CARE HOME ADULTS 18-65
Milton House 39 - 41 Spencer Road Bedford Beds MK40 2BE Lead Inspector
Dragan Cvejic Unannounced 14 June 2005 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 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 Stationary 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 House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Milton House Address 39 - 41 Spencer Road Bedford Beds MK40 2BE 01234 216460 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Hurry Bhautoo Ms Mila Bhautoo Care Home 13 (13) (13) Category(ies) of LD - Learning Disability registration, with number LD - Learning Disablilty over 65 of places Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 02/11/04 Brief Description of the Service: Milton house was a residential care home, currently registered to provide support to 13 adults with learning disabilities. All the 13 bedrooms were singles. There were 9 service users residing in the home. The building consisted of two attached houses linked by access doors on both ground and first floors.Community facilities and shops were a short distance from the home, which was also within walking distance of Bedford town centre, and the bus and train stations. The accommodation, which was not suitable for people with physical disabilities because of the narrow hallways and stairs, was organised in three sections. One of the original houses was divided into flats, one on each floor, with three bedrooms each, a kitchen, bathroom and living room. The other had seven bedrooms, distributed between the floors, with the lounge, dining room and kitchen on the ground floor and bathroom on the first. There was also a WC and shower on the ground floor. The office/sleeping in room was on the ground floor as was the laundry (in the part divided into two flats). There was a small enclosed garden and parking for three vehicles at the side of the building, two by the kitchen and one outside the ex-garage. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out in the morning hours and most service users had already gone to day centres. Two remaining service users were spoken to and contributed to the inspection. Both night and day staff were seen during the inspection, as well as the manager who came in on her day off. The inspector used a case tracking methodology, read documents and had a tour around the building. The Inspector spoke to 2 service users, 3 staff and the manager. What the service does well:
A service user just had a cup of tea in the lounge and the staff member was hoovering the lounge and finishing cleaning the kitchen. A service user asked politely: “Do I need to go to my bedroom?” After staying in the lounge, She continued: “ I want to stay here until 65.” She stated that she wanted to come here and she chose the home. The inspector was present at the handover and concluded that staff knew service users very well, their preferences, likes and dislikes. They were aware of and commented on emotional needs as well as on daily routine activities. The manager described the good points of the home: “We give them good care. We assess their needs and give them a choice”. This choice was evident through different documents that the home kept on service users. Many forms, instructions and information was provided in graphic format, in pictures, so that service users were clear, were able to understand and to follow the suggested instructions. Care plans had a shortened, graphic version and were made available to service users. Written care plans were dated and signed by service users. They were comprehensive, well written and contained risk assessments. A skilled and committed staff team worked well. The staff member confirmed: “We work as a team and communication is very good.” This fact was confirmed when the staff team discussed the broken glasses of one of the service users. One service user was on holiday and two more were getting ready to go in July. Service users were involved in daily life at home. They had a flexible cooking rota, by which each of them cooked a meal for everyone. Unless there was something preventing them doing so, in which case the staff stepped in did their chores. One service user commented to the staff that he was not happy
Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 6 at the day centre and staff gave him advice in dealing with this issue and offered further support if needed. The staff encouraged service users to make their own decisions, to take risks, to decide on what they want and supported them when the help was needed. What has improved since the last inspection? What they could do better:
There were some aspects where the home did not meet the standards, for example the wishes in cases of death were not recorded for all service users, but the staff explained that the subject of death was something that would upset some service users and, quite rightly, a discussion about that was avoided. The repair work in the kitchen needed to be done on a drawer that did not have a front panel. Not all radiators were guarded, but this was addressed in a risk assessment. Service users were encouraged to choose, cook and prepare their own meals, but when a particular individual had something that was not on a menu, this was not recorded. Service users that smoke needed to go out to smoke to keep the dining room smoke free.
Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 7 Staff files were not kept on the premises, but in the owner’s home, due to the lack of space. However, this arrangement offered better confidentiality and safety for these documents and the manager stated that the files could be made available on request in 10 minutes. 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 House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,45 The home provided sufficient and appropriate information about the home and offered an opportunity to service users to make an informed choice regarding admission to the home. EVIDENCE: The last admission demonstrated that service users were given sufficient information about the home that helped them make an informed choice. Many documents, including terms and conditions, were presented in graphic, picture format. Trial visits were offered. Assessments were collected from social workers and the manager assessed potential service users herself. A service user confirmed that she chose the home. Terms and conditions were clear and were presented both in written and simplified graphic format. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 The home provided a very individual approach to service users and highly respected their abilities and wishes and encouraged them to make their own decisions. EVIDENCE: Each service user had a care plan covering most aspects of daily living. These were reviewed in-house on a monthly basis. Basic goals were presented in picture format and made available to service users. Service users spoken to confirmed that they were involved both in care planning and reviewing their goals and objectives. The home engaged appropriately external professionals, such as a CPN, or arranged for service users to attend regularly opticians, dentists and other medical professionals. Service users were also involved in running the house. There was a cooking and washing up rota in graphic format displayed and it dircetly related to the service users’ meeting minutes. The manager explained flexibility regarding house chores, in cases when service users were not well enough to perform their duties and the staff would step in. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 11 The home provided information about independent advocacy and several service users had an advocate. Service users were allowed to take risk. When a service user forgot his bag in a public transport staff supported him to find it. The home’s communication book was kept in the main lounge, but did not contain details of confidential nature. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,14,16,17 The home ensured that service users had a choice to take part in various activities, both inside and outside of the home and encouraged them to express and use their abilities as they chose. EVIDENCE: Only two service users were in the home at time of this inspection, as they attended day centres. Their files demonstrated that they could choose and attend a day centre of their preference. Service users were actively involved in creating a daily routine in the home. There was a rota in picture form displayed on the board in the kitchen. Service users cooked once a week each, they did their own cleaning, they washed up on a rota basis and were making decisions on these issues on their own. Both service users went out during the inspection, when and how they liked. Holiday was the main topic of their conversation, as they were getting ready to go. Another service user was already away on holiday. The menu was created at service users meetings. They chose what they wanted to cook and staff helped with providing the options thus extending the ideas and menus. In cases when service users were not able to contribute to the cooking process, the staff followed users’ choices and prepared the chosen
Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 13 meal themselves. Service users could eat when they wanted, what they wanted and staff’s advice helped them maintain a various, nutritional, healthy diet, within the service users’ wishes and preferences. The home did not record when service users had a meal as an alternative to the menu. The home catered for special dietary needs, including diabetics. Some service users organised and washed their laundry themselves with staff’s supervision. The size of the home contributed to the very homely atmosphere that was present at meal times. A service user commented that staff knew her preferences, likes and dislikes. The staff spoken to quoted the right answer when asked about the service users likes and dislikes. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Knowing the service users well and monitoring their health needs was a characteristic and the objective of the home. Service users were well looked after and medical help was sought for them when there was a need for it. EVIDENCE: Service users’ records demonstrated that they had all their health appointments booked and that they were helped to retain or improve their health. Staff discussed the replacement of glasses during the handover and the file contained information relating to the glasses that needed replacement. The files contained the evidence of the health related appointments for each individual. A service user and her key-worker confirmed involvement of a CPN when more specialist input was needed for the service user’s conditions. Chiropodist, dental and optician’s appointments were recorded. Sampled medication records were checked and were found to be correct. The storage, administration and records of medication were appropriate. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 15 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 standard(s) The home offered good protection to service users. EVIDENCE: A service user was admitted after a higher risk level in her own home, but the home ensured full protection for her and worked co-operatively with the police and probation service. Risk assessments used in the home were working documents and were kept up to date and contained the service user’s signatures. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 16 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 standard(s) The home was suitable for current service users and met their needs regarding the environment. The house itself was just an ordinary house and the service users benefited from the homely and domestic settings, which was not different to the average household. EVIDENCE: The location and layout of the home were suitable for the service users accommodated. There was a choice of four communal living rooms and each service user had a single bedroom. There were four bathing facilities and separate toilets. As well as the main kitchen there were two small cooking facilities. The home was clean and odour free. The tour around the house demonstrated that the entire home was arranged in a domestic style. The main kitchen had a cabinet with no front panel on a drawer. A service user insisted and showed her bedroom to the inspector and the very personalised arrangement demonstrated the users individuality and personal choice. Another service user commented that he was proud of his bedroom and stated that the accommodation suited to his needs. Some service users had their own keys for the main door as well as for their bedrooms.
Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 The home employed a sufficient, skilled and motivated staff team that collectively were able to meet the service users needs. EVIDENCE: The home had a level of staffing that was adequate for the number of service users in residence. The staff were clear of their roles and of service users conditions and needs. The staff were motivated and committed. Training was appropriate, induction was based on LDAF and the mandatory training was up to date, from the statements provided by the manager and staff members spoken to. Staff stated that they were well supported, regularly supervised and that they felt free to contact the manager at any time day or night. The staff files were not kept on premises due to the lack of space, but the manager and the owner reassured the inspector that files could be made available within 10 minutes of the request. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home was well managed, in an inclusive style whereby both service users and staff could have impact on the day to day management. An individual approach and ethos in the home, in particular, ensured protection of service users. Their rights, wishes and preferences were promoted, respected, encouraged and used to empower them to lead as normal as possible life. EVIDENCE: The manager was also one of the owners. She was qualified, she had just completed her RMA training and skilfully ran the home. The ethos of the home was inclusive, creative and enabling. The staff were clear of their roles and expectations and knew the philosophy of the home. Service users enjoyed an open atmosphere where their voice was heard and respected. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 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 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Milton House Score x x x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 3 x I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 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 21 Regulation schedule3 Requirement The registered person must ensure that the boxes regarding the wishes about death of service users in their care plans are filled in and reviewed. Timescale for action 30/12/04 now 30/09/05 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 17 24 Good Practice Recommendations There should be records of an alternative to menu food, cooked and consumed by the service users. The drawers panel in the kitchen should be fixed. Milton House I51 s14937 Milton House v233798 140605 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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