Inspection on 30/11/05 for Milton House

This inspection was carried out on 30th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 2 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 20/07/07

Milton House 23/02/07

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 Carol Mitchell Unannounced Inspection 30th November 2005 09:40 Milton House DS0000014937.V268538.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 House DS0000014937.V268538.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 House DS0000014937.V268538.R01.S.doc Version 5.0 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) Mr Hurry Bhautoo Mrs Premila Bhautoo Mr Hurry 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.V268538.R01.S.doc Version 5.0 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. 14th June 2005 Date of last inspection Brief Description of the Service: Milton house is a residential care home, currently registered to provide support to 13 adults 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. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over nearly 5 hours on 30/11/05. The inspector spoke to three of the ten residents living at the home, and looked at their records. (People living at the home spend a lot of time at outside activities and day care during the week.) The inspector also looked around some parts of the building, and spoke to three members of staff. The manager was away on holiday at the time of inspection, and the inspector is very grateful to people living at the home and all staff members for their help with this inspection. What the service does well: Staff at the home support the people living there well. A resident said “everyone’s nice”. Another resident said “they were very nice to me when I first came”. The staff know the residents well and they have been trained. A member of staff said “the boss is very good at training.” People living at the home are encouraged to do as much for themselves as possible, they get involved in what is going on in the local community, they are very busy. A resident said “I work on the farm, and do gardening.” Families visit, and residents visit their families a lot. People living at the home are listened to by staff who try to make sure that everyone is understood. Meetings are held, and staff talk about the complaints procedure at each meeting, and then ask residents to say how they would complain if they need to. Staff try to make it comfortable, and “home from home” for residents. Support plans are written with each individual resident, and this means that staff can use the plans to help them support people living at the home in the right way. Important documents have been produced with less words, and more pictures so that more people are able to understand these better. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 6 Staff feel well supported too. A staff member said “I can always go to my manager with anything, I never feel on my own. It’s a brilliant team here!” Staff have handovers, supervision, and staff meetings. 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. Milton House DS0000014937.V268538.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 House DS0000014937.V268538.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): 1, 2, 3, 4, 5 The manager makes sure that people who wish to live at the home are able to find out about it first. This means that by the time they move in, residents have been able to choose properly, and they feel sure they will be supported in the right way for them. EVIDENCE: A resident said that he had visited the home on several occasions before moving in. The resident called these “tea visits”, and indicated that they had been very useful. He explained that he knew a lot about the home before he lived there, he had met staff and other residents. Staff and other residents had also been able to get to know the resident before he moved in. Assessments are available, together with the support plans for each individual resident. Written information about the home is reproduced in a way that can be understood by many residents. These documents use fewer blocks of text, and include more picture illustrations. Residents are given statements of Terms and Conditions, and these should be checked against the relevant standard to make sure that details such as the room to be occupied are included. Milton House DS0000014937.V268538.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, 8, 9 The staff know how to give the right support to the people living at the home, because their needs are thought about by staff who have training and experience. The staff write down the support needed by each resident. EVIDENCE: The manager and staff write individual support plans, which are reviewed, and which include risk assessments . Support plans are discussed with individual residents who are encouraged to sign, and sometimes help with the writing. Detailed and helpful information is recorded, including advice about how to understand and communicate with residents, and how choice is offered to individual residents. Staff questioned were able to talk about the content of the support plans. Residents and staff spoke freely to each other, and in a very relaxed way, during the inspection. Some residents are very able to make their wishes known to staff, and at least one resident sometimes writes to staff. Staff are able to discuss how they understand the wishes of residents who may have limited verbal communication. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 10 Meetings for residents are held and these are much enjoyed. Staff are keen to make sure that residents know that this is their home, and the views of people living there are always listened to. A resident spoke about the way he spends his week, and was very pleased because he is able to do what he wants to do, and is fully occupied. Residents are encouraged to make their own decisions, and are given guidance as necessary. For example on the day of inspection a resident decided what to wear, and staff encouraged an appropriate decision for the weather conditions. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 The manager and staff make sure that people living at the home do as much as possible for themselves, and that residents spend their time in the right way for them. Therefore, people living at the home have opportunities for personal development. EVIDENCE: A resident told the inspector about his voluntary work on a farm, and that he also enjoys doing gardening for a community organisation. He also attends a day centre, and sees a lot of his family. During the week of the inspection he was to go shopping with his father. All of the residents attend different day centres, and are out and about a lot during the week. The home has a minibus which is large enough for all of the people currently living at the home. Residents enjoy “sparkle night” (a disco) once a week. Residents do not spend much time at home, but when they are at home, staff support various activities such as hair washing and writing. Various activities in the local community have been attended. Recently, these include a fireworks display, switching on of the town Christmas lights, going out to dinner, and enjoying a river trip. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 12 A resident explained that he is able to use a separate lounge and kitchen near his bedroom when he wishes. Residents hold keys to their rooms. The room was unlocked by the resident, and the inspector was shown around this and other living areas, without assistance or prompting from staff. Residents take responsibility in their lives as they are able. For example residents may hold their own money, and they are encouraged to look after themselves, and their surroundings. A resident explained that she helps with the polishing. There is a menu, and a hot meal is provided every evening. Residents are able to choose something different, and such variations from the main menu are now recorded. Residents said that they like the food. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Staff are kind, and they know about how to support people living at the home because they are trained. Also, support plans have been written for each resident, and these are used by staff to make sure that the proper support is given. EVIDENCE: Residents are relaxed and chat with staff in a confident way. Staff were able to advise the inspector how residents prefer to be addressed. Individual support plans are written, and these have detailed information about how to support residents. There is also information in the plans about any medical conditions, and health appointments are kept and recorded. Staff have received training in various areas, and feel confident when supporting the residents and their care. When questioned, staff were able to describe in detail, how they give different levels of support to individual residents, depending on the need and circumstances. None of the residents taking medicines are currently self-medicating. On this occasion the tablets were not inspected. However, a sample of medicine administration sheets was in good order, and a staff member described how the medicines are organised. Staff have received training about medicine Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 14 administration, and the home’s pharmacist periodically talks to staff, and checks all the medicines. Since the last inspection, staff have written down any wishes that residents have regarding what should happen in the event of their death. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 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 the following standard(s): 22, 23 Staff have received training, are keen to listen to the views of people living at the home, and always try to do the right thing. Therefore, residents can be sure that staff try hard to protect them from abuse. EVIDENCE: Meetings for residents are held regularly and questionnaires have been sent out to residents and their families. Sometimes additional meetings are called by residents. At every meeting staff describe the complaints procedure, and staff try to make sure residents understand what has been said by asking them to explain to staff and each other what they would do if they needed to complain. The complaints procedure is also given to families. Residents and staff have a friendly and warm relationship, and residents feel able to speak up about how they are feeling with confidence. Some residents are able to write down their thoughts, wishes and preferences. Staff are keen to find out about what residents think, and were able to describe how certain non-verbal, or confused verbal communications are understood. During the inspection, several inaccuracies were found in the records kept of residents’ monies, and some action to deal with this matter was taken at the time of inspection. Staff have received training about the protection of vulnerable adults, and are anxious to make sure that residents are not abused in any way. However, discussions on the day of inspection highlighted a need for further training in the area of reporting. (Staff should be knowledgeable and confident about specific instructions to follow if they become aware of, and therefore need to report, a possible abuse situation.) Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 16 Staff files were unavailable for inspection on this occasion. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 17 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): 24, 25, 28, 30 Staff know that this is “home” for the people living there, and so they do their best to make it feel like home. The home is also maintained, decorated, and kept clean, so that residents can be sure they are living in a comfortable and safe place. EVIDENCE: The home has a homely feel, and comfortable furniture is provided. A staff member described the home as a “home from home”. Parts of the home are decorated as this is needed, and equipment is looked after and kept in working order. Two new cookers have been bought since the last inspection. All areas visited were clean at the time of inspection. A resident was able to tell the inspector that he likes his room, and that he has everything he needs. (Residents’ personal possessions were plentiful in each of the bedrooms seen). The resident likes being able to use the lounge and kitchen near his room, and says that this “feels like a flat”. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 Staff are trained and really want to support the residents in the right way. They receive the right support to help them do this, and therefore people living at the home do benefit from well supported and supervised staff. EVIDENCE: The manager was not present, and the staff files were not available during this inspection. However, the staff questioned had received training, and were able to describe in detail how they support individual residents, and to talk about their role in the home. Staff receive handovers to update them on how the residents are doing, they attend staff meetings, and receive supervision sessions. The staff feel well supported, and talked about being part of a very strong and friendly team, with good management support. Residents said that they are well looked after by friendly, and “lovely” people, mentioning staff members by name. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 19 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): 37, 39, 41, 42, 43 Most aspects to do with the running of the home are well organised. When there are problems every effort is made to improve things. This means that residents do benefit from living in a well run home. EVIDENCE: Staff and residents like the way the home is run, and when questioned staff could not think of changes they would like to introduce. Staff spoke highly of the manager, who has completed training for Registered Managers of care homes. Staff said that the manager makes sure that the staff receive the right training. Such training includes that relating to health and safety such as manual handling, fire, and first aid. The management approach in place at the home leads to staff valuing the views of residents and actively seeking these. Residents are able to express themselves in a variety of ways, and have confidence that they will be listened to. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 20 Two records about residents’ monies were available for inspection. The records did not match each other, or the money being held. (The manager, who may have been able to explain the situation, was out of the country at the time of inspection.) The member of staff in charge had not been provided with a proper handover of information which made things difficult for the staff and this will need attention for the future. Some action to deal with the matter was taken immediately. One simple system is required which is clear and easy to understand by all staff members using it. Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 21 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 2 Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milton House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 1 3 2 DS0000014937.V268538.R01.S.doc Version 5.0 Page 22 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 YA23 Regulation 13(6) Requirement Timescale for action 10/12/05 2 YA41 All staff must be aware of the process to follow should they personally have to report an incident of alleged abuse 17(2)sch4.9 One clear system for the recording of resident’s monies must be used. 05/01/06 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 YA5 YA43 Good Practice Recommendations The statements of Terms and Conditions should be checked against the relevant standard to make sure that details such as the room to be occupied are included. In the absence of the manager there should be a full handover about the management responsibilities and the person appointed should have the skills and experience necessary to undertake the role Milton House DS0000014937.V268538.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 House DS0000014937.V268538.R01.S.doc Version 5.0 Page 24 - 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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