Inspection on 05/07/06 for Millstream

This inspection was carried out on 5th July 2006.

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 8 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 31/07/07

Millstream 09/01/07

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 Unannounced Inspection 5th July 2006 09:00 Millstream DS0000057566.V301402.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.V301402.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.V301402.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 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.V301402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User with Huntingtons Disease whose date of birth is 03.12.1940. Date of last inspection 12th January 2006 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 has catered specifically for adults with a diagnosis of Huntington’s Disease, and has recently undertaken a variation to provide care to service users who have a diagnosis of an Acquired Brain Injury and whose individual needs they can meet. 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. Fees range from £1,000 - £1,800. Millstream DS0000057566.V301402.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 key inspection that took place over two days. It took into account a thorough look at how well the service is supporting service users in the home. Information relating to the inspection was gained through detailed provided to The Commission by the manager in the form of the PreInspection Questionnaire, and any information or concerns the CSCI has received since the last inspection. During the course of the visit documentation within the home was viewed and case tracked. A tour of the premises was undertaken and observations made. Discussions were held with the manager and a number of staff members. Time was also spent talking to people living in the home and with visiting relatives and listening to their views. The home has been through a period of change during the past six months. A new provider has purchased the home and it is now part of a much larger organisation. The manager is also newly in post, having started approximately one month prior to the date of the site visit. The manager is currently in the process of familiarising himself with the systems and structures of the home and getting to know the service users and staff. He is also prioritising as to how he aims to ensure that the home is meeting all the standards. The manager was extremely supportive during the site visit and was open to suggestions and comments and he stated that he found the visit a valuable tool to assist him in identifying any areas of concern that need addressing. What the service does well: What has improved since the last inspection? The home has recently gone through another period of change with a new manager in post and new organisational systems and structure being put into place. This has made it difficult to identify specific improvements. Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 6 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. Millstream DS0000057566.V301402.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.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Service users do not benefit from having access to up to date and appropriate information with regards to the service that the home offers; therefore it is not possible to make an informed choice about moving into the home. Service users are supported in ensuring that the Home can meet their needs prior to admission, but their care may be compromised by staff not being trained in meeting their specialist needs. EVIDENCE: Copies of The Statement of Purpose and Service Users Guide were obtained and following a review of these documents it was identified that they are considerably outdated and contain information that is either no longer accurate or relevant. They are not reflective of the new organisation and there is some key information missing from both documents. They both need to be completely reviewed in line with Standard One, amended where appropriate to reflect the service provided and re-issued. A requirement is being made to this effect. A pre-admission need assessment is completed for all service users – they contain information with regards to personal needs, healthcare, eating and drinking, mobility – including movement and handling, communication needs, Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 9 exercise and leisure activities amongst others. The assessments are reflective of the needs of the service users, however, these documents could be completed more thoroughly with the information being reflected into the care plans. The manager stated that he is aware that documentation needs reviewing and as he becomes more familiar with the processes of the home this is an area he will be looking into. The manager demonstrated an awareness that service users will only be admitted if the home can be confident that they can meet individual needs and also that they will be compatible with other service users already living in the home. Although the home is now registered to accommodate people with a diagnosis of Acquired Brain Injury (ABI), the manager will not admit any service users into the home whose assessments indicate that they will not be compatible with other people already in residence. He recently received an application for a service user to be admitted into the home with a diagnosis of ABI – however there were other associated problems which meant that this service user could pose a risk to those currently living in the home and the application was refused. Specialist training has not yet taken place for staff to support service users with ABI. Staff spoken to demonstrated an awareness of the needs of service users with Huntingtons Disease – although it was also identified that not all staff had received specialist training in meeting the needs of this service user group and most of their skills and awareness had been built up through working with the service users. The home promotes and supports visits to the service prior to moving in and family input is actively encouraged. A copy of the contract was obtained; this is the generic contract for the larger organisation. Although it contains most of the required information it was not specific to Millstream and did not run in conjunction with the current local documentation for the home. There was also no evidence to support that service users have been issued with and agreed to a contract with the new service providers and a requirement is being made to this effect. Millstream DS0000057566.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. Service users do not benefit from comprehensive care plans that fully support them in meeting individual needs. Their safety may be put at risk, as the care plans are not supported by risk assessments that address how to fully support service users in meeting their needs. EVIDENCE: Care plans were viewed and there are two files that are used for service users. There is a ‘current’ file, which is used for the ongoing care needs of the service user and a secondary file that is used as an archive file. It was identified that the organisation of the information is not consistent and this leads to a lack of continuity in the care provided. The care plans have not progressed since the last inspection and there is no evidence of risk assessment outcomes being incorporated into the format as identified at the last visit. Evidence showed that there was no continuity of care plan formats and that they are not reviewed on a regular basis. In some cases the assessments had identified a need through the risk assessment Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 11 process and this had not been incorporated into the care plan. One example of this was with regards to a service user who was observed to be asleep in the doorway of the living room floor – the inspector was informed that this gentleman prefers to sleep on the floor – and this in itself is not an issue. However the concerns are with regards as to how the home manages this and direct observation demonstrated that this gentleman was alone at this point and on further investigation into his risk assessment information it was identified that he should be supervised – this was not related into the care plan as to how the supervision should be carried out and there was no evidence of the supervision as at the time all staff were in the dining area assisting other service users with their meals. There were no recommendations made into the care plan as to how to support this service user positively with his needs. There are some assessments in place to support service users with their best interests however as previously noted not all of these assessments are adhered to – this appears to be related to staffing levels. There are further risk assessments in place and some are detailed, however they vary in content and there is no continuity in the format and the results and outcomes to reduce risks are not fed into the care plans and this contributes as to how the service further promotes and protects the people who are in receipt of the service. Millstream DS0000057566.V301402.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. Leisure activities need to be promoted in order for service users to benefit from appropriate and more fulfilling lifestyles. The meals provided in this home are good and offer choice; variety and cater for special dietary needs. EVIDENCE: Service users are supported by key workers and are encouraged where able to take part in different leisure activities. This includes going horse-riding, shopping and going out to lunch. There is still no activities co-ordinator in place and although staff were seen to spend time with service users there appears to be little stimulation to occupy them when they are in the home. The involvement of family and friends is promoted and a relative spoken to confirmed that they kept her informed of any issues and she found the Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 13 manager and staff to be very supportive. Service users are supported to go on holiday and are able to choose where they wish to go. Service users are encouraged to be as independent as possible and promoted to manage their own money and have opportunities to go shopping. Staff demonstrated a full awareness with regards to meals and the nutritional needs of the service users within the home. There is a full time Chef who has worked in the home for a number of years. She is responsible for the purchasing of food and there was a varied menu in place. People with Huntington’s Disease need a high calorie intake due to their condition and many need assistance with eating their meals. Food is pureed for some people and served in individual portions. Service users spoken to confirmed that they enjoyed their meals. There were concerns identified with regards to the amount of staff available to assist at mealtimes – as the majority of service users need assistance and this is quite a lengthy process. This meant that some service users had to wait for quite a long time for their meals. The home must look into ensuring that there are sufficient staff available to assist service users with their meals. Millstream DS0000057566.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Service users would be better protected if staff had undergone appropriate medication training and record keeping was improved. The personal and health care needs of service users are mainly met, but service users would benefit if appropriate referrals were made when the need is identified. EVIDENCE: Care plans and personal files showed evidence that service users are supported with their personal care in a manner that promotes their privacy and dignity. Members of staff spoken confirmed this and observation showed that service users are supported sensitively and with treated with respect. Records viewed showed that there is a high input from relevant healthcare professionals and that individuals’ health is closely monitored. However it was identified on two service users files that it had been recognised that there was a need for additional Occupational Therapist intervention and that a referral should be made – this had not occurred. A requirement is being made with regards to this. Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 15 A spot check was carried out on medication and concerns were noted with regards to the record keeping of MAR sheets. There were gaps evidenced in the MAR sheets and the tablets did not correspond with the records. An immediate requirement was made with regards to this. Staff are also not appropriately trained in medication and this needs to be addressed. Bottles and boxes of tablets that had been opened were not dated as to when they had been opened and this made it difficult to audit the tablets – a good practice recommendation is being made that these should be dated. Millstream DS0000057566.V301402.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. There is a complaints procedure in place and service users can be confident that their concerns will be listened to and acted upon. Service users are potentially at risk from abuse due to lack of staff training in Adult Protection issues. EVIDENCE: On the day of the site visit a service users raised a serious concern with regards to a member of staff – the manager was seen to take appropriate action at the time and followed correct procedures. There was one complaint recorded – although this had not been dealt with in the stated timescales. The home implements full checks prior to any new members of staff starting including CRB and POVA checks. Some staff have had training with regards to protecting service users but the home must ensure that all staff are trained in this area. Millstream DS0000057566.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home provides a comfortable, homely and clean environment but service users would benefit from their individual rooms fully meeting their needs. The home needs to ensure that service users are fully protected with regards to infection control issues. EVIDENCE: Millstream is a large premises that accommodates up to twenty people. The home is comfortable, airy and clean. Many of the service users are wheelchair users and the home is accessible and suitable for it’s purpose. There are lifts to all floors All rooms are single occupancy and en-suite. Although, of the bedrooms viewed, they appeared to meet the needs of the service users - it was identified that there are some serious storage issues in individual rooms with items for personal care use being stored on the floor. Items were also being stored on the top of wardrobes – including in one room a television – a requirement is being made that all rooms have appropriate storage and that Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 18 appliances are positioned on suitable units. As well as all individual rooms being en-suite there are additional adapted bathrooms and accessible toilets situated around the home. A full tour of the environment was undertaken and overall the home was clean and well maintained. There are four lounge areas, one of which is designated as a smoking lounge, and a dining area – there is also a patio area to the rear of the property and many of the service users were using this space on the day of inspection. There is also additional communal space that is currently undergoing refurbishment and the home is in the process of adapting a further space for storage of adaptations and equipment. There are suitable adaptations around the home to meet the needs of the service users. The laundry area is currently being re-sited and at the time of this site visit the rooms were being refurbished so that they would meet hygiene and infection control guidelines. Laundry is currently being managed through the original facilities, however through staff shortages it was identified that a large amount of damp washing had been left in several baskets for a substantial part of the day waiting to be loaded into the tumble dryer – requirements is being made with regards to infection control issues and staffing levels and the home must ensure that they take into account that there are adequate ancillary staff on duty. There are sluicing facilities situated around the home – it is strongly recommended that these rooms are risk assessed to ensure that they are safe and that any unauthorised persons will not access them. Millstream DS0000057566.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 and 35. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The service users benefit from being cared for by staff who have a good understanding of their needs, however staff shortages and lack of training results in service users being put at risk. EVIDENCE: Although this area has been judged as poor – considerations must be taken into account that the staff care and support the service users to the best of their abilities. All staff spoken to demonstrated a good understanding of the needs of the people living within the home and they were all committed to promoting their best interests. When talking to staff they were all very positive about the new Manager and the future of the home. However evidence showed, with regards to training, supervision and staffing levels that that there are serious shortfalls. Staff spoken to expressed concerns with regards to staffing levels and in some cases they were concerned that their own skills were not being updated appropriately. The home has worked out the staffing needs based on the guidance recommended by the Residential Forum and the number of staff hours provided are below this level. All service users within the home are dependent upon the staff for their needs and there are key times within the day when Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 20 there are not enough staff to safely support service users including getting up in the morning and at mealtimes. A requirement is being made that the home ensures that there are enough staff on duty to meet the needs of the service users. Recruitment is ongoing and the manager demonstrated an awareness of the recruitment process for new staff. References and CRB checks are completed and staff have contracts and job descriptions. Training needs were identified at the last inspection and evidence on this visit showed that training has not progressed satisfactorily. There was a matrix in place that was being used to show the outstanding training requirements of staff and this evidenced that a high proportion of staff are lacking in key areas of up to date training including adult protection, first aid, movement and handling and medication. Of those who had completed their medication training it was also evidenced that some members of staff had completed courses that were not suitable to fully ensure that they could meet the needs of the service users. The larger organisation has a trainer and they need to ensure they access this facility – a requirement is being made with regards to staff training. Currently the levels of staff with an NVQ are also below the recommended levels and the home needs to address this. Records for staff also evidenced that the induction is not in depth enough and does not meet with the Skills for Care specifications. Millstream DS0000057566.V301402.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Service users benefit from a manager who is clearly committed to safeguarding and promoting individuals independence, rights and choices and is assisted by a staff team who care about the service users. However, service users would be better protected if safe working practices were fully adhered to. EVIDENCE: At the time of the site visit the manager had been in post for just over a month and was in the process of familiarising himself with the systems and structures of the home. He has the relevant qualifications needed to manage the home and demonstrated a commitment towards improving areas of concern. He stated that his priorities were the training and care plans. He was aware that there was a need for improved communication within the home and was looking into addressing these issues. Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 22 The manager stated that there had been a quality assurance survey carried out and this was currently being collated – a requirement is being made that the outcomes of this are forwarded to The Commission. The opinions of service users are listened to and they are able to contribute to the running of the home. A selection of policies and procedures was sampled – as the home has recently become incorporated with a larger organisation they are in the process of updating the paperwork. It was identified that some of the policies and procedures are not appropriate for this home as they cater for a different client group – the organisation must ensure that all documentation in place meets the specific needs of the people living within this home. Staff are made aware of new policies and procedures and are updated on a regular basis. The home has taken steps to ensure that all relevant safety checks are up to date and ensures that service users live in a safe environment – there are some concerns with regards to safe working practices as not all staff are trained appropriately – but this has been identified in the staffing section of this report. Overall the manager and staff demonstrated that they were committed to ensuring that the home would be able to meet the needs of the service users and as the new manager settles into his post he will be able to address the issues that affect the health, safety and welfare of the service users. Millstream DS0000057566.V301402.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 1 2 3 3 2 4 3 5 1 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 1 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 2 32 2 33 1 34 3 35 1 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 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X X 3 2 2 X 2 X Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 24 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 Homes 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) 5 (1) (2) (3) Sched. 1 Requirement The Registered Person shall ensure that the Statement of Purpose and Service Users Guide are reviewed and updated. In that they contain all the relevant information as stated in Standard 1 and Schedule 1 of The National Minimum Standards for Younger Adults and Regulations 4 and 5 of the Care Homes Regulations 2001. They must also be accurate and reflective of the service provided. The revised documents must be forwarded to the Commission within the timescale stated. “The registered person shall produce a standard form of contract for the provision of services and facilities by the registered provider to service users” In that the new provider organisation ensures that all service users have an appropriate contract. “The registered person shall make arrangement for service users to receive where DS0000057566.V301402.R01.S.doc Timescale for action 31/08/06 2 YA5 5 (1) (c) 31/08/06 3 YA19 13 (1) (b) 05/08/06 Millstream Version 5.2 Page 25 4 YA20 13 (2) 5 YA26 23 (2) (m) 13 (4) (c) 6 YA30 13 (3) 7 YA33 18 (1) (a) necessary, treatment, advice and other services from any healthcare professional” In that where a need is identified for a referral to be made to a healthcare professional the home must action this and keep records. “The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home” In that MAR sheets must be completed accurately. “The registered person shall having regards to the number and needs of the service users ensure that suitable storage facilities are provided for the use of service users and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated” In that personal care items and personal belongings are stored appropriately and that televisions or other items are not kept on top of wardrobes. “The registered person shall make suitable arrangements to prevent toxic conditions and the spread of infection in the care home” In that laundry must not be left wet in baskets. “The registered person shall… ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users” In that there are enough staff n DS0000057566.V301402.R01.S.doc 05/08/06 05/08/06 05/08/06 31/08/06 Millstream Version 5.2 Page 26 6 YA35 18 (1) (c) (i) duty to meet service users needs in particular with regards to the a.m. shift and at mealtimes. An action plan must be forwarded to the Commission within the timescales stated. “The registered person shall… that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training” In that staff must be trained in meeting the needs of the service users. An improvement plan on how the home aims to address outstanding training issues must be forwarded to The Commission within the timescales stated. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is a good practice recommendation that bottles and boxes of tablets are dated as to when they are opened to promote more efficient monitoring of medication within the home. It is strongly recommended that the sluice rooms are risk assessed to ensure that they will not be accessed by any unauthorised persons and that any soiled articles or cleaning substances are stored appropriately. It is strongly recommended that the home ensures that the percentage of staff who hold an NVQ are in line with the guidelines set out in the National Minimum Standards. It is strongly recommended that the policies and procedures reflect the needs of the service users within this home. 2 YA30 3 YA32 4 YA40 Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millstream DS0000057566.V301402.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!