This inspection was carried out on 31st July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Millstream 31/07/08

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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Millstream Mill Road Frindsbury Kent ME2 3BT Lead Inspector Anne Butts Key Unannounced Inspection 31st July 2009 09:40 Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Millstream DS0000057566.V376449.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 (0) registration, with number of places Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical disability (PD). The maximum number of service users to be accommodated is 20. Date of last inspection 31st July 2008 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 started at £1,200. Millstream DS0000057566.V376449.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 a Key Unannounced inspection that took place over the course of one day. Time was spent touring the building, talking to staff and some of the people living in the home. Observations were made of the support provided to people in the communal areas of the home and a selection of records were reviewed. We (the Care Quality Commission) also looked at information provided to us since our last visit in July 2008. All services are required by legislation to provide an Annual Quality Assurance Assessment (AQAA). This gives us information about how the service considers they are performing and where they feel they can make improvements. It also provides statistical information about the service. Information from the AQAA has been used in this report where appropriate. 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 Care Quality Commission (CQC) to be able to make an informed decision about each outcome area. Further information can be found on the CQC’s website with regards to our processes including information on KLORA’s and AQAA’s. At the time of our visit the service did not have a registered manager. The registered provider has appointed a person to run the home on a day to day basis in the position of manager for a period of time in order to address shortfalls within the home. They are not registered with the commission, but will be referred to as ‘the manager’ within this report. What the service does well: Staff working in the home are kind and caring and communicated well with the people living in the home. The meals provided are varied nutritious and healthy and service users have a choice about what they would like to eat at each meal. Drinks and snacks are available throughout the day. Specialist diets are catered for. The larger organisation has recognised where improvements are needed and has put into place an action plan to address this. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Millstream DS0000057566.V376449.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.V376449.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their families benefit from having the opportunity to visit the home prior to moving in and the assessment process meets their needs adequately. However people would benefit from this process being more in-depth in order to fully meet individual needs. EVIDENCE: The home has a Statement of Purpose and Service Users Guide in place. These documents contain all the relevant information about the home and the services provided. The Service Users Guide, however, is out of date and some of the information is incorrect including the name of the manager and registered provider. At the time of our visit there was no evidence to show that people have easy access to this document and the registered provider needs to ensure that it is up to date and available to people living in the home. We looked at the assessment process for two people who had moved into the home to see if their needs were being thoroughly assessed. Each person had a needs assessment in place and the documentation was for the most part in line with the national Minimum Standards, in that it covered the different areas of need. However they were poorly completed and did not fully explore or identify individual needs. Many parts were not dated or had not been completed and the process was not consistent. This lack of information means that it was not possible for the home to start developing meaningful Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 9 care plans for the person. The manager has identified the shortfalls in the assessment process and is working with staff on the improvement of these including implementing a full nutritional assessment and further developing a personal profile for people. She told us that all the assessments were currently under review. Millstream only provides care and support to people with a diagnosis of Huntington’s disease or people who have an Acquired Brain Injury and do obtain assessments from the placing authority and work closely with specialist organisations such as the Huntington’s disease society. People have the opportunity to visit the home prior to moving in. Millstream DS0000057566.V376449.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The updated care planning system has the potential to fully support people with their individual and changing needs and give clear guidance to staff. An improved risk management culture will further support this. Service users are able to make some decisions about their lives but this needs to be developed further. EVIDENCE: Each person living at the home has a care plan which is information and guidance for staff on how to support people with their individual needs. Prior to looking at the care plans we spoke with the manager. She told us that all the care plans were currently under review and being re-written along with updated assessments. She had recognised that the current care planning system was poor and did not identify or give clear guidance on individual needs and did not have a holistic approach. She has introduced a new care plan system which will be person centred and focussed on the individual, developed with Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 11 the person and the key workers. There is an action plan in place with timescales to address this. We looked at four care plans, both in the original format and those which had been completed using the new system. Care plans still in the original format were bulky, not easy to navigate and guidance for staff was task orientated. Information in these care plans was not clear and difficult to find. They lacked clarity and guidance and included statements such as ‘assist with personal care’, but did not identify what assistance was needed or what the person could manage for themselves. Improvements we had identified at our last visit had not been maintained. The new care planning system, however, has identified individual areas of support, how to support the person and what their individual preferences are. The new plans are individualised and the two we viewed covered all aspects of health and social care, medical needs, specialised needs, behaviour management and interventions. The manager has also recognised that the current risk assessments were not meaningful and lacked clear guidance on recognising any risks and how to reduce these and were not tailored for the individual need. For example a risk assessment for eating and drinking concentrated on reducing spillages and lacked guidance on a risk of choking. A risk assessment for movement and handling stated for there to be one – two people and there was no guidance on using a hoist. The new system is clearer and specific to the person. For example eating and drinking gave clear guidance on the diet, the position needed for the person to able to eat safely and reduce the risk of choking, fluid needs and the ability of the person to be able to manage their own food. A movement and handling risk assessment was clear about the needs of the person and how staff should support and what equipment to use. Information from these was placed into the care plans giving clear guidance. The manager has also introduced new risk assessments and systems for monitoring and identifying risks. We spoke to staff about their understanding of individual needs and they were knowledgeable about the care and support needed. Staff spoke positively about the new care planning system and told us the ones which had been implemented were much improved. All service users are supported by a key worker, and part of their role is to have a monthly review with the individual person and to look at any changing needs and personal aspirations. Records evidenced that staff were not managing this properly. There were only limited reviews in place and they lacked evidence to show what action had been taken. Some of the reviews identified things people would like to do or have access to and gave timescales for action, but there was no robust evidence or change in the care plan to show that this had actually occurred. We observed staff contact with the people living in the home and saw that this was positive. Staff communicated and interacted well at all times. They involved people in conversations. When we spoke to staff they demonstrated an understanding of the needs of the people living in the home and displayed a respectful and caring manner. People living in the home indicated that the staff are good. Millstream DS0000057566.V376449.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from support and care in their daily living routine that is flexible to suit their needs and preferences. Improved opportunities for achieving any identified aspirations would further enhance their daily lives. The home provides a varied and nutritious menu which meets the needs of the people living in the home. EVIDENCE: We looked at how people are supported to spend their day. Staff we spoke with were aware of the individual needs and preferences of people living in the home. Routines are flexible and people are generally supported in making choices about how they spend their day. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 13 At our last visit we found that people’s choices and opportunities were restricted and arranged outings for people were cancelled on a regular basis due to staffing levels. At this visit staff told us that this had improved and that although there were occasions when a planned outing was postponed, this now did not happen on a regular basis. We spoke to the activities co-ordinator and she described the different pastimes and events that have been arranged. This included in house activities such as music sessions, arts and crafts, aromatherapy and light therapy for example. People are also being supported to go into the community and trips to the coast and a local zoo had been arranged. On the day of our visit two people had gone swimming and the activities coordinator told us that this occurs on a regular basis. The new care plans also identify support with individual pastimes. For example one stated that the key worker was to spend time on each shift to talking to the person or reading the paper to them. The key worker meetings are also used to identify individual preferences and choices, although as previously identified it was not always possible to evidence that any action had been taken. We discussed this with the manager and she said that she would monitor and review the outcomes of these meetings. Staff indicated that they had limited opportunities to spend quality time with people due to their task orientated duties. The manager told us that there are plan to recruit an additional activities co-ordinator. Part of the action plan implemented by the manager is to ensure that goals and aspirations must be recorded with evidence of how they will be met and timescales for implementation. People are supported in maintaining links with family and friends and their involvement is encouraged. The home does recognise the rights of the service users to make their own decisions and choices. We saw that people were able to make choices about what they did within the home and where they spent their day. People have keys to their own rooms and their privacy is respected. Staff told us that they were aware of individual needs and there were agreements in place with different people for staff to enter if they have any concern for their safety. People with Huntington’s disease need a high calorie diet and the home clearly recognises this. There is a varied menu which offers a varied and nutritious diet. Meals are prepared so that they cater for individual needs including ensuring that meals are pureed or liquidised for those people who need their meals prepared this way. People have a choice of what they would like to eat and are supported by staff in a sensitive manner. 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. Millstream DS0000057566.V376449.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health needs are met and service users have access to all professional health care services as required. Service users are not adequately protected by the Home’s administration and recording of medication. EVIDENCE: At our last visit we saw that the care plans had started to identify people’s preferences relating to their personal care support. We were told at that time that this would be further developed, but records showed that this had not occurred until recently with the introduction of the new care planning system. New care plans now identify people’s preferences and support needs. Discussions with staff evidenced that they respected people’s wishes and were aware of their individual needs. Times of getting up and going to bed are flexible, and people can choose. People are supported with their healthcare needs and have access to a G.P. and other healthcare professionals as needed. The home works closely with the Primary Care Trust Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 15 and the Huntington’s disease society in supporting people with their medical and healthcare needs. The home also works closely with the Speech and Language Therapy (SALT) team in order to promote people’s healthcare needs. The new care plans contain direct reference to this support. The manager has introduced a more robust system for supporting and monitoring people with their changing needs. Due to people’s conditions they are at a high risk from falls and falls are now monitored more closely and evaluated as to the cause and whether it is due to their condition or other factors. We also saw that the new system will also further support people with their emotional needs. Currently behaviours were monitored and records made, but there was no evidence of any significant action being taken. There was no recognition of any triggers or circumstances which may affect people’s moods or behaviours. A new care plan we viewed identified this persons emotional needs, what could trigger any anxiety and action to take to support and reduce this. At our last visit we made two requirements in relation to medication. We saw at this visit that there had been some improvements but there were still shortfalls. We saw that there was clear guidance for individual people for medicines which are taken on an as required basis. Handwritten entries on MAR sheets were signed and counter signed. Medication Administration Record (MAR) sheets did not evidence any gaps, but we saw that in one case the amount of tablets remaining did not correspond with the amount administered. One medicine had been prescribed as to be taken every second or third night but we saw that this had been administered on consecutive nights, so it was not in accordance with the prescribed instructions. Controlled drugs were stored separately in locked cabinets, but the system for the recording of the administration of these drugs was of concern. The home used a bound controlled drugs book, but there was no continuity to the entries, the system for recording the amount of drugs received into the home was poor, which means there is no robust audit trail. We also identified at our last visit that the systems for recording medications for social leave were not robust. This had not improved. Following our visit we have made a referral to the Care Quality Commissions pharmacy inspector and they will visit the home and carry out a full inspection on medication. We discussed this with the manager at the time of the visit. Millstream DS0000057566.V376449.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The adult protection procedures within the home serve to support service users. A more up to date complaints procedure would further support people. EVIDENCE: There is a complaints procedure and this is on display. The information in the Service Users Guide, however, is out of date. The Annual Quality Assurance Assessment identified that there had been two complaints received up until April this year. People we spoke to indicated that they would speak to a member of staff or the manager if they had any concerns. Some staff have been trained in Safeguarding Vulnerable Adults procedures and there is an ongoing training programme for those staff who have not yet completed this. Staff we spoke to were aware of how to report any concerns. The home has made referrals to the safeguarding vulnerable adults team in the last twelve months, and these have been investigated. There are systems in place to support people with their personal finances. The administrator maintains robust audited records for individual people. There is a system in place to enable people to be able to access their money, and if people wish they can manage their own finances. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment meets the needs of the people living in the home, but would benefit from some refurbishment and redecoration. EVIDENCE: We looked at the communal areas of the home and viewed a small selection of bedrooms. We saw that many of the communal areas are in need of redecoration and refurbishment as walls were marked and chipped and carpets were dirty. The Annual Quality Assurance Assessment did not identify any refurbishment plans. We spoke to the manager and she told us that the larger organisation were investing money into the property. The maintenance man also told us that painters and decorators were due into the home within the next few weeks. He also said that the manager was supporting him in obtaining funds to ensure that maintenance issues were addressed. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 18 There are four lounge areas, one of which is a smoking lounge. The lounge on the first floor is currently out of use, but we were told that there are plans to refurbish this for the benefit of people living in the home. All bedrooms are en-suite and have been individualised. People are able to bring in their own possessions. 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. There is a dedicated laundry area in the home with separate washing, drying and ironing areas. On the day of our visit we saw that they were clean and well maintained. Staff feedback did indicate that this was not always the case as staff felt that there were occasions when they did not have enough time to undertake a thorough cleaning of the laundry area. Staff have been trained in Health and Safety and Control of Substances Hazardous to Health (CoSHH). Staff we spoke to also voiced concerns about the overall cleanliness of the home. We were told that there were not enough cleaning hours and that when cleaning and laundry staff were on annual leave they were not replaced. At the time of our visit we saw that the home was clean and generally fresh. There was evidence of an odour in the main lounge and this has been an ongoing problem. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of 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. This will further be enhanced once all staff have benefited from training. Staffing levels meet individual daily needs, but would benefit from ongoing review. EVIDENCE: The home arranges the rotas so that there are eight staff working in the morning, seven in the afternoon and there are three members of staff on a waking night duty. There is also additional ancillary staff for preparing meals and cleaning. Staff told us that they have enough time to assist people with their care needs, although they do not always have time to spend with people on a one to one basis. People living in the home have varied sleep patterns and conversations with staff and records evidenced that some people will stay up late, get up early in the morning or be awake during the night. There are additional staff available to assist with getting people up. Staff told us that there is usually two or more people up at any one time during the night. Staff also told us that they were also responsible for carrying out some domestic Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 20 duties during the night and said that ‘the nights could be quite hectic at times’. The registered provider needs to ensure that the night staffing levels are kept under review as peoples need change. We observed that staff reacted quickly when the emergency buzzers were activated and responded to peoples needs. The organisation has policies and procedures in place for staff recruitment, which include ensuring that all the necessary checks, as required by law for care homes, are in place. We looked at the files for four members of staff, including the newest recruits. Staff files evidenced that all staff complete an application form, have a face to face interview and if suitable for the position are offered the post in writing. The Care Homes Regulations state that a full employment history, together with a satisfactory written explanation of any gaps in employment, must be obtained for each care worker. We saw that this was mainly adhered to, there were some shortfalls, however in relation to ensuring that full employment histories are obtained, in that on one application form there was no evidence that a three month gap in employment had been explored and another application form did not have an employment history prior to 2007. The registered provider must ensure that a full employment history is obtained in line with regulation. Checks are carried out for people including obtaining a minimum of two references and a Criminal Records Bureau (CRB) and POVA (Protection of Vulnerable Adults) first check. Files we viewed evidenced that these were all in place. Staff do not start work until they are in receipt of the POVAfirst and CRB checks. We looked at the staff training matrix. The manager told us that she had recognised that there were shortfalls in staff training and had implemented a training programme for all members of staff. Training dates have been arranged and members of staff have been allocated on the training where they need to be updated. Training courses have been arranged for mandatory training needs including movement and handling, medication and safeguarding vulnerable adults. Staff are now being trained in SCIP, which is behaviour intervention training and also Mental Capacity Act training. Staff told us that had attended training and that they had found it beneficial. The registered provider must ensure that the training programmes continues. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the current management of the home is aimed at improving the service for their benefit. Longer terms arrangements need to support this. The health, safety and welfare of service users and staff are mainly promoted and protected. EVIDENCE: Millstream is part of the Independent Living Group (ILG), who is the registered provider for this service, and as such is supported by an executive and senior management team. During the last twelve months the home has not benefited from a stable management structure and has lacked leadership and guidance. This has recently been recognised by ILG and an operations manager from the senior management team is currently managing the home on an interim basis. We were told that this is to address shortfalls and raise Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 22 standards within the home. We were also told that the longer term management plan was to advertise and recruit a full time manager for the home with the intention of this person becoming the registered manager for the service. The registered provider needs to ensure that this is implemented to promote the ongoing smooth running of the home. At the time of our visit the manager had only been in place for approximately four weeks, but had already put into place an action plan with timescales for issues which needed to be addressed. This has been referred to throughout the report. A staff meeting had also recently been held which had been attended by the chief executive officer for ILG. The aim of the meeting was to discuss with staff the way of moving the service forward and ensuring that the home was run in the best interests of the people living there. We spoke to staff about the proposed changes and the feedback was mainly optimistic, although some staff did voice concerns that they had been promised change before and that it had not materialised. We spoke to the manager about this and she stated that she was aware of these concerns and that the commitment was to making improvements. The registered provider carries out regular quality assurance visits and have used these to start to address the issues they have identified. The manager has also recognised that the system for reporting incidents or falls has not been robust. She was able to evidence that improved systems for reporting incidents were being implemented and also improved records for falls monitoring and action to be taken on how to support people with reducing these. 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. We discussed the implications of the Mental Capacity Act and Deprivation of Liberty safeguards for people living in the home. The manager told us that no one living in the home was subject to a deprivation of liberty authorisation. Training is also being implemented for staff with regards to the Mental Capacity Act. Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 23 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 2 2 2 3 X 4 3 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 2 25 3 26 X 27 X 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X X 2 2 X X X 2 Version 5.2 Page 24 Millstream DS0000057566.V376449.R01.S.doc 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 YA2 Regulation 14 Requirement The registered person shall not provide accommodation to a service user unless the needs of the person have been fully assessed. In that pre-assessment documentation evidences that a full assessment of need has been undertaken. The registered person shall prepare a written plan of care as to how the service users needs in respect of the health and welfare are to be met. In that the care plans continue to be developed so that they give clear guidance on how to meet individual needs. “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 service users are supported to with their choices through the key worker management system. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. In that the risk assessments identify individual needs are specific to the DS0000057566.V376449.R01.S.doc Timescale for action 31/10/09 2 YA6 15 (1) 31/10/09 3 YA7 12 (3) 31/10/09 4 YA9 13 (4) (c) 31/10/09 Millstream Version 5.2 Page 25 5 YA20 13 (2) 6 YA20 13 (2) 7 YA24 23 (2) 8 YA33 18 (1) (c) 9 YA35 18 (1) (a) person and give clear guidance to staff. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home In that controlled drugs are recorded, stored and administered in line with regulations. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home The registered person shall ensure that the premises are suitable for achieving the aims and objectives of the service. In that the premises are kept in a good state of repair with an ongoing maintenance and refurbishment programme. The registered person shall ensure that staff employed at the care home have training appropriate to the work they are to perform. In that the staff training programme ensures that all staff receive mandatory and specialist training in order to fully support the people living in the home. “The registered person shall 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 night staffing levels are kept under review. 31/10/09 31/10/09 31/12/09 30/11/09 30/10/09 Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Millstream DS0000057566.V376449.R01.S.doc Version 5.2 Page 27 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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