Inspection on 09/01/07 for Millstream

This inspection was carried out on 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 05/07/06

Millstream 12/01/06

Millstream 06/09/05

Millstream 23/11/04

Millstream 28/04/04

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

CARE HOME ADULTS 18-65 Millstream Mill Road Frindsbury Kent ME2 3BT Lead Inspector Anne Butts Key Unannounced Inspection 9th January 2007 09:30 Millstream DS0000057566.V326527.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.V326527.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.V326527.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.V326527.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. 5th July 2006 Date of last inspection Brief Description of the Service: Millstream is a large care home situated on the outskirts of Strood. Local services are approximately 1½ miles away downhill. It is in keeping with the local area. The home caters specifically for adults with a diagnosis of Huntington’s Disease, and service users who have a diagnosis of an Acquired Brain Injury and whose individual needs they can meet. The home can accommodate and provide a service to twenty service users. The home is set over three floors. All bedrooms are en-suite and there is a range of shared spaces. There is a designated smoking lounge. There is a large rear garden which has terraced, paved and lawned areas and has good access for service users. There is some parking space to the front of the building. The home provides a range of information of prospective and current service users including a Statement of Purpose and Service Users Guide and CSCI reports are made available in the home. At the time of this visit fees ranged from £1,000 - £1,800. Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Key inspections are now an integral part of the process for The Commission for Social Care Inspection under the Inspecting For Better Lives (IBL) procedure. These are undertaken in order to ensure that individual services are meeting the standards and ensuring that the outcomes for service users are in their best interests. This is the second key inspection undertaken at this home since the inspection year started in April 2006. A site visit was carried out at the premises by one inspector who was in the home from approximately 10.30 am until 6.00 pm. Time was spent touring the building, talking to staff and service users, observing as to how service users are assisted in their day to day living and also reviewing assessments, care plans and other relevant documents. Due to the nature of the disabilities of the service users, some of the individuals have communication difficulties however a range of comments made are included in the main body of this report. The manager and staff who were on duty assisted the inspector during the inspection process. At all times the manager and staff were helpful and demonstrated a pro-active approach to ensuring that service users were being supported to the best of their abilities and resources. What the service does well: What has improved since the last inspection? Since the last visit there have been some minor improvements, however overall the service has stood still and not progressed to any great degree. The storage in service users bedrooms have improved and televisions are now no longer sited on the top of wardrobes. Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 6 Staff training in mandatory areas of care has largely been addressed, although there are still some outstanding training needs. There are some improved systems in place with regards to the documentation surrounding the needs assessment and care plans but as yet they have not been implemented. 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.V326527.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.V326527.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 poor. This judgement has been made using available evidence including a visit to this service. Service users are not benefiting from the provision of information that is fully up to date and accurate. The pre-assessment process meets individual needs satisfactorily, but service users would benefit from a more detailed process so as to ensure that their needs can be fully met. Service users cannot be assured that they will receive a full range of the specialist services offered in order to enhance their daily lives. EVIDENCE: The Statement of Purpose and Service Users Guide have been partially updated since the last visit and are now more specific to Millstream and the services they provide. The manager stated that there is still further work that needs to be completed on these and that this is currently ongoing. It was noted that some of the therapeutic services described within these documents were not actually being provided the service users as a matter of course and conversations with staff and service user records confirmed this. The service is not fulfilling its contract terms with regards to what facilities and services are available within the fee structure. Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 9 There is a full needs assessment process in place and prior to any service user moving into the home, the manager or deputy manager visit the person in their current environment and carry out a pre-assessment. Samples of these assessments were viewed and there is now a new format in place that is intended to cover the full range of the needs of the service users. As at the last visit it was observed, once again, that although the assessments were completed the information contained within these was still fairly sparse – for example many parts of the assessment stated the service user ‘needs assistance’ but did not expand as to how this assistance should be provided. These assessments are also used to form the basis of a life history – but again it was observed that the information contained within these was only partially completed in some of the files. The assessments and life history are used as part of the service user plans, however in order for staff to be able to fully support the service users – all the information must be more in-depth and reflective of the service users needs. Staff spoken to during the course of the visit were able to demonstrate an awareness of the needs of the service users. Specialist training with regards to Huntingtons Disease or Acquired Brain Injury is still outstanding for the majority of staff although some staff had received specialist training with the Speech and Language Therapist. Records also evidenced that the home has close links with the Speech and Language Therapist and there are regular reviews with service users in order to ensure that the home can meet their changing needs. Other specialist therapeutic services described within the Statement of Purpose were not, however, being provided. A requirement has been made with regards to the home ensuring that they provide these services. A requirement was made at the last visit for the home to ensure that each service user has an appropriate contract the manager stated that this was still under review and, therefore, this was not inspected at this visit. The requirement, however, remains outstanding. Millstream DS0000057566.V326527.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 6, 7, and 9 Service users have an individual plan, however the further development of these plans with more comprehensive detail would benefit service users. Risk assessments do not serve to fully protect service users as the outcomes are not detailed and included in the service user plan. EVIDENCE: Service user plans are in place for all service users, but they are not developed from efficient assessments that identify as to how to fully support individuals. As a consequence these plans are still not addressing the full needs of the individual and despite concerns being raised at previous visits that individual plans need to be developed further there has still been no progress with regards to this. Currently plans are reviewed regularly but there is no evidence to support that they are reflecting any changes in the needs of the Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 11 individual. Service user plans also do not identify any personal goals or aspirations that people may have or any specialist therapeutic interventions. The Deputy Manager was able to evidence that he is aiming to improve the format of the service user plans and has contacted the Huntingtons Disease Association for guidance. He has developed a new format in line with a recognised service user plan model and this includes at least twelve activities of daily living. Service user plans need to be updated as a matter of urgency and the home must take into account as to how they will support individuals in identifying any aspirations. The plans must also identify as to how they will support service users with any specialist requirements. Staff were seen to be supportive towards service users and assisted them with their daily routines. Service users are encouraged with their right to make their own decisions and to live their lives, although their choices are limited as staff within the home spend their time assisting with daily needs and support and do not have the time to offer additional activities or promote different choices. One service user stated that “the staff are good and they help me with things I need doing” There has been some improvement in risk assessments for new service users, in that the information they contain is more explanatory, although risk assessments viewed for service users who had been living in the home for a longer period still remained limited in the information that they contained. For example a risk assessment carried out for assisting with bathing identified that assistance was needed but did not outline as to how this assistance should be provided. Of the risk assessments viewed, some had not be reviewed following any changes, in that a movement and handling assessment carried out in May 2006 identified that there was assistance needed and that the home was waiting for a sling – discussions with staff confirmed that the sling had arrived, but this had not been incorporated into an updated movement and handling assessment. One service user who had identified behavioural problems associated with his condition did have a management behavioural plan in place that had been agreed with him. Full outcomes of risk assessments are still not being incorporated into the service user plans. Discussions with some members of staff did evidence, however, that they had a good understanding of the risks that may affect service users and that they promoted their daily living choices to the best of the resources that were available to them. Millstream DS0000057566.V326527.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 11, 12, 13, 14, 15, 16 and 17 Service users are well supported by staff in meeting their daily needs, but only have limited opportunities to access a range of recreational and community activities or pastimes. Family and friends are promoted in supporting service users and maintaining contact. Service users benefit from meals that support choice and offer a balanced and nutritious diet. EVIDENCE: Observations, records and discussions with staff indicated that people living at the home had only limited opportunities to take part in age, peer and culturally appropriate activities. The range of activities and social opportunities on offer Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 13 did not support people with a variety of choice in accordance with their abilities. Many of the service users are unable to, or have no wish to participate in organised activities, but there was little evidence to show how the home is supporting people with individual activities tailored to their needs. Some service users do go horse-riding, and people are actively supported and encouraged in visiting the local community and going shopping. Overall staff demonstrated an awareness of the need to support service users with their daily living activities but there was no evidence of the opportunity for service users to access a wider range of activities or maintain their interests. There is a key worker system in place, however staff are fully occupied supporting service users on a re-active basis and responding to their daily care. The home has still not employed or nominated a designated person who can further support service users with any leisure interests, pastimes or aspirations that they may have. Evidence of a survey was viewed on some records to show that at some point the home had spoken with service users and asked them about any pastimes, interests or therapeutic activities they may be interested in, and although these surveys showed a positive response there was no evidence to show that any of these had been implemented. The manager was able to confirm that one or two service users preferred a routine and had set days to go out and about, and some service users did have music therapy sessions – however even these events were only occurring once or twice a week and service users appear to spend the majority of their time watching television in one of the communal areas. The home does support service users in maintaining links with family and friends and their involvement is encouraged. Service users have unrestricted access within the home, dependent on their abilities, and are able to choose where they prefer to spend time. Staff were observed interacting and talking to service users and treating them with respect. The home does respect service users rights to keep pets and one lady was being supported in keeping birds. Meals are a high priority in the home and there is a full time chef in place, who is supported by a kitchen assistant. The chef was able to demonstrate a good knowledge of the specialist needs of the service users. Many of the service users need their food liquidised and the chef confirmed that that they were served in individual portions. Many of the service users need assistance with their meals and at the last visit concerns had been raised as to the amount of staff on duty during the mealtimes as this was quite a lengthy process. However, at this visit members of staff were able to confirm that mealtimes were now more relaxed and that service users did not have to wait. Menus showed that there is a good variety of food and that choices are always available. Millstream DS0000057566.V326527.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 18,19 and 20 Limited progress has been made on improving arrangements to ensure that the physical and emotional needs of the service users are identified and met. These shortfalls have a potential to put service users at risk. Service users are not adequately protected by the Home’s administration and recording of medication. 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. A review of the care records for service users showed that the home does support service users with their healthcare needs and access a range of healthcare support including input from the local hospice and speech and language therapist. The home also maintains close working relationships with Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 15 the local General Practitioner – although members of staff did voice some concerns with regards to the response from the local surgery – the home must ensure that they record their contacts with any external professionals and the response that they have received. They must also ensure that if they are not satisfied they must record this and the action that they then take to address this. The Statement of Purpose says that the home will undertake to make arrangements for service users to access therapeutic techniques including both the speech and language therapist and physiotherapist. Evidence was seen that there is a high input from the speech and language therapist, however there was no evidence of physiotherapy input – and this was supported by staff who stated that service users did not receive this support. A room originally designated for physiotherapy is now used as part of the laundry area. Staff also confirmed that service users did not receive a counselling service as also described in the Statement of Purpose. Records viewed did not show at to whether service users were offered these services – the home must ensure that it supports service users with therapeutic techniques as offered and in accordance with their needs. Records should also indicate if service users do not want these services. A requirement has been made with regards to the home meeting the specialist needs of service users under Standard 3. A review of medication was undertaken as part of this visit and it evidenced that there is still some errors in the recording onto medication administration records. Individual boxes and bottles were also not dated as to when opened and this is made it difficult to audit the tablets. Since the last visit staff have undergone further training and only nominated members of staff administer medication. The home must ensure, however, that their monitoring and auditing of records is more robust in order to ensure that medication errors do not occur. Requirements are being made with regards to medication. Millstream DS0000057566.V326527.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 22 and 23 Service users can be confident that the home will take any complaints seriously and that their views will be listened to and acted upon. There are good procedures in place for safe-guarding service users, however they would further benefit from all staff being in receipt of Adult Protection training. EVIDENCE: There is a complaints procedure in place that meets the National Minimum Standards and the home is pro-active in supporting service users with any concerns. One service user stated that if she had any problems she could always speak to the manager or any members of staff. The home also closely monitors any incidents and takes appropriate action where necessary. The manager responds quickly to areas of concern and a recent incident had resulted in disciplinary action being taken. Only a limited number of staff records were viewed, although all showed that Criminal Record Bureau checks were in place and that POVA (Protection of Vulnerable Adults) first checks were in place. It was not possible to evidence that all staff and undergone appropriate training with regards to Adult Protection issues and the home must ensure that this is carried out for all members of staff. Millstream DS0000057566.V326527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 24, 26 and 30 The service users benefit from having access to their own en-suite rooms with sufficient additional toilets and specialised bathrooms. There had been little change to the décor or furnishing in the last twelve months, and planned refurbishment of key areas of the home remain unfinished. EVIDENCE: A brief tour of the home was undertaken with a selection of service users bedrooms being viewed. Millstream can accommodate up to twenty people. The home was overall comfortable, airy and clean. Many of the service users are wheelchair users and the home is accessible with lifts to all floors. There are four lounge areas, one of which is designated as a smoking lounge, and a dining area – there is also a patio area to the rear of the property that is used during the warmer months. There is additional communal space on the lower Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 18 floor - at the time of the last visit a refurbishment programme had just been started in this area, however little progress has been made and the room is currently not in use. All bedrooms are single occupancy and en-suite. At the last visit it had been identified that some of the service users bedrooms did not have appropriate storage for personal care items and in one bedroom a television was positioned on top of the wardrobe. The home has addressed these issues and storage was seen to be improved and there were no items stored on top of wardrobes. Bedrooms viewed were personalised with individual belongings and one service user stated how much she liked her room. Overall the home was clean and reasonably well maintained although some areas were showing some signs of general wear and tear. The laundry has still not been re-sited and it is currently split into two areas at separate ends of the home. In its current form it is not suitable for its stated purpose, with neither area providing effective and manageable conditions to do the laundry, and the machines that are situated in the original area are not in a room that promotes the control of the spread of infection. A requirement is being made that the laundry facilities are organised appropriately and are able to meet the needs of the home. Millstream DS0000057566.V326527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 32, 34 and 35 The service users benefit from being cared for by staff that are committed to their well being, however their care may be compromised as staff have not received adequate specialised training. Service users’ safety may be compromised by the home’s recruitment procedures not being fully adhered to. EVIDENCE: Throughout the visit staff were observed to interact well with service users and were motivated to supporting them to the best of their abilities with their daily needs. The atmosphere within the home between staff and service users was relaxed and staff demonstrated genuine regard and respect for the people living within the home. Discussions staff with evidenced their appreciation of the individual needs and they were clear about their role in supporting people. The home has access to the larger organisations training department, and staff are supported in undertaking the recognised mandatory training courses. The Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 20 manager stated that all the trainers were approved in the areas of training. There are still some staff who have not undertaken the relevant mandatory courses, however training has improved and there are further courses booked in for staff over the next two – three months. Although the mandatory training needs are being addressed there are still considerable shortfalls with regards to areas covering the specialist needs of the service users including awareness of individual conditions. Some staff have undertaken specialist training from the Speech and Language therapist and a few members of staff have taken courses in Huntington’s disease and Acquired Brain Injury but in order to fully support the specialised needs of the service users living in the home the organisation must ensure that staff have the opportunity to attend specific training that is targeted and focussed on ensuring the best outcomes for people. The Statement of Purpose also confirms that it provides specialist training for staff in Huntington’s disease and Acquired Brain Injury. A requirement is being made with regards to training. The organisation is now supporting staff with undertaking an NVQ with eight people starting the course and a further eight booked in. Staff records were viewed for new members of staff, and there are systems and procedures in place for recruitment. Staff had a current Criminal Records Bureau check and a POVA first. Of the files viewed it was identified that two references were not always being obtained and that in some cases the references were not satisfactory this was discussed with the manager at the time and it was recommended that he or the deputy manager check references and confirm that they are happy with them. The manager stated that staff do not work unsupervised before they are in receipt of the Criminal Records Bureau check and whilst they are undergoing their induction training – they are supported by a more senior and experienced member of staff. The manager stated that there is a formal structured induction programme now in place, but on the day of the site visit there wasn’t one available to view. Millstream DS0000057566.V326527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 37, 38, 39 and 42 The support and commitment provided by the manager and staff benefits service users and supports them in their daily lives. However, their care is compromised by the lack of resources available to provide specialised services in order to fully meet individual and changing needs. EVIDENCE: Although the outcomes for this area has been judged as poor this is in relation to the lack of specialised service provision for service users and that the larger organisation has not allowed the home to develop and there appears a lack of purpose. Throughout the visit the manager demonstrated his awareness of the needs of the service users and his commitment to promoting their best interests. Since Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 22 he has been in post he has taken some steps to address the issues of concern raised at the last visit and communicated a clear sense of direction and leadership with staff and service users. However, overall it appears that home has not progressed to any great degree in improving its’ services for the people living in the home. The daily care practices are generally good but the home prides itself on delivering a specialised service to a specific service user group but this is not happening as the therapeutic services, the pursuit of a range of purposeful and interesting activities and specialised training for staff as stated in the Statement of Purpose are not available as a matter of course. The manager and staff are unable to be pro-active in their approach with regards to expanding the specialised care needed to fully support service users. It should be recognised that there has recently been a change in the share ownership of the larger organisation and it is now under a new directorship and will be operating under the combined name of the Independent Living Group (ILG). This is approximately the third change in the larger organisation in recent years and although there has been no direct disruption to the daily lives of the service users it has not enabled the home to develop into a specialised care service to meet the particular needs of the people living in this home. It is hoped that the new directorship will be able to recognise and address the need to develop this service. Requirements in this report are reflective of the overall lack of direction this home currently has. Prior to this visit the home had undertaken a survey with service users, relatives, staff and care managers to gain feedback with regards to the service provided. The home acknowledged that there was a limited response but there was a positive response with regards to the support provided by the staff and management and the atmosphere within the home as well as the standard of the individual bedrooms. The report also acknowledged where the surveys had identified weaker areas and these included the activities for service users and formal reviews with care managers. The report concluded that the management of the organisation would look into these areas. The health and safety of service users is generally well protected with the maintenance of a safe environment, regular safety checks, monitoring of incidents and infection control practices. There are some concerns with regards to risk assessments for service users, but these have been addressed elsewhere within this report. The everyday care and support provided by the manager and staff is aimed at fully supporting service users but there is no additional support to promote a progressive and beneficial service for people living in the home. Millstream DS0000057566.V326527.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 2 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 1 3 2 X X 2 X Millstream DS0000057566.V326527.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) Requirement The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as “the statement of purpose”) which shall consist of— a statement of the aims and objectives of the care home; a statement as to the facilities and services which are to be provided by the registered person for service users; and a statement as to the matters listed in Schedule 1. The registered person shall supply a copy of the statement of purpose to the Commission and shall make a copy of it available on request for inspection by every service user and any representative of a service user. Nothing in regulation 16(1) or 23(1) shall require or authorise the registered person to contravene, or not to comply with— any other provision of these Regulations; or the conditions for the time being DS0000057566.V326527.R01.S.doc Timescale for action 23/02/07 Millstream Version 5.2 Page 25 in force in relation to the registration of the registered person under Part II of the Act. In that the Statement of Purpose must be accurate and reflective of the service provided. The home must ensure that the services and facilities that are offered within this document are available to service users. This requirement remains outstanding with an original timescale date of 31/08/06. 2 YA3 YA19 12 (1) (a) (b) “The registered person shall 23/03/07 ensure that the care home is conducted so as— To promote and make proper provision for the health and welfare of service users; To make proper provision for the care and, where appropriate, treatment, education and supervision of service users.” In that arrangements must be made to offer and support service users with specialist services that will meet their needs and as offered in the Statement of Purpose. The registered person shall 23/02/07 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. This remains outstanding with an original timescale date of 31/08/06. “Unless it is impracticable to 05/04/07 carry out such consultation, the DS0000057566.V326527.R01.S.doc Version 5.2 Page 26 3 YA5 5 (1) (c) 4 YA6 15 (1) Millstream registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met.” In that service users’ plans must set out in detail the full needs of the service user and how the home will meet these needs. 5 YA9 13 (4) “The registered person shall 05/04/07 ensure that— All parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; Any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated,” In that risk assessments must identify any risks and hazards and the action to be taken to minimise these. The outcomes should be recorded in the individual plan and reviewed. 05/04/07 “The registered person shall having regard to the size of the care home and the number and needs of service users Consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training.” DS0000057566.V326527.R01.S.doc Version 5.2 Page 27 6 YA12 16 (2) (n) Millstream In that there must be opportunities for service users to access appropriate activities or pastimes in accordance with their varying abilities. 7 YA20 13 (2) The registered person shall 01/02/07 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. This requirement remains outstanding with an original timescale date of 05/08/06. The registered person shall 01/02/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home In that boxes and bottles of tablets must be dated as to when opened. “The registered person shall 06/04/07 having regard to the number and needs of the service users ensure that— The physical design and layout of the premises to be used as the care home meet the needs of the service users;” In that the laundry facilities must be appropriate and meet the needs of the home and service users. “The registered person shall, 23/03/07 having regard to the size of the care home, the statement of purpose and the number and needs of service users— Ensure that the persons DS0000057566.V326527.R01.S.doc Version 5.2 Page 28 8 YA20 13 (2) 9 YA30 23 (2) (a) 10. YA35 18 (1) (c) (i) Millstream 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 training must be organised so that staff are appropriately trained in meeting the specific needs of the people living within the home and this training must be targeted and focussed on ensuring that staff can provide the best outcomes for service users. 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 YA2 Good Practice Recommendations It is strongly recommended that the pre-assessment needs documentation is completed in a more detailed manner fully exploring as to how the home will meet the needs of the service user It is strongly recommended that the home ensure that two satisfactory references are obtained for new employees. It is strongly recommended that the policies and procedures reflect the needs of the service users within this home. 2 3 YA34 YA40 Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millstream DS0000057566.V326527.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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