Inspection on 23/08/07 for Millwater

This inspection was carried out on 23rd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 14/08/08

Millwater 07/03/07

Millwater 25/01/06

Millwater 08/07/05

Millwater 05/01/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD Lead Inspector Sarah Bennett Key Unannounced Inspection 23rd August 2007 10:10 Millwater DS0000063161.V343312.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.V343312.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.V343312.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) the.willows@ashbourne.co.uk West Regent Ltd Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 8 people who have a learning disability aged 18 to 65 years of age only. 7th March 2007 Date of last inspection Brief Description of the Service: Millwater Care Home has been registered to provide a learning disability service for up to 8 younger adults. Accommodation is in single rooms with en-suite facilities. There is a large communal lounge and dining area and a small lounge/ quiet area/ activity room. There is a commercial kitchen and the people living there need support from staff to use this. There is a separate laundry. 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 activities. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) 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 provisions 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 a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Three people who live 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. The people who live at the home were spoken to. Due to their learning disability and communication needs it was not always possible to get their views on the home. An ‘expert by experience’ took part in part of the visit. An ‘expert by experience’ is a person who, because of their shared experience of using services and / or ways of communicating, visits a service with an inspector to help them get a picture of what is like to live there. Where they are quoted directly in this report they are referred to as the ‘ex by ex’. Following the last key inspection the Commission had concerns about this home and the safety of the people living there. However, this key inspection has found that several improvements had been made improving the lives of the people who live there. 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. The ex by ex said, “On arrival today lots of people were out, I was pleased with this”. Some people had been out for lunch, one person said, “It was wonderful, I had chicken, which I really like.” Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 6 People living at the home said they could keep in touch with their family and friends. The home was well decorated and furnished and the people who live there said that they like it. 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. The ex by ex said, “The people I spoke to both said they wouldn’t change anything and they are really happy, this was great to hear”. What has improved since the last inspection? What they could do better: Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 7 Care plans and risk assessments should be sorted out so that it is clear to staff what the current needs and risks of individuals are. When people refuse to be weighed this should be written down to make sure that staff are monitoring individual’s weight to ensure their health needs are met. Individual’s receipts should be sorted and filed so it is clear to audit they are for the items listed on their record and their money is spent appropriately. Their records of belongings should be dated and updated regularly to make sure that each person knows what belongs to them and if anything goes missing they know when they bought it. Staff need to look at ways of how they can stop parts of the home from smelling bad so that it is comfortable for all the people living there. There should be more staff meetings, training and staff should have more supervision sessions so they know how to meet people’s needs. 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.V343312.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.V343312.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, 5 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 so they can make a choice as to whether or not they want to live there. Individual’s needs are assessed before they move in and they can visit so they know whether their needs can be met there. Each person has a contract so they know the terms and conditions of their stay. EVIDENCE: The statement of purpose of the home had been updated recently. It included all the relevant and required information so that prospective service users would know what the home provided and could make a decision as to whether or not they would want to live there. The service users guide had been updated recently and was produced using some pictures making it easier to understand. It stated that other formats are available on request so that is accessible to the people living there. The admission policy stated that a pre-admission assessment would be carried out before a person was admitted to the home. At the last inspection a full assessment had not been completed before a person moved into the home. However, records sampled at this visit included a pre-admission assessment that was completed before the person moved in. There would also be Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 10 preparation before the person moved in which would include visits to the home. The admission criteria included that it was important that the person was compatible to live with the other people living there. It stated that each person who moved into the home would have a three - month trial period in which it would be decided if their needs could be met there. The terms and conditions of people’s stay at the home were outlined in the service users guide. Records sampled included a copy of this that had been signed by the person living there and the Deputy Manager. Millwater DS0000063161.V343312.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 in care plans and risk assessments so they know how to support people safely to meet their needs and achieve their goals. The people living there are supported to make choices about their dayto-day lives. EVIDENCE: At the last inspection care plans lacked detail so it was not clear for staff how to meet the needs of individuals. Records sampled at this visit included an individual care plan. These stated how staff are to support the individual with their personal care included promoting their independence, communication, behaviour, day activities, leisure and social needs, sexuality, independence, sleep, eating and drinking, their health needs and their mobility. Care plans were person centred and written from the individual’s point of view about themselves, their needs and the goals they want to achieve. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 12 Some people’s ability to make choices is limited due to their learning disability. Staff were observed empowering people as much as possible to make choices about what they wanted to eat, drink or where they wanted to spend their time. Minutes of a meeting of the people who live there showed that they talked about holidays, activities, days out and their bedrooms. Staff had responded to each of the points raised and written down how they were going to ensure that individual’s choices would be followed and people would get to do the things they wanted to do. Records sampled said that people are looking at colour charts to choose how they want their bedroom decorated. The ex by ex said, “ People said they are happy with the food. One person had just been out for lunch and chosen to have chicken as this was her favourite meal and staff were aware of this.” “ One person said she was really happy in her home and chose what clothes she wears and what time she goes to bed. This lady has recently chosen a chair for herself and is getting it in one of her favourite colours, green. Both people we spoke to seemed happy they have a choice and staff around sounded like they were promoting this”. Staff have made an effort to get the relatives and friends of the people living there involved in their care and helping them to make choices and decisions. Recently they held a cheese and wine evening for relatives. Photographs of this showed and staff said that several relatives attended and during the evening the Manager outlined the future plans and goals for the home. A newsletter was sent to relatives and friends in July that introduced the new manager and Team Leader, talked about activities that people have done, plans for holidays and asked for comments and suggestions as to how the home could be better. Records sampled included individual risk assessments. These had improved since the last inspection and stated how staff are to support the person to minimise the risks involved in using toiletries and hazardous substances, taking their medication, using the shower or bath, falling out of bed, tripping, spending time in their bedroom, moving around, eating and drinking, the person’s behaviour. All care plans and risk assessments had been reviewed monthly and updated where there had been changes to the person’s needs or goals. The Manager said they are changing the format of how care plans and risk assessments are evaluated so they are more detailed and state what is working and what is not working. Some care plans and risk assessments tended to be repetitive. They should be sorted out and consolidated to make it easier for staff to follow what each person’s needs and risks are. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 13 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. Arrangements ensure that people living in the home experience a meaningful lifestyle. People are offered a healthy diet and are encouraged to choose what they want to eat and drink. EVIDENCE: Some people go to day centres during the week where they said they meet their friends and attend college courses. Staff said that two people are going to start college in September. The home has a vehicle that is provided from the home’s budget for staff to drive to enable people to access the community. The Manager said that they have also requested a car so it will be easier for some of the older people who are less mobile to get in and out of it. During the day staff supported people to do different activities: Some people went out for lunch to a restaurant in Shirley, some people went into Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 14 Birmingham to the Think Tank museum and one person went on the bus to the local supermarket to do some shopping. Staff said and records showed that recently people had been on day trips to Safari park, Twycross Zoo, Tamworth Castle, the Maize Maze and Cadbury World. Daily records sampled showed that people do activities that they enjoy including watching films, playing dominoes, doing arts and crafts, watching TV, going out for meals, going to church, shopping, to the cinema, parks, playing swing ball, walks by the canal and the pub. Two people like to spend most of their time in their bedrooms. One person said that they like to clean their bedroom and do writing and some baking there. Staff said they are encouraging both people to try new activities and to spend some time out of their bedrooms. Records showed that the activities on offer to all the people living there had improved since the last inspection. It was one person’s birthday at the weekend. They were talking to staff about going shopping on Saturday as they wanted to buy some clothes and were looking at a catalogue to choose what else they wanted for their birthday. They were having a party the next evening and were looking forward to singing on the karaoke machine. One person will only go out of the home with their family. Staff are working on a plan to help overcome this and become part of the community. At the moment they are trying to encourage them to get into the vehicle as they will get into their relatives car. The ex by ex said, “ Its great the staff are encouraging this”. Staff said that two people are going to a caravan for a week in Skegness in September. They are also planning holidays for other people to Cornwall and to Sherwood Forest. Staff said and records showed that where appropriate people are supported to have regular contact with their family and friends through visits and telephone calls. People said, records showed and people were observed being supported to make their own meals, help with cooking the main meal, clean their bedrooms and make their own drinks. The ex by ex said, “ One person said they were happy for the staff to make their meals, but I was pleased to hear the staff do encourage them to cook meals with support. Its important people are supported to be independent as possible”. The ex by ex thought the menu did not seem very easy to read. Staff said that they have recently bought ‘Widgit’ (a computer software program that uses symbols) and the menus are to be produced using these. People said that they could choose what they eat and drink. Records of food provided sampled showed that people have a varied diet that includes fruit and vegetables. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 15 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. Arrangements ensure that the personal care and health needs of the people living there are met. A lot of improvement has been made to the medicine management systems to ensure that people get the medication they are prescribed to ensure their health needs are met. EVIDENCE: The people living there were dressed appropriately to their age, gender and the activities that they were doing. Some of the women had their nails painted and they said that staff do them for them. There did not appear to be much interaction with one person during the day apart from staff asking them if they wanted a drink or something to eat. Staff said that due to this person’s autism they will initiate contact and if staff make contact with them too often this upsets them. Staff said the person would respond to certain staff more than others. Records showed that plans are in place that included staff encouraging the person to take part in activities and Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 16 to interact with staff and the other people living there. Some staff have received training in autism and other staff are booked to attend this training. Staff were observed interacting with people throughout the day positively and in a way that respected the individual’s needs. Staff praised people when they behaved positively and diverted their attention to other things when their behaviour was negative placing themselves or others at risk of harm. Since the last inspection Health Action Plans had been developed for each person. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. Staff said that for one person meeting with a member of staff in the morning and again in the afternoon and talking for ten minutes has improved their well being and this had improved their behaviour. Staff were observed recognising when people were unwell and taking action to ensure they saw their GP. Records sampled showed that health professionals are involved in the care of individuals where specialist input is required. Records included the advice given by these professionals and showed that staff had followed these to ensure the well being of the individual. This had improved since the last inspection and since June this year when a Speech and Language Therapist visited one person and found that staff were not following their guidelines which could have put them at risk of choking. Staff said and records showed that guidelines had been followed and adaptations had been made to ensure the person was seated appropriately when eating so reducing the risk of them choking. Records showed that people had regular check ups with the dentist, optician and chiropodist where appropriate. Records showed that generally people were weighed regularly to ensure they were not losing or gaining a lot of weight, which could be an indicator of ill health. There is a weighing chair at the home. The Dietician recommended in May this year that one person be weighed weekly. Their records showed that they had not been weighed every week. Staff said that the person often refuses to be weighed and they try to encourage them but they will not always sit on the weighing chair. When people refuse this should be recorded to show that staff are ensuring that individual’s health needs are being met. The Pharmacy Inspector visited in June 2007 and found that the medicine management in the home was poor. Since then staff have worked hard to improve this. Boots supply the medication using the monitored dosage system in blister packs, which makes it easier for staff to give the right medication to each person at the right time. Medication was stored in a locked cabinet that was organised and the medication that could not be stored in blister packs was stored in individual labelled boxes so that staff do not get confused as to which medication belongs to which person. Only the senior staff give medication at present and the Deputy Manager said that Boots are planning to train all the Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 17 staff. A Team Leader is also doing in-house training and will assess each member of staff’s competency before they can give. Where people are prescribed PRN (as required) medication written protocols are in place that state when, why and how much of the medication should be given to the individual. When PRN medication had been used a record was made on the back of the Medication Administration Record (MARS) as to why it was given to ensure that staff are following the protocol. MARS had been signed appropriately and these cross-referenced with the blister packs indicating that medication had been given as prescribed. An air conditioning unit had been provided in the medication room to keep it cool so that the medication is stored at the right temperature. The extractor funnel from this was hanging out of the window leading into the lounge. Staff said this is being fitted to the air duct in the medication room. Staff test the temperature of the medication room daily to ensure it is kept cool enough. Some medication needs to be stored in a fridge. A separate medication fridge is provided for this so that it is not stored with food items that could become contaminated. Staff test the medication fridge temperatures daily to ensure that the medication is stored appropriately. Records showed that the temperatures were within the correct limits. There were guidelines for staff on what to do if the temperature is exceeded. Separate storage is provided as required to store Controlled Drugs (CD’s) that are prescribed to individual’s cabinet. There were no CD’s prescribed at the time of the visit. At each handover of shifts the contents of the medication cabinet are checked to ensure that medication is being given to individuals as prescribed and that no medication is missing or being misused. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 18 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 are in place to ensure that the views of the people living there are listened to and acted on. Arrangements generally ensure that the people living there are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure was produced using pictures and a few words making it easier to understand. It included all the relevant and required information so that people know how to complain if they were unhappy about anything at the home. People who live in the home said they would know who to speak to if they were unhappy about anything and their concerns would be listened to. The complaints policy for staff included guidance on what to do if a complaint is made to ensure that complaints are handled appropriately. An anonymous complaint about the service provided to some of the people living there and staffing levels was made to the Commission in July this year. The Commission asked the Operations Director to investigate this. They ensured that urgent concerns raised were investigated immediately and other concerns were fully investigated and informed the inspector of their findings. Findings showed that the complaint was not upheld and where any action was necessary this was taken to ensure the safety of the people living there. In one person’s records sampled there were details of concerns raised by their relative in April this year that they were being ‘drugged’ and were too drowsy. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 19 A Team Leader investigated this in line with the complaints policy and found that the person’s medication was being given as prescribed. However, they also found that the person had been out a lot that week and may have been tired from the activities. This was fed back to the relative who raised the concern and no further concerns were raised. Following the last inspection there was an Adult Protection meeting concerning one person who lived there. A representative from the home failed to attend this meeting. However, since then there have been changes to the management of the home and the Adult Protection Team no longer have concerns about the care of the person as they believe all risks have been reduced. The prevention of abuse policy included contacting the Commission and social services if there were an allegation made or abuse was suspected. This is in line with the local multi-agency policy on protecting vulnerable people from abuse. It also detailed the ways in which abuse can be prevented e.g. robust recruitment practices, staff training and support, effective communication, complaints and whistle blowing procedures, adequate staffing and stable staff team with a valuing and strong leadership. The findings of this inspection show improvement in these areas so reducing the risk of abuse happening in the home. Staff have received training in the prevention of abuse. Some people living there behave in a way that ‘challenges’ the service. Records sampled included individual detailed behaviour management plans. These stated the techniques for staff to use with the individual to reduce the behaviours and that physical intervention and PRN medication was only to be used as a last resort. Staff have received training in challenging behaviour. Individual finance records were looked at. The records cross-referenced with the money in each person’s purse or wallet indicating that their money had been spent and secured appropriately. Receipts were kept of all expenditure. For one person there were many receipts and it was difficult to audit these to ensure they were for the items listed on their record. These should be sorted and filed appropriately. Individual records of belongings are kept to ensure that each person knows what belongs to them and if anything goes missing they know when they bought it. For one person this was not dated. These should be dated and updated regularly when people buy new things. . Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 20 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, 27, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally in place to ensure the home is homely, comfortable, safe and clean for the people living there. EVIDENCE: The home was well decorated and furnished throughout. The lounge and dining room was homely and comfortable for people to spend time relaxing in. New flooring had been provided in the medical room. There are bedrooms on the ground and first floor. A lift is provided between the floors so that people who have difficulty in using the stairs can get to their bedrooms easily. All bedrooms have an en suite and one person on the ground floor has a walk-in shower making it easier for them to get in and out of the shower. Bedrooms were decorated according to individual tastes and interests and included several personal items. Around the bedrooms on the ground floor there was a strong offensive odour. However, staff had tried to minimise this by the flooring being replaced in one of the bedrooms, the windows were open Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 21 and there were fresh flowers. Other ways of minimising this odour need to be explored to ensure that the home is comfortable for all the people living there. The ex by ex said, “I noticed a poster of Thomas the Tank engine and this concerned me that this was age appropriate”. Staff said that one person living there really responds to this and because of their needs may be upset if it was taken down. Staff need to continue to ensure that bedrooms reflect the tastes and interests of the people living there as well as ensure that people are offered opportunities to widen these. The ex by ex also said, “ I was a bit uncomfortable with people having numbers on their bedrooms door, this doesn’t make it very homely.” Staff said that they thought numbers were on doors for fire safety reasons so rooms could be easily identified in case of a fire. This could be explored further with the Fire Officer and if not needed a more personal way of identifying bedrooms could be looked at. Keypads were being fitted to the front doors during the inspection to ensure the safety of the people living there. These were to be linked to the fire alarm so that everyone would be able to get out if needed in an emergency. A separate laundry is provided. Soiled clothing does not need to be carried through areas where food is prepared, cooked or eaten so minimising any risks of cross-infection or contamination. The home was clean and the people living there are involved in cleaning of their bedrooms to promote their independence. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Further improvement is needed to ensure that staff are well trained and supported to do their job so that they can support the people living there to meet their needs and achieve their goals. The recruitment practices protect the people living there. EVIDENCE: The AQAA stated that out of twenty-one staff, eleven have NVQ 2 or above in Care and five are working towards achieving it. This exceeds the standard that at least 50 of staff have achieved this in order to ensure they have the skills and knowledge to meet the needs of the people living there. Rotas showed that there are four to five staff on duty for each shift during the day and three waking night staff each night. One person has 1:1 staffing twenty-four hours a day in order to meet their needs. The AQAA stated that since the last inspection one full -time and one part-time staff had left. The ex by ex said, “The home seemed to have a good atmosphere, the staff all were Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 23 friendly and looked like they got on well with people that live there and have good relationships. Both people we spoke with said they really like the staff.” The minutes of a staff meeting held in July stated that nineteen staff attended. They discussed responsibilities of key workers, medication training, handovers arranging holidays for the people living there and the menus. Staff meetings should be held regularly to ensure that all staff are aware of any organisational changes and changes to the needs of the people living there and how to support them. Three staff records were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been done before the person started working there to ensure they are ‘suitable’ to work with the people living there. Staff records showed that staff completed an induction when they started working at the home to ensure they knew about the home’s procedures and how to support the people living there to meet their needs and achieve their goals. A training needs analysis of the staff team had been completed to identify what training staff had received and what they still needed to do. Staff had received training in medication, moving and handling, food hygiene, first aid, fire safety, care planning, managing challenging behaviour and using physical intervention, infection control, autism, nutrition and abuse. The Manager said that further training had been arranged on challenging behaviour and also hazardous substances (COSHH). Staff have asked for training on bi-polar and on Downs syndrome and the Manager said she would be arranging this. Staff records did not show that staff had regular formal, recorded supervision sessions with their line manager. Staff said they have supervision about every three months. Staff should have at least six supervisions every year to ensure they know how to support the people living there, their performance is monitored and their training needs are identified. Records did show that staff had an annual appraisal where areas of personal development were identified and objectives were set for the forthcoming year. These objectives now need to be monitored through regular supervision. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 24 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. Arrangements have improved to ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin all self-monitoring, review and development by the home. The health, safety and welfare of the people living there is promoted and protected. EVIDENCE: Since the last inspection the Registered Manager has left. An Acting Manager was in post who has now been recruited as the permanent Manager and will be applying to the CSCI to be registered. The findings of this inspection show that the Manager has led the staff team to ensure that the people living there benefit from a well run home. The Manager said she is well supported by her Manager and the organisation. Staff said that the Manager is very positive and supportive. The ex by ex said, “The manager had good values but I was Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 25 disappointed she only said goodbye to the inspector and not me as she was leaving the home.” The Operations Manager visits the home weekly and spent the day there during the inspection completing an audit of the home as required under Regulation 26. Their visits include talking to the people who live there and asking what they think about the home. Questionnaires had been produced using pictures for the people living there to complete and give their views on the home. One person who had completed it said, “ Millwater is really, really nice, I love all the staff, I love my room.” A small group of staff meet every three months to look at health & safety issues within the home. The minutes of the last meeting showed that they discussed fire training and reviewed fire drills, reviewed accidents and incidents, medical device alerts and updated the health and safety notice board. Staff test the fridge and freezer temperatures daily to ensure food is stored safely and reduce the risk of people having food poisoning. A valid certificate of employers liability insurance was displayed. Staff test the water temperatures weekly to make sure they are not too hot or cold. Window restrictors are fitted to the windows to ensure they cannot be opened fully putting people at risk of falling from them. Staff check that these are in good repair monthly and record when they are repaired. Some people use wheelchairs to move around at home or in the community. Staff check these every month to make sure they are in good repair and safe for the person to use. Fire records showed that staff regularly test the fire equipment to make sure it is working. Regular fire drills are held so that staff and the people living there know what to do if there is a fire. A Corgi Registered engineer last completed the annual test of the gas equipment in July 2006 to ensure it is safe to use. The Operations Manager contacted the engineer during the day to arrange for them to do this again. A copy of the gas safety record was forwarded to the Commission following the inspection and stated that the gas equipment was in a satisfactory condition. Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 26 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 3 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 3 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 2 36 2 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 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 27 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 YA19 YA23 Good Practice Recommendations Care plans and risk assessments should be sorted out so that it is clear to staff what the current needs and risks of individuals are. When people refuse to be weighed this should be documented to ensure that staff are monitoring individual’s weight to ensure their health needs are met. Individual’s receipts should be sorted and filed so it is clear to audit they are for the items listed on their record and their money is spent appropriately. Individual records of belongings must 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. Other ways of reducing the offensive odour on the ground floor should be explored to ensure that the home is comfortable for all the people living there. DS0000063161.V343312.R01.S.doc Version 5.2 Page 28 4. YA23 5. YA30 Millwater 6. YA33 There should be at least six staff meetings held each year. This will ensure that all staff are aware of any organisational changes and changes to the needs of the people living there and how to support them. All staff should receive the training they need to meet the specific needs of the people living there. All staff should have at least six formal, recorded supervision sessions each year. This will ensure they know how to support the people living there, their performance is monitored and their training needs are identified. 7. 8. YA35 YA36 Millwater DS0000063161.V343312.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V343312.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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