CARE HOME ADULTS 18-65
Millstream View Mill Lane Adwick Le Street Doncaster South Yorkshire DN6 7AG Lead Inspector
Ramchand Samachetty Unannounced Inspection 6th March 2006 13:00 Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 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 View DS0000032073.V284990.R01.S.doc Version 5.1 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 View DS0000032073.V284990.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Millstream View Address Mill Lane Adwick Le Street Doncaster South Yorkshire DN6 7AG 01302 721408 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) Doncaster Metropolitan Borough Council Pamela Hankinson Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users with challenging behaviour can only be accommodated in the 8-bedded unit. 26th October 2005 Date of last inspection Brief Description of the Service: Millstream View is a Care Home registered to provide accommodation, care and support to up to 13 young adults with a learning disability (18-65 years of age). The accommodation is offered within two separate units. One unit, which is located on the ground floor, provides care for up to 8 young adults with learning disabilities and challenging needs. The second unit is located in a part of the building where the accommodation has been arranged into 5 individual and separate flats. Both units have separate access. They have designated staff groups. The Home is situated on Mill Lane, in Adwick-Le-Street village, Doncaster. It is close to local amenities, including shops, a post office, and a church. The ‘Adwick Social Education Centre’ is situated next to the Home, and is attended by the majority of the service users of Millstream View. Millstream View is owned and managed by the Social Services Department of the Doncaster Council. There is a registered manager, Mrs. Pam Hankinson, who is responsible for the day- to- day running of the Home. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on 6 March 2006, starting at 13.00 hours and finished at 17.00 hours. The inspection included a tour of the premises, conversations with four service users and three care staff. Interactions between staff and service users were observed. At the time of this inspection, the manager was on planned leave and a senior care officer was in charge of the Home. Issues were discussed with the officer in charge at the time of the inspection. Care documentation and other records were checked and progress achieved since the last inspection was reviewed. What the service does well: What has improved since the last inspection?
The environment has been partly improved. One lounge has been decorated and some minor repairs carried out. The admission procedure has been included in the statement of purpose.
Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 6 The process of conducting care reviews and risks assessments have been improved. 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 View DS0000032073.V284990.R01.S.doc Version 5.1 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 View DS0000032073.V284990.R01.S.doc Version 5.1 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 and 4. Information about the service is available to prospective service users, but in practice, not all of them are given a choice of where they live. The aspirations and needs of prospective service users are not always assessed in time and for the purpose of admission at Millstream View. Prospective service users are not always provided with the opportunity to visit and ‘test drive’ the Home before their admission. EVIDENCE: The Home’s statement of purpose has been reviewed to include its admission procedure. The procedure for emergency admission to the Home lacks clarity, in particular, on how ‘suitability to live at Millstream View and compatibility with other service users’ are determined and applied in practice. The Home’s statement of purpose still lacks information regarding arrangements made for dealing with reviews of service users’ plans and for respecting privacy and dignity of service users. The inspector checked the care files of two service users who had been recently admitted to the Home. In both cases, it appeared that they had been admitted with little notice to the Home. They had not had the benefit of the appropriate pre- admission visits to familiarise themselves with the Home, and
Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 9 less still for staff and existing service users to consider the issues of ‘compatibility’. There was no information to suggest that the service users or their next of kin had exercised a choice in and had agreed on the placement. It is worrying to note that the full assessment for one service user was sent to the Home almost one month after her admission. However, care staff were told that the service user has ‘challenging needs’. In another instance, a service user was discharged from a long stay hospital to Millstream View, in February 2006. In discussion, staff explained that she had also been admitted at short notice. The assessment of need from the placing social worker was dated August 2005 and had been slightly updated in January 2006. There was no evidence that the Home had assessed the needs of the two service users in question on their admission, to ensure that it could appropriately meet their needs. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 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 Care and support needs and personal goals, of individual service users, were appropriately addressed in their plans of care. EVIDENCE: A sample of individual care plans was checked. They were developed from needs assessments and also from their subsequent reviews. Actions to meet identified care and support needs were appropriately specified and acted upon. Regular reviews of individual care plans were undertaken and their outcomes implemented. Risks were appropriately assessed and actions to manage such risks were laid out, implemented and reviewed. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 11 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): 17 Millstream View continues to provide its service users with a good catering service. EVIDENCE: Service users continue to take their lunches at the day centre that they attend. The Home provides them with breakfast, dinner and supper. Menus were discussed with service users. The Home continues to provide a good and varied choice of wholesome food to service users. The cook explained that the new trolley service for cooked food to the ‘flats’ was working well. The temperature of the food served from the trolley is not affected and the food is served at the required temperature. However, staff stated that the hot trolley was difficult to handle and to push along, due to its weight and the need to go through a few fire doors. The risk assessment should be reviewed to address these issues. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 12 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): The key issues were checked at the previous inspection and were fully met. EVIDENCE: Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 13 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): The key standards were checked at the previous inspection. EVIDENCE: Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 14 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 Service users are provided with an adequate standard of accommodation, which could be further improved to ensure a more comfortable environment. EVIDENCE: The inspector, accompanied by a senior member of staff, undertook a tour of the premises. The communal areas were adequately decorated. The lounge in the ‘flats’ has been decorated and the sink, which was located in it, has been removed. However, the floor coverings in various communal areas, which are worn out and appear to be ‘lifting up and loose’, have not been replaced yet. One of the bedrooms (bedroom 2) requires a ‘safety mirror’. Some windows are deteriorating and are not closing properly. Although a programme of window replacement was underway, the affected windows have not been repaired or replaced. The storage facility for service users, remain inadequate. The service must improve on the furniture that it provides to its service users, so that they can keep their belongings appropriately and safely. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 15 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): 32 and 34. There is a committed and skilled staff team at Millstream View, in order to ensure that the needs of service users are appropriately met. EVIDENCE: From conversations with a few service users and from observation, it was noted that there were good interactions between them. Service users stated that staff were kind, caring and very helpful’. At the time of this inspection, the registered manager was on leave and a senior care officer was deputising for her. All the other members of staff were satisfied with the way the Home was being managed in her absence. Staff spoken to, confirmed that training has been provided in a few areas. Six care workers had completed their induction in ‘Learning disability award Framework’. Three care workers had completed their NVQ level 2 in Direct Care. Three others have enrolled on NVQ courses. Most care staff have undertaken refresher courses in ‘Moving and Handling’ and ‘Health and safety’. Staff stated they have identified a need for training on ‘control and restraint’ procedures, given the nature of some clients’ behaviours. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 16 The training needs of care staff must be appropriately identified and addressed. A programme for such training must be put in place and implemented. Recruitment and selection of staff continues to be based on the corporate policies and procedures of the Doncaster Local authority. One new member of staff has joined Millstream View, through a transfer from another residential care service of the same Authority. Staff stated that the pre-employment checks had been carried out. Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 17 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): 39 Little progress is being made to ensure that the views of service users and their representatives are appropriately sought and obtained, to help in the review of the service. EVIDENCE: In discussion, staff explained that they felt that consultation with service users was limited because of the latter’s communication difficulties. They also felt that service users’ meetings were not well used for the same reason. Some members of staff stated that they could benefit from training on communication such as the use of makaton and British sign language. The Home has not yet used user satisfaction questionnaires to get feedback from service users and their representatives. There was no evidence of the involvement of advocacy service for the benefit of service users. However, staff were clear that by using centred planning, they were helping service users achieving their goals and aspirations.
Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 18 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 1 3 X 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X 1 X X X X Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 19 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, 5 Requirement The statement of purpose and service user guide must be improved so that they fully comply with the regulations. (Previous timescale of 27/01/06 not fully met). Assessment of care needs for service users must be undertaken on their admission to the Home. The registered manager must confirm that the Home is able to meet the assessed needs of the service users, on their admission. The floor coverings as identified must be repaired or replaced. (Previous timescale of 24/02/06 not met). A ‘safety mirror’ must be provided in the bedroom identified. (Previous timescale of 24/02/06 not met) The windows in the service users’ bedrooms as identified, must be repaired or replaced. (Previous timescale of 24/02/06) Appropriate storage facility must
DS0000032073.V284990.R01.S.doc Timescale for action 15/06/06 2. YA2 12, 14 15/06/06 3. YA24 12, 23 15/06/06 4. YA24 12, 23 15/06/06 5. YA24 12, 23 30/06/06 6. YA24 12, 23 15/06/06
Page 20 Millstream View Version 5.1 7. YA32 12, 18 be provided to service users, by the Home. (Previous timescale of 24/02/06 not met) A staff training and development programme must be developed in conjunction with staff, and implemented. An effective quality assurance and monitoring tool must be developed and must take into account the views of service users and their representatives, including advocates as appropriate. 15/06/06 8. YA39 12, 24 30/06/06 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 YA4 Good Practice Recommendations Prospective service users should be given appropriate opportunities to ‘ test drive’ the home before their admission. The risk assessment regarding working practices should be reviewed to address the handling and moving of the hot food trolley. 2. YA17 Millstream View DS0000032073.V284990.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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