Inspection on 20/07/07 for Milton House

This inspection was carried out on 20th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton House 04/07/08

Milton House 23/02/07

Milton House 30/11/05

Milton House 14/06/05

Milton House 02/11/04

Milton House 05/07/04

Milton House 30/05/02

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Milton House 39/41 Spencer Road Bedford Bedfordshire MK40 2BE Lead Inspector Katrina Derbyshire Unannounced Inspection 20th July 2007 11:00 Milton House DS0000014937.V347999.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 Milton House DS0000014937.V347999.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. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address 39/41 Spencer Road Bedford Bedfordshire MK40 2BE 01234 216460 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) premilab@hotmail.co.uk Mr Hurry Bhautoo Mrs Premila Bhautoo Mrs Premila Bhautoo Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (13) of places Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Change to categories - LD (13), and LD (E) (13) No service users under the age of 35 will be admitted. The home is also to be registered to provide care to ONE (1) service user with a mental health disorder (MD) (1). This condition applies only to the service user who has been identified to the National Care Standards Commission. At such time as this identified service user ceases to live at the home, the NCSC must be informed immediately and this condition of Registration will be adjusted to reflect this fact. 23rd February 2007 Date of last inspection Brief Description of the Service: Milton house is a residential care home and provides support to 13 people with learning disabilities. Community facilities and shops are a short distance from the home, which is also within walking distance of Bedford town centre, and the bus and train stations. The building consists of two attached houses linked by access doors on both ground and first floors. The accommodation is 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 house has seven bedrooms, distributed between the floors, with the lounge, dining room and kitchen on the ground floor, and bathroom on the first. There is a WC and shower on the ground floor. The office/sleeping in room and laundry are situated on the ground floor. There is a small enclosed garden and some off road parking. The Deputy manager provided the following information on charges in July 2007. The fees for this home vary from £309.66 per week, to £665.60 per week, depending on the funding source and assessed need of the person. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 20th July 2007. During the inspection several areas of the home were visited and the inspector spent time with some of the people who live at the home in the dining area and their own rooms. The care of three people was examined by looking at their records and interviewing them and staff who look after them, alongside speaking with other people that live at the home. Comment cards were also received from 3 people living at the home that show their views of the service that they receive. Information from the home, through written evidence in the form of a Annual Quality Assurance Assessment has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: People living at this home feel that the staff help then to follow their individual interests. This means for those that like to go into town to have lunch or others who may like to go to the cinema for instance, staff help then by going with them if they need their support. If someone needs to see a Doctor if they feel unwell, staff are very quick to arrange this on their behalf if they need help with this. Staff will also find out if that person needs someone else to go with them, and will also arrange this. This means people living at the home receive prompt treatment and support to access medical treatment. There is also a very relaxed atmosphere in the home; many of the people living at the home spoke of the staff’s friendliness and felt that it was this that made them feel at ease. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 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 House DS0000014937.V347999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The system in place for staff to assess the needs of prospective people is not sufficient to ensure that they would have the information to know if they would be able to meet their needs. EVIDENCE: It was raised at the previous inspection that people living at the home did not have pre admission assessment information within their care records. As many of the people living at the home had lived there for several years, the senior management had undertaken a more recent assessment of needs. The Deputy manager confirmed at the time of this visit that it would be this template that would be used for assessing the needs of people who may move into the home in the future. However the documents seen did not provide sufficient guidance to make clear all of the needs of each person and how they should be supported. One person under the heading of ‘history of behaviour’ had only the entry, ‘aggressive and suffers from depression’, other entries seen were noted to follow this limited information on the assessed needs of the person. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Opportunities for people to make decisions about their lives are satisfactory and make people feel in control of their own lives. EVIDENCE: The care plans examined showed that changes had been made since the previous inspection; however further improvements are still required. In most entries there was insufficient direction to staff, one example was that for one person the plan stated that they ripped their undergarments, but no guidance was in place to staff to explain what they should do if the person did this in the physical and emotional support that should be provided. People spoken to described how they still felt in control of their own lives, they found that the homes staff empowered and supported them in living their lives. One person spoke of the importance of their family to them and the contact Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 10 that they had, the person confirmed that staff encouraged contact and that their family were always welcome in to the home. Feedback also received through returned comment cards to the Commission for Social Care Inspection also indicated that staff enabled people to do the things that they enjoyed. At this visit one person was going into town to look around the shops and go out for lunch, a member of staff was seen to accompany them so as they were not able to go on their own. Risk assessments were in place within the individual care files examined. Risks that had been assessed included dietary needs, moving and handling and risk of leaving the home on the persons own. However the frequency of review on some of these was unclear, as they seemed to be separate to the care plans and a linkage between the two is needed. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at the home have a good level of access to local facilities so benefit from being part of the community and having their social needs met. EVIDENCE: Through speaking with people living at the home and returned comment cards to the Commission for Social Care Inspection, evidence shows that people are satisfied with the provision of meals at the home. Menus examined showed that a choice is available. Toast and cereals are offered at breakfast time, many people are out during the day and either take sandwiches or go to a café for lunch and then there is an evening meal on offer. The stocks of food kept at the home were examined. A good amount of protein, carbohydrates, fruit, dairy and vegetables were seen to be in place. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 12 Within the care records examined, entries were seen within the daily notes to show that people participated in a variety of activities and occupation. People attended varying day care services where they were able to participate in a curriculum of activity and development. Examples of these included cooking, art, music and social development. Staff confirmed that people supported by themselves attended events within the local community. Both staff and people living at the home spoke of going to the local parks, shops, pubs and cinema for example. One person spoken with had a good knowledge of the local area and all facilities available to them, they would read the local paper that advertised local events and opportunities alongside staff updating them. Information provided by the home show that activities provided include, pictures, watching films, shopping and arts and crafts. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 13 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. We have made this judgement using a range of evidence including a visit to this service. The personal support given to people is sufficient so people receive care that respects them as individual people and maintains their dignity. EVIDENCE: Through observations at the time of this visit it was noted that staff approached people living at the home in a sensitive manner when addressing them. People were seen to be supported and encouraged by staff in maintaining their personal hygiene and making themselves refreshments. When a person needed encouragement relating to their clothing, this was done discreetly by the staff member, who offered constant verbal reassurance to the person. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 14 Within the individual care records examined it was noted that there were documents from a variety of medical specialists. These documents showed that people received regular support from Doctors and Nurses. Staff confirmed that they assisted people to attend hospital appointments and the outcome of any medical intervention and subsequent guidance was recorded. Feedback through returned comment cards to the Commission for Social Care Inspection showed that people felt they received the medical that they needed. The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct. The storage of medicines were seen to be in a locked facility. Records were seen to show returns of unused medication. Staff confirmed that they did receive regular updates in the administration of medicines and observations were made of medication and noted to be appropriate and follow safe practice guidelines. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. The complaints policy is clear so people at the home know how to make a complaint and that they will be responded to. EVIDENCE: As reported at the previous inspection, all care files had a copy of the complaints procedure within them. These were presented in picture format to aid in the understanding of the document; in addition all had been signed and dated by the person to show that they had been shown this document. Feedback from speaking to people living at the home and returned comment cards confirmed that people were comfortable in complaining in they wanted to and knew that they had the right to do so. Training records and information supplied by the home showed that all staff had attended training in the safeguarding of adults. The policy of the home in this matter was examined and its content reflected local guidance. In addition a copy of local protocols was seen to be in place, this included the reporting procedure of any alleged abuse. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The standard of décor, furnishings and fittings in this home are now sufficient to provide a homely environment for people to live in. EVIDENCE: Requirements were made at the previous inspection relating to the flooring, cleanliness and guarding of radiators in certain areas of the home, these were noted to have been carried out. Individual rooms seen contained personal effects belonging to the person. These included photographs of the person and their family, televisions, music centres, ornaments and pictures. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 17 Communal areas in the home were noted to contain domestic style furnishings and in the dining area on the ground floor were of an adequate standard. Two of the chairs had torn covers and were stained. The overall cleanliness was noted to be satisfactory. Stocks of cleaning materials were seen to be in place and staff confirmed that there were cleaning schedules in place. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 18 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, 34 & 35 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at the home feel that the staff have the skills to meet their needs. EVIDENCE: At the previous inspection a requirement was made relating to the recruitment of staff. Items were not in place prior to staff commencing employment in the home, these included references and a Criminal Records Bureau check. The specific documents relating to those employees had now been secured by the manager and were seen to be in place. However it was not possible to assess full compliance with this previous requirement as no new staff had been employed at the home, therefore this requirement will remain so that the recruitment practices of the home can be assessed fully. Training records and staff confirmed that alongside statutory training staff had undertaken further training in relation to their roles. The home had been active in commencing staff on a National Vocational Qualification programme and all Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 19 staff had development and appraisal plans in place. Certificates of attendance were maintained for all courses undertaken. Staff spoke of the training available to them. Training undertaken by staff included fire safety training, understanding mental health, and assessment of need and Protection of Vulnerable Adults. Information through discussions with people living at the home indicated that they felt well cared for, that staff treated them well, respected their privacy and that they felt safe at the home. The homes staff team had clearly defined roles and the observations on the day of inspection demonstrated staff were clear in their roles and were able to advise and explain their post and associated responsibilities. Examples were when a person makes a complaint, staff were aware that they would need to seek guidance from senior staff at the home in certain instances, to provide the best outcome for the person. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 20 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. We have made this judgement using a range of evidence including a visit to this service. Health and safety systems are sufficient to provide an environment for people at the home, which reduce the risks associated with this area. EVIDENCE: Both people living at the home and staff spoke of the manager in positive terms. They described her as supportive and felt that she was approachable and competent in her role. However it was not clear at the time of this visit the hours that she worked in the home as she was not part of the staff rota that was viewed. Staff stated that she worked predominantly Monday to Friday, subsequent written confirmation was received by the home to state that her Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 21 details were now entered onto the rota and this made clear the hours that she worked. As reported at the previous inspection, the views of the people living at the home were taken and it was them that were the central focus of the running of the home. Health and safety systems at the home were seen to be carried out in accordance with the guidance within the homes policy. The most recent fire and environmental health inspection reports show that the home had met the standards in these areas. In addition cleaning products were seen to be locked away, risk assessments had been undertaken for areas and activities in the home. Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 22 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 23 YES 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) Requirement Further development must be made to ensure all people have been fully assessed prior to moving into the home, so there is sufficient information to know if the staff at the home have the skills to meet the persons needs. Care plans must have sufficient guidance to staff in how to meet the individual needs of the person to ensure continuity of care. All furnishings must be of a sufficient standard to ensure people have a pleasant environment in which to live. The registered person shall not employ a person to work in the care home until he has obtained, in respect of that person, all the information and documents specified in paragraphs 1 to 7 of schedule 2. Timescale for action 30/09/07 2. YA6 15(2) 30/09/07 3. YA24 13(4)(a)(c) 31/10/07 4. YA34 19(1)(b) 31/03/07 Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 24 An Immediate requirement was issued 26/02/07 (This was a previous requirement not able to be assessed at this inspection as new staff had been employed since that time) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Milton House DS0000014937.V347999.R01.S.doc Version 5.2 Page 26 - 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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