Inspection on 15/11/05 for Milton Heights

This inspection was carried out on 15th November 2005.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton Heights 25/05/06

Milton Heights 12/01/06

Milton Heights 14/03/05

Milton Heights 23/11/04

Milton Heights 28/01/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Milton Heights Milton Abingdon Oxfordshire OX14 4EH Lead Inspector Catherine Kane Unannounced Inspection 15th November 2005 07:50 Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 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 Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 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. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Milton Heights Address Milton Abingdon Oxfordshire OX14 4EH 01235 831686 01235 821956 emma.pithers@nft.org.uk 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) Home Farm Trust Mrs Emma Pithers Care Home 39 Category(ies) of Learning disability (39), Learning disability over registration, with number 65 years of age (39) of places Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of services users accommodated at any one time must not exceed 39. 14th March 2005 Date of last inspection Brief Description of the Service: Milton Heights is one of four registered homes in Oxfordshire run managed by Home Farm Trust (HFT), a national voluntary organisation that provides care services for people with learning disabilities. It is registered to accommodate 39 people. The accommodation is split into a number of self-contained houses and is situated in a rural location within easy reach of Didcot, Abingdon and Oxford. A day centre with a café and shop and large gardens with a greenhouse are included within the Milton Heights site. Here a variety of day activities, learning and work opportunities are provided for the people who live at Milton Heights and for people living in the community. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place during the day of Tuesday 15 November 2005. This was an unannounced inspection therefore managers and staff did expect this visit. Two inspectors and a pharmacist inspector spent over 8 hours in the home. They spent this time meeting and speaking with residents, managers, staff and visitors to the home. One inspector and the pharmacist inspector arrived in the home very early while some residents were having breakfast. The inspectors read a lot of notes and files kept in the home. One inspector went to a meeting and saw how this home works well with other health and social care agencies to try to find the best way to help support a resident who is having a difficult time. Another inspector spoke individually with a number of staff that work in this home. The pharmacist inspector looked in detail at how staff helped residents to look after and take their medication. The inspectors would like to thank each resident who took the time to speak with them and for sharing their experiences. The inspector plans to spend a lot more time with residents at the next inspection. The inspectors would also like to thank the managers and staff for their assistance and visiting health care professionals for their co-operation during the inspection. What the service does well: What has improved since the last inspection? The person centred plans have been introduced. Repairs and redecoration of one house has been completed. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The assessment process used by the home to make sure that Milton Heights is the right place for a new resident before they are offered a place is generally thorough and detailed and includes introduction visits. EVIDENCE: The manager understands how important it is to make sure that Milton Heights is the right place and her staff team have the right skills before offering a new resident a place. During the inspection the inspector spent a few minutes speaking with a young person who has recently moved to Milton Heights. The inspector read the manager’s pre admission assessment and the resident’s person centred plan; this information provides staff with guidance on how to care for this person. The initial referral assessment completed by the resident’s care manager was not seen by the inspector at the time but the manager stated that this had been received. The inspector asked that this document is located and a copy made available for the inspector to see; by the time of writing this report this had not yet been provided. This document could provide detailed background information for the home and should be available for staff to refer to. The inspector is aware of 2 individuals where placements in HFT homes in Oxfordshire have been unsuccessful and questions if the pre admission assessment process could therefore be improved. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans had the essential information staff need to be able to care for residents. The systems for assessing risk were generally good. (See also Standard 20) EVIDENCE: The inspector viewed at random the files for three residents; each had the essential information that staff need to be able to care for people who live in this home. A person centred planning system has been introduced and outcomes of recent reviews that had taken place for some residents including goal setting were seen. Residents are encouraged to be independent where possible and risk assessments seen generally take this into account. Some residents look after their own medication; risk assessments had not been completed in relation to this. (See also Standard 20) Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Staff help residents to get to see their local GP, dentist and other community healthcare services when it is needed. The home was able to provide some extra support to residents when needed. Some practices relating to medication could potentially put residents at risk. EVIDENCE: Information need by staff to be able to provide personal and health care support was included in care plans. During the inspection an inspector saw how the home worked closely with healthcare professionals to provide additional support for a resident who was having a difficult time. The home has also provided a resident with support when admitted to hospital. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 12 The following comments are the observations of the pharmacist inspector: Company policy was available in the central office and local medication procedures were in the offices of separate residences. Written risk assessments for self-administration were not available for those residents who held responsibility for some or all of their medicines. For two residents the medication administration record (MAR) sheet did not indicate self-administration or record the supply of medicines. Staff said that monitoring did take place. Storage for medicines was in locked cupboards. Three out of date medicines were found. The temperature of one room containing lockable medicine cupboards was 27.50C. In another building medicine cupboards were in a laundry area. One bottle of a medicine needing cool storage was in an unlocked domestic refrigerator and another was in a locked cupboard. Key security was discussed and this varied between residences. A carrying box, without a lid, was being used for the administration of morning medicines. Three creams in this box did not have dispensing labels or a resident’s name and two were not on the MAR sheets. Medication receipt, administration and disposal records were sampled. There were concerns that some instructions lacked detail, particularly if only ‘as directed’ was stated. Staff added vitamin preparations, purchased for individuals, to the printed chart supplied by the pharmacy, in order to keep administration records. The home had a list of over the counter homely remedies that may be bought as stock. Administration from stock was recorded in a separate book. Team managers are responsible for ensuring that information on allergies, medical conditions and medication are up to date. Stocks and administration of homely remedies were recorded in a book, for this purpose Labels, on the pharmacy dispensed monitored dose system, include a description of the tablets or capsules. One description was of white tablets but the tablets supplied were purple. A member of staff said that it had been checked with the pharmacist, that the tablets supplied were correct, but this had not been recorded. Lists of staff names with their approved signatures or initials were kept per residence. Medication assessment/training forms were seen, with up to four stages signed and dated by assessors. Dates seen were up to four years ago, for an individual. A form was not available for all staff on the lists of sample signatures. Staff spoken to were unsure what details were being assessed in each stage. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 13 Staff spoken to had not received medication training from an external source, with relevant knowledge of medicines. For an invasive technique, that occasionally needed to be used, staff said that training by had taken place but no records of this training were available. A few patient information leaflets were kept with the medication records, but these information leaflets were not available for most medicines. Staff were unaware that patient information leaflets could be requested, if not supplied by the pharmacy. Other information about medicines was kept but not all had a reference source or a date. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Staff are recruited in a way which protects residents and are generally appropriately trained and supervised. (See also Standard 20). EVIDENCE: The inspector looked at a random sample of 10 staff files. The files contained the relevant information required but the inspector would recommend that the files are audited to ensure that they contain relevant and current documentation. All staff files inspected contained a job description and a copy of the employment contract and terms and conditions. The company advertises in the main medias but many staff hear of vacancies through word of mouth. Evidence was found at the inspection by looking at staff files and in talking to staff that the organisation implements a formal process where applications are sent out, formal interviews set up, references taken up and the appropriate police checks undertaken. All staff C.R.B enhanced disclosures were checked and found to be in order. The organisation can now destroy these. All new C.R.B forms must be kept till the next inspection. Evidence was found that induction, reviews and yearly appraisals are taking place. Staff related to the inspector that they feel supported by the management team and that formal sessions are available to them to have individual supervision on a regular basis. Some staff expressed concern on the turnover of staff and the use of agency staff but agreed that this had improved in recent months. The qualifications and experience of the staff interviewed was found to be satisfactory. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 17 Many staff have undertaken or are undertaking N.V.Q training in care. General training was found to be available to all staff. (See also Standard 20). Managers informed the inspector that they were reviewing future training to ensure that staff with English as a second language are fully included. Staff spoken to, were very positive about the availability of training and felt that were actively encouraged to attend training courses. The company runs a merit award system where staff who exceed the required expectation are financially rewarded. The inspector feels that this initiative be commended. Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 4 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milton Heights Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000013110.V266421.R01.S.doc Version 5.0 Page 20 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. 1 Standard YA2 Regulation 14(1)(b) Requirement The registered person must provide confirmation that the care manager’s assessment document asked for during the inspection is available for inspection. A documented risk assessment must be produced for all residents who choose to selfadminister any of their own medication. All staff who administer medicines must have training from an external source with creditable knowledge of medicines. Timescale for action 15/12/05 2 YA9YA20 13(2) 15/12/05 3 YA20 18(1)(c) (i) 15/02/06 Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 21 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 Refer to Standard YA2 YA20 Good Practice Recommendations The inspector recommends that the pre admission assessment process is improved. It is strongly recommended that storage of medicines be improved so that medicines are securely stored at temperatures recommended by medicine manufacturers, usually room temperature below 25 degrees Centigrade. Storage of medicines in unlocked domestic refrigerators should be risk assessed. Out of date medicines should be identified and disposed of. When medicines are transported around the home it should be done in a secure manner. Care should be taken that medicines can be quickly and securely locked away in the event of an emergency. The supply of medicines for self-administration should be recorded. Following risk assessments appropriate records should be kept of monitoring activities. Staff should not sign for administration if they have not administered a medicine. It is recommended that prescriber’s be asked to include directions of dose and frequency on all prescriptions. It is recommended that care plans contain clear instructions to staff as to the meaning of as required or as needed, following consultation with the prescriber. Records of all medication training and assessment should be accessible and used to plan updates. Training for named care workers, for use of an invasive technique should be fully documented and incorporate an assessment of competence, together with all subsequent reassessments. The inspector strongly recommends that only staff who are authorised to administer medication have access to keys that give access to medication cabinets. The inspector recommends that staff files should be audited leaving the current relevant information on file. 3 YA20 4 YA20 5 YA20 6 7 YA20 YA34 Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton Heights DS0000013110.V266421.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!