Inspection on 14/08/08 for Millwater

This inspection was carried out on 14th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Millwater 03/03/10

Millwater 03/02/10

Millwater 01/12/09

Millwater 23/08/07

Millwater 07/03/07

Millwater 25/01/06

Millwater 08/07/05

Millwater 05/01/05

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD Lead Inspector Sarah Bennett Unannounced Inspection 14th August 2008 09:25 Millwater DS0000063161.V370303.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 Millwater DS0000063161.V370303.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. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millwater Address 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD 0121 706 3707 0121 765 5536 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) www.schealthcare.co.uk West Regent Ltd Amanda Jones (not yet registered) Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, of the following age range 18 and 65 years (maximum number of places 18). The maximum number of service users who can be accommodated is 18. 23rd August 2007 2. Date of last inspection Brief Description of the Service: Millwater Care Home has been registered to provide a learning disability service for up to 18 younger adults. The home is separated into three units: Swan, Dove and Wren. Each unit has their own kitchen and cooks their own meals. Generally people spend their time in the unit in which they live but do from time to time visit people living in other units. Accommodation is in single rooms with en-suite facilities. There is a communal lounge and dining area in each unit and also a small lounge/ quiet area/ activity room. In Swan unit there is a commercial kitchen and the people living there need support from staff to use this and in Dove and Wren units there are small domestic type kitchens. There is a separate laundry in Swan unit. Facilities for laundry are available in the kitchens in Dove and Wren units The grounds are fully enclosed with access from inside the building only. There is a small area outside the main entrance for off road parking. The home is situated close to major bus routes in and out of Birmingham City Centre, local shops and amenities are within walking distance and the Swan Shopping Centre is approximately one mile away. The service users guide stated that the last inspection report is available on request from the Manager or in the home’s reception area. The service users guide stated that the fees charged are from £850 per week depending on individual assessment. This includes accommodation, 24 hour staffing, all meals and beverages, laundry (except dry cleaning) and in – house activities. This information was current at the time of the inspection and the reader may wish to contact the care service for updated information. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. Four of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. A partial tour of the premises took place. A sample of care, staff and health and safety records were looked at. Due to the needs of several of the people living there it was not possible to ask for their views on the home so time was spent observing practices and interaction from staff. Where people were able to comment on the care they receive their views have been included in this report. The manager and staff on duty at the time were spoken with. What the service does well: The people that live at the home are supported to make choices about what they do with their day, what they wear and what they eat and drink. The people living there often go out and do the things they enjoy doing. People living at the home said they could keep in touch with their family and friends. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 6 The home was well decorated and furnished and the people who live there said that they had chosen how their bedrooms were decorated. The staff are only recruited following checks on their experience, character and backgrounds to make sure they are suitable to work with the people living there. The home asks the people who live there and their family and friends who visit what they think of the home, what they do well and what they do not do well. People who come to live there have a full needs assessment before they move in so they know their needs can be met there. The people living there have written individual care plans and risk assessments that are detailed. They tell the care staff how to meet each person’s needs and help them achieve their goals. Staff spend time sitting with the people who live in the home and talking to them about their day, what they like doing or did not like and what they want. Records are kept that show that staff are checking on how people are and if their health needs are being met to ensure they are well. If people are unwell staff make sure that they get to see a health professional who will give advice so they can be well. The medicine that the people living there have is well managed to make sure they have it as the doctor has prescribed it. What has improved since the last inspection? Staff had worked on care plans and risk assessments so it is clear to staff what the current needs and risks of individuals are. Staff had written down when people had refused to be weighed to show they are monitoring individual’s weight to ensure they are well. Staff had sorted and filed people’s receipts for money they had spent so they can be audited and it is clear their money is spent appropriately. The home did not smell bad so that it is comfortable for all the people living there. There have been more staff meetings and staff have been supported more so they know how to meet people’s needs. Staff have had more training to give them the skills to meet the needs of the people living there. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 7 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. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 8 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 Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 9 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, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make a choice as to whether or not they want to live there. Individual’s needs are assessed before they move in to ensure they can be met there. EVIDENCE: The service users guide and statement of purpose included all the relevant and required information so that people would have the information they need about the home to so they can make a choice as to whether or not they want to live there. There is also a brochure about the home. All of these included pictures and photographs so making them easier to understand. The service has developed to include a further two units since the last inspection. Seven people have been admitted in the last 12 months. Records sampled showed and the AQAA stated that senior staff complete a full assessment of the person’s needs to ensure the home is an appropriate placement. The assessment process uses the organisations assessment procedure and they have also developed their own which is more relevant to the needs of people who have a learning disability. The AQAA also stated, “Where possible, advocacy services are involved to assist the person in making Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 10 an informed choice about the service.” Staff spoken to and records sampled showed that the needs of the other people living there are considered when a person is going to be admitted. Consideration is given as to whether or not they would be compatible so that the home can meet the needs of all the people living there. The AQAA stated that prior to admission a full information pack is sent out to all enquiries and each potential person to be admitted is given the opportunity to attend Millwater for lunch, overnight stays and trial periods to ensure they are fully aware of what is on offer before the decision is made to move in. Records sampled showed that people visited before they moved in. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need so they can support the people living there to meet their needs and achieve their goals. The people living there are asked what they think about the home and are supported to make decisions about their lives so they can do the things that they enjoy. EVIDENCE: The records of four of the people living there were looked at. These included an individual care plan that detailed how staff are to support the individual to meet their needs and achieve their goals. The person, their relatives and advocate where appropriate are involved in their care plan. Where people are able to they had signed their care plan to show they agreed with it. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 12 Care plans had been regularly reviewed and this had involved the person. Generally, care plans had been updated as individual’s needs had changed however, one persons care plan relating to their hair care did not state how the person’s hair was to be cared for at that time. This had changed recently but their care plan had not been updated so that staff may not know how to support the person. Their hair did not look tidy and would benefit from proper care to raise their self-esteem and well being. Their plan stated that they need assistance to choose the right products for their skin. It did not state what these were which may impact on staff’s ability to care for the person’s skin appropriately. From care plans a person centred plan (PCP) is also developed for each person. This is a personal plan about what the person wants and needs. These included pictures making them easier to understand. One person had been admitted a few days before. Some of their PCP had been completed from the information obtained in the pre-admission assessment. This was already being added to as staff got to know the person and their likes and dislikes. The AQAA stated, “Targets and goals are set by the person with the support of staff towards achieving independent living skills.” Care plans sampled showed that people are encouraged to develop the skills they have and to learn new skills to be as independent as possible in their daily lives. Each person is asked for their views on the home in a questionnaire that includes pictures making it easier to understand. Records sampled showed that people who had lived at the home for longer than a few months had completed these and stated that they were happy living there and with the support they received from staff. One person said that they were unhappy with the decoration of their bedroom. Since then all bedrooms are being decorated to individual tastes. One person said that they had been involved in writing and changing their care plan. One person said that they wanted their room painted purple. When looking at their bedroom the manager said it is planned to paint this room purple, as that is what the person had requested. The manager had completed an action plan after questionnaires had been completed that stated how they planned to address the issues raised. This is good and shows that people’s views are listened to and action taken to ensure the home is run in they way the people living there choose. The AQAA stated, “We involve the people living at the home and their relatives in all decision-making within the service.” Meetings had been held with the people living there and their relatives where this is appropriate. Minutes of these meetings showed that they talked about how they wanted their bedrooms decorated, holidays, what food they wanted to eat and the activities they wanted to do. Senior staff had completed an action plan following the meetings to address the issues raised. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 13 Records sampled included individual risk assessments. These detailed how staff are to support individuals to do things and be as independent as possible whilst minimising the risks to their health and safety. They had been regularly reviewed and updated as people’s needs had changed and staff had got to know people better. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living there experience a meaningful lifestyle and do the things they want to do. People are offered a healthy diet so ensuring their well being. EVIDENCE: Some people attend college courses during term time. Some people attend day centres during the week. One person said they would soon have two weeks holiday from the day centre and were looking forward to going out with staff during this time. During the day staff were observed to support people in activities that were relevant to their interests inside and outside the home. At the last inspection two of the people living there spent a lot if not all of their time in their bedroom, which could be very isolating and difficult for staff to involve the person in meaningful activities. They were observed spending time in the Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 15 lounge and enjoying the interaction of others. They also now go outside of the home for short periods and this is increased gradually to help build their confidence. Staff are to be commended for the work they have done with these individual’s to improve their quality of life. Since the last inspection a minibus had been provided so that it is easier for people to access activities in the community. The AQAA stated, “In the last 12 months there has been an increase in community involvement and use of local amenities.” Daily records sampled showed that people often went out of the home to do activities that they liked. They went bowling, to the park, to church, the cinema, for walks, to pubs, restaurants and shopping. Inside the home people listened to music, watched TV and DVD’s and play games. Staff said that some people go to a disco every Monday at a local pub and that some people went with staff to the Spice Girls concert in Manchester. Records showed that every fortnight there is a music and movement session in the home that people could take part in if they want to. One person said, “ I had a big party here for my birthday.” People said and photographs seen showed that people were able to celebrate their birthdays in the way they wanted. The manager said that holidays had been arranged for most people in September and October this year. Small groups of people are going to Blackpool, Skegness or Cornwall depending on where they chose to go and who with. One person is going on their own with two staff as is appropriate to their needs. This is not yet booked but is being planned. One person’s relatives visited during the day and had lunch with them. They said that they were made to feel welcome and could visit when they wanted to. One person living there said, “Sometimes my family ring me or I ring them and I can use the phone when I want”. Daily records sampled showed that people were encouraged to be as independent as possible. Some people had made their own breakfast and drinks, helped to cook tea, laid the table, do their laundry and been shopping with staff for food and personal items. People were observed helping staff to clean their home and prepare their meals. People said that they sometimes help to make meals and they go shopping with staff for food. One person said, “In the evenings I help with cooking and the washing up and watch TV.” Each unit does their own food shopping and cooks their own meals. At lunchtime the people that were at home had a takeaway from the local chip shop. One person said that they do have takeaways sometimes but not all the time as food is cooked in the home so takeaways are a treat. Staff asked individuals what they wanted from the chip shop for their lunch. People were observed helping to lay the table and prepare their evening meal. For some Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 16 people this was a snack as they had a bigger meal at lunchtime either when they were out or from the chip shop. Menus sampled showed that a variety of food was offered that included fresh fruit and vegetables for a healthy diet. Fresh fruit and vegetables were available. People were encouraged to have fruit as a snack. The menu did not include a choice but staff and people living there said that if a person does not like what is on the menu they are offered an alternative. One person said that they would like to have more Caribbean food. Menus showed that Caribbean dishes are offered occasionally. The manager said that this person has a Caribbean meal once a week at the home and also goes to a Caribbean restaurant each week. The manager said that they would ensure that the person had the choice of having Caribbean dishes more often. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living there are supported to meet their personal and healthcare needs so ensuring their well being. EVIDENCE: The people living there were well dressed and this was appropriate to their age, gender, the weather and the activities they were doing. People said that they bought their own clothes with support from staff. People had individual styles of hair and dress. One person had been to the hairdressers the day before with support from staff and had their hair coloured and cut. Several staff commented to the person how nice their hair looked so helping to raise their self-esteem. One person had their nails painted and said that they had gone to a local shop to have them painted and would be going back there the next day to have them repainted. One person said, “ I’m doing alright here, since living here I’m not shy anymore, I have two key workers and they are alright.” Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 18 Staff said in the lounge in front of other people living there that one person had their bowels opened that morning. Although this information may need to be shared amongst staff so that the person is not at risk of being constipated the other people living there do not need to know this personal information. Another member of staff talked about the behaviour of one person while they were out in front of other people living there. Again this information is private and should only be shared amongst staff. This was discussed with the manager who said that they would speak to staff about this to ensure it does not become common practice to share personal information in the company of other people living in the home. Records sampled included an individual health action plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. The plans were produced using pictures making them easier to understand. Records sampled showed that when people were unwell staff ensured that they went to the GP to ensure they got the treatment they needed. Where appropriate people are referred to health professionals. Records sampled showed that advice from these professionals is followed so that people are helped to be well. Records showed that people had regular dental and eye tests so to help them keep well and to ensure that their health was not deteriorating. One person said they get worried about going to the dentist but that staff and their relative supported them with this. Records sampled showed that people are weighed regularly. This helps to ensure that people are well as losing or gaining a significant amount of weight can be an indicator of an underlying health problem. Some people refuse to be weighed and this is now recorded to show that staff are trying to monitor people’s health. Records sampled showed that people who were underweight had gained weight since living at the home. One person who was a bit overweight has lost weight. This indicates that people are being supported to eat a diet that is appropriate for them to be well. Currently all the medication for the people living there is stored in locked cabinets in a room in Swan unit. The manager said that a room is to be used in Dove unit for medication that will store the medication for the people living in Dove and Wren units. In the medication room an air conditioner unit had been fitted. Previously the room was very hot which could have meant that medication was stored at too high a temperature so possibly reducing its effectiveness. The room was very cool at the time of the visit. The medication for the people who live in Swan unit was looked at. Boots supply the medication using the monitored dosage system. The pharmacist pre-packs a months supply of each person’s medication in blister packs for each dosage. This makes it easier for staff to know what medication each Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 19 person has and at what time. The Medication Administration Records (MAR) sampled had been signed appropriately indicating that medication had been given as prescribed. Boots visit the home to audit the medication. Records of these indicated that the systems for managing the medication are in good order. Some medication is stored in bottles and staff had labelled these with the date the bottle had been opened. This helps to audit the medication to ensure it is being given correctly. Some people are prescribed as required (PRN) medication. A protocol was in place for each of the medications prescribed to the person. This stated when, why and how much of the medication should be given to ensure it is not over used, which could reduce its effectiveness or affect the person’s health. Records sampled showed that people’s medication is regularly reviewed to ensure it is effective in meeting the individual’s health needs. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on and they are protected from harm. EVIDENCE: The AQAA stated, “We have a robust and clear complaints procedure in place for those who use our service and for staff. We manage complaints effectively and have clear timescales in which we provide a response.” There has been one complaint in the last 12 months. This was responded to within the stated timescale of 28 days and was not upheld. The complaints procedure is produced using pictures making it easier to understand. This was displayed in the home and was available in individual’s records so that the people living there and their relatives would know how to make a complaint. People spoken to said that they would know who to complain to if they were unhappy. We have not received any complaints about this service in the last 12 months. However, since we visited we received an anonymous complaint about the service from which a safeguarding referral was been made to the Local Authority responsible for placing people at the home. A strategy meeting in line with the Multi-Agency Guidelines on the Protection of Vulnerable Adults was arranged to look at this. The meeting agreed that the allegations were not founded and therefore no further action was taken. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 21 The AQAA stated, “We continue to train our staff at regular intervals on the importance of Safeguarding Vulnerable Adults”. Staff training records confirmed this. Each person had an inventory of belongings so it is clear what belongs to each person and would be easier to track if an item were to go missing. One persons inventory seen indicated that it had not been updated since October this year. The manager said it had been as they had helped the person to clear out her room and dispose of some of their old clothes. Another persons inventory was not dated so it was not clear when they last had the items. Some people living there sometimes display behaviour that can be ‘challenging’, which can affect their well being and that of the other people living there. Behaviour management plans were in place that stated how staff are to support the person when they behave in this way and this was often distracting them to more positive behaviours. Where people sometimes cause harm to the other people living there when displaying this behaviour a detailed risk assessment was in place to ensure that this was minimised as much as possible. The manager said it had been difficult to set up individual bank accounts for people because they are not able to sign or have the mental capacity to agree to this. Bank accounts are being set up and where appropriate the person’s relative or advocate has been involved in this so speaking on their behalf. Some people look after their own personal money. The finance records of two of the people living there were looked at. The records cross - referenced with the amount in the person’s wallet indicating that their money was spent appropriately. Since the last inspection individual receipts had been filed so it was clear to see what they had spent their money on. People had spent their money on personal items and not on things that should be provided as part of the fees they pay. The manager said that all finance information is now linked to the organisations Head Office on the computer and is regularly audited. This gives an extra safeguard to ensure people’s money is spent appropriately. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, clean and safe environment that meets their individual needs. EVIDENCE: Since the last inspection all three units of the home have been registered and there are people living in all the units. In each unit there is a communal lounge and in some units this is an open plan lounge/dining room. In Dove and Wren units there are small domestic type kitchens. In Swan unit there is a commercial kitchen. The home is well decorated and furnished throughout making it homely and comfortable to live in. Each person has their own bedroom and en suite toilet and shower. Communal bathrooms are provided so that people can have a choice of having a bath or Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 23 shower. Bedrooms seen were personalised according to individual tastes and interests. They were well decorated and furnished in colours that people had chosen. Others were soon to be redecorated so that the person who had moved in now had their bedroom in the way they wanted. All the people living there have a key to their bedroom so they can lock it if they want to. The AQAA stated that adaptations had been made to bedrooms and bathrooms to meet individual’s needs. The banister on the stairs on the landing between Dove and Wren units was lower than waist height, which could put people at risk of falling over it. The manager said that they would contact the maintenance team to make it higher and so reduce the risk. The lounge and dining room of Swan unit is carpeted. The manager said this is to be replaced with flooring when funding is available to reduce unpleasant odours due to some people living there being incontinent of urine. This was not a strong odour at the visit but should be replaced soon as over time this could become worse making it an unpleasant room for people to relax and eat their meals in. Odours that were present outside people’s bedrooms at the last inspection had now gone making it more pleasant. The home was clean and the people living there were involved in cleaning it with staff so developing their independence skills. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing ensure that the people living there are supported by a trained and supported staff team that know them well. EVIDENCE: The AQAA stated that 40.7 of staff have National Vocational Qualification (NVQ) level 2 or above in Care and 51.8 are working towards achieving it. The standard is that 50 of staff have achieved this training so staff do not yet have the skills and knowledge they need to meet the needs of the people living there. The manager said that the Team Leaders would have achieved NVQ 3 by October this year and those staff currently doing NVQ 2 will have completed this by December this year. The Deputy Manager is doing NVQ 4. Since the last inspection a part time administrator and senior support workers had been recruited. The manager said that five full – time staff had left in the last 12 months. The manager said that they are recruiting for two part time and one full time support workers and for two full time seniors. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 25 The manager said and rotas showed that during the day there are eight staff on duty and the deputy manager and manager are not included as part of the eight but are extra. At night there is one sleep in staff and three waking night staff. Observations during the day indicated and staff said that these levels are adequate to meet the needs of the people living there. Records of staff meetings showed that the frequency of these had increased since the last inspection and they were now held regularly. This gives staff an opportunity to keep updated with what is happening in the home and organisation and if there are changes to the needs of the people living there. The records of three of the staff who work there were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been obtained to ensure that ‘suitable’ people are employed to work there. Records sampled showed that when staff first started working at the home they completed an induction so they know how to support the people living there to meet their needs and achieve their goals. The AQAA stated, “All staff training is now ongoing and in line with individual supervisions. All new staff receive a full and comprehensive induction.” Training records sampled showed that staff had received the training they need to support the people living there to meet their needs and to be safe. Team leaders and the deputy manager have completed the ‘Train the Trainers’ Award so they can deliver the training to staff. The Team leader said that when she does sleep-ins she has an opportunity to do some training with the night staff so they can keep updated without having to come in to do training when they are not on duty as often happens with night staff. Records showed that further training on infection control, moving and handling, physical intervention and managing behaviour, safeguarding, food hygiene and person centred planning is planned in the next few months. There was a folder of information available for staff to read about specific needs of individuals so that staff know how to support the person. An external training provider delivers specific training on autism so that staff know how to support people living there who have autism. Records sampled showed that staff have regular supervision with their line manager. Records of this showed that they are supported in their role and any training and development needs are identified. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements ensure that the people living there benefit from a well run home and their health, safety and welfare is promoted and protected so ensuring their well being. EVIDENCE: The AQAA stated the manager has completed the Registered Managers Award to ensure they have the skills and knowledge to manage the home. The manager has submitted an application for registration with us and has previously been registered by us in another area. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 27 The manager said and an internal newsletter stated that the organisation has care awards. This year the day care co-ordinator and the manager have been awarded day care co-ordinator and manager of the year. The manager said that the operations manager visits often and is always available for support. Records showed that the operations manager visits regularly as required and each month provides a report of their visit showing that they have completed an audit to ensure the home is being well run. The AQAA stated that they could do better by obtaining the views of external agencies on a regular basis to ensure that we are continually improving with their feedback. The AQAA stated that an electrician had completed the annual test of the portable electrical appliances in July 2008 to ensure that they were safe to use. The AQAA stated and records sampled showed that a Corgi registered engineer had completed the annual test of the gas equipment in June this year and stated that it was safe to use. Records sampled showed that staff complete visual checks of people’s wheelchairs every month to make sure they are safe and any faults are reported. Fire records included a detailed risk assessment for each unit that stated what action was needed to ensure that the risks of there being a fire were minimised as much as possible. The manager said and records showed that they have an evacuation sled so that people who are immobile can be supported to get out of the home safely if there were a fire. Records showed that staff had practised using this so they would know what to do. Regular fire drills had been held so that staff and the people living there would know what to do if there were a fire. As each person living there has different needs and behaviours they have an individual evacuation procedure so that staff know how each person would need to be supported. Staff check the fire alarm every week to make sure it is working. Staff check the water temperatures every week to make sure they are not too hot, which could put people at risk of being scalded. Records showed that the water in one person’s shower room was too hot so a new thermostatic valve that regulates the temperature had been fitted to reduce the risk of them being scalded. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 3 X Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA17 YA18 Good Practice Recommendations All care plans should be regularly updated, as people’s needs change and should detail what staff support each person needs so their needs are met appropriately. People should be offered meals appropriate to their cultural background if that is what they prefer so ensuring that staff respect their cultural needs. Staff should not discuss the needs of people living there in front of other people living there. This shows that people’s privacy is not respected and may affect individual’s self esteem. Individual records of belongings should be dated and updated regularly to ensure that each person knows what belongs to them and if anything goes missing they know when they bought it. The banister on the stairs on the landing between Dove and Wren units should be higher so that people are not at risk of falling over it. The flooring in the lounge/dining room in Swan unit should DS0000063161.V370303.R01.S.doc Version 5.2 Page 30 4. YA23 5. 6. Millwater YA24 YA24 7. YA32 be replaced so it is a pleasant room for people to relax and eat their meals in. Staff should complete their NVQ qualification within the expected timescales to ensure they have the skills and knowledge to meet the needs of the people living there. Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Millwater DS0000063161.V370303.R01.S.doc Version 5.2 Page 32 - 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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