Inspection on 04/07/08 for Milton House

This inspection was carried out on 4th July 2008.

CSCI found this care home to be providing an Adequate service.

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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton House 20/07/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Milton House 39/41 Spencer Road Bedford Bedfordshire MK40 2BE Lead Inspector Katrina Derbyshire Unannounced Inspection 4th July 2008 10:00 Milton House DS0000014937.V367972.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.V367972.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.V367972.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 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.V367972.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. 20th July 2007 Date of last inspection Brief Description of the Service: Milton house is a residential care home and offers 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 is 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 toilet and shower on the ground floor. The office/sleeping in room and laundry are also situated on the ground floor. There is a small enclosed garden and some off road parking. The following information on charges was supplied by the manager in July 2008. The fees for this home vary from £354.00 per week, to £675.00 per week, depending on the funding source and assessed need of the person. Additional charges are made for transport, trips, holidays and meals if taken outside of the home. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection received information about the service in May 2008 from Bedfordshire Social Services, this related to competency of some staff, safeguarding, staffing levels and activities. This unannounced visit took place on 4th July 2008. During the visit the communal areas of the home were seen alongside some of the individual accommodation. The inspector spent time with some of the people who live at the home in their rooms and the communal areas. Management and staffing records were examined. The care of two people was looked at in detail. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the management’s submission of documentation. 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, to look into the concerns that had been raised, and to follow up on previous requirements. What the service does well: People living at the home still feel that staff help then to follow their individual interests. This means for those who like to go into town to have lunch or others who may like to go to the cinema for instance have opportunities to do this, although it is mainly during the day. One person who had just returned from town said, “oh yes I like going out very much and I had my dinner, yes I go every week”. Many of the people also attend day support facilities across Bedfordshire, here they can participate in a range of development programmes including life skills, music therapy and peer support programmes. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 6 Again staff at the home continue to be good at making sure people receive the medical support that they may need. If someone needs to see a Doctor if they feel unwell, staff are still 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. What has improved since the last inspection? What they could do better: There are several areas that the owner needs to look at to make things better for the people living there. Some examples are as follows. Staff need to receive training in areas that will help them better understand the specific needs of the people living at the home. Although staff have undertaken training in other areas for example, health and safety, it would help to improve the standards of care if they could attend training about challenging behaviour alongside the other specific needs of people living at the home. Only 50 of staff had received training in this area, even though there had been several incidences where people living at the home had become both verbally and physically abusive. This must be carried out to safeguard both the other people living at the home and staff. Staff had rewritten documents known as care plans because we had made a requirement about this when we last inspected, but they still need to be clearer. These documents tell staff all about the person and what they should do to support them in meeting their needs. This is important so everyone working to support the person does so in the same way and continuity of care is given. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 7 Staff also need to make sure that when someone living at the home is loosing or gaining weight that they make sure that they are weighed regularly. A nutritional risk assessment must be undertaken, then if a risk is identified staff must seek guide from a dietician for example. This will help the person in maintaining a healthy diet, through receiving specialist advice in this area. 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.V367972.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available 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 inspection in February 2007 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 visit in July 2007 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. No new admissions to the home had taken place since that time; therefore this requirement could not be assessed for compliance and will be looked at next time. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Opportunities for people to make decisions about their lives are inconsistent and make some people not feel in control of their own lives, disparity in care planning does not ensure all people receive continuity of care. EVIDENCE: Through examination of care plans kept within the individual folders for each person it showed that there were documents in place, which briefly indicated some of the needs of the person. In most entries there was sufficient direction to staff to state how the person should be supported. However one person had on several occasions been both verbally and physically abusive to others. There were no clear guidelines for this to staff in how the person should be supported, or indeed about the protection of other people living in the home or themselves. Acknowledgement is given that support from the social work team Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 11 had been sought about this, however very clear guidance must be in place at the home to safeguard everyone. Some people spoken to described how they still felt in control of their own lives, however others did not feel the same way. People described being able to choose what they were going to wear each day as an example of having choice, in addition contact with friends and family was not restricted. Observation at this visit also showed that people moved freely around the home, choosing to go to their private accommodation, sit outside or sit in one of the communal areas. However the experiences of one person, whom Bedfordshire Social Services had contacted the Commission for Social Care Inspection about had not been positive. The person had felt that they had no choice when they had moved rooms earlier in the year; they had not felt staff had provided the support that they needed when they had felt bullied by other people in the home. Direct feedback from a Social Worker supported this; they felt that staff had not addressed all issues. In addition people felt that going out in the evening was restricted, this was supported through examination of the staff rota where it showed that only one staff member was on duty after 8 pm. Risk assessments were in place within the individual care files examined. Risks that had been assessed included gambling and external contact when leaving the home. Staff through questioning confirmed that they had received training in the area of risk assessment; in addition they demonstrated a sufficient level of understanding in the possible risks to people living at the home although the action taken when a risk had occurred was not always sufficient. One example of this was when a person had become aggressive both verbally and physically to another person. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home do have some access to local facilities so benefit from being part of the community and are supported in maintaining personal relationships. Although delivery and quality of food needs to improve to meet every ones individual tastes. EVIDENCE: People living at the home were not directly involved in the preparations for the evening meal, but some people were seen going into the kitchen to make themselves a drink. On the day of this inspection, two people stayed at the home whilst others attended varying day support facilities. A staff member accompanied the two people who stayed at the home into town; they confirmed on their return that they had eaten at a local pub. One person said, “It was lovely” when speaking about their lunchtime meal, staff also confirmed that this took place weekly for people who wanted to do this. The evening meal Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 13 consisted of tinned pilchards, potatoes and vegetables; four out of five people commented that they would like more variety in the menus at the home. On examination of menus, these showed that there was minimal change to options available and this was supported through looking at the type of food that the home had in stock. On examination of the food stocks at the home, it showed that levels of dry and tinned goods were sufficient to cover a number of week’s menus. The cleanliness of the fridge and freezer was inadequate with marks being in place to show that they had not been cleaned recently. Other areas of the kitchen and food storage were seen to be clean at this visit. In addition items of food in the freezer were not stored safely. Some food had been stored in ripped carrier bags with no other covering, and was unmarked so there was no way of knowing what it was and the date it was purchased. Through discussion with people living at the home on the day of this inspection and through examination of care records, alongside feedback from Bedfordshire Social Services it was evidenced that some people felt that there were sufficient choices and activities whilst others did not. Three people spoken with discussed the opportunities that they had to attend day centres and also when staying at the home during the week, being supported to go into town during the day. Others felt that activities were restricted, as only one member of staff was on duty after 8 pm so going out in the evening was limited as was any activities held within the home. The Deputy manager stated that if a trip was to be arranged then extra staff would be employed to accommodate this. Feedback received concerning one person described that the person ‘would feel frustrated’, as there were limited opportunities in the home especially in the evenings. Feedback through attendance at a strategy meeting in May 2008 and through examination of documents alongside discussion with people living at the home, all confirmed that people were able to maintain personal relationships and maintain contact with family and friends. Entries seen showed several people received visitors weekly and/or went to visit family members. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are good at supporting people to access health care support so that their health needs are met. EVIDENCE: Through observation of the people living at the home it was noted that their clothes, hairstyle and makeup reflected their individual personalities. Guidance and support regarding personal hygiene was offered and the level offered by staff was reflected in the care plans tracked on this inspection. One care plan included the need for staff to prompt a person to have their shower at the end of the day, this was seen to be done. Within the individual care records examined it was noted that there were documents from a variety of medical specialists as assessed at the previous inspection. These documents showed that people received regular support from Doctors and Nurses. Staff confirmed that they assisted people to attend Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 15 hospital appointments and the outcome of any medical intervention and subsequent guidance was recorded. The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct in most instances, however the balance of one medication was incorrect. The owner on looking into indicated that this was due to inaccurate record keeping by some of the staff. 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.V367972.R01.S.doc Version 5.2 Page 16 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 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Managements understanding and the systems in place for safeguarding adults is inconsistent and places some people at risk from abuse from other people living at the home. The complaints procedure in the home is satisfactory and results in people being listened to and their concerns acted upon. EVIDENCE: Entries were seen within the care records of one person, they were dated the 26th June 2008. They described that one person had started to become aggressive to another person that lived at the home ‘punched … in the face and then broke their phone into pieces’. This had been reported under the local Safeguarding protocols to social services, but not to the Commission for Social Care Inspection. In addition the owner did not have the updated referral procedures. Although at the time of this visit the home was awaiting direction from social services, guidance to the risks and specific measures staff should take to safeguard people until a strategy meeting was held was not clear. A requirement has been made. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 17 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 confirmed that people were comfortable in complaining in they wanted to and knew that they had the right to do so. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 18 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements are needed to some of the décor and fittings to create a homely environment throughout the home for people to live in. EVIDENCE: At the previous inspection we reported that two of the chairs had torn covers and were stained in the dining area. Covers had been placed over these, although they were very loose fitting indicating that they were not the correct covering. In addition areas in the home had marked and scuffed walls. One of the doors on a kitchen cupboard had come off, although the Deputy manager then started to put this back on. 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.V367972.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The number and/or deployment of staff and training is not sufficient for all people to feel that they receive the support that they require. EVIDENCE: Information received by the Commission for Social Care Inspection raised concerns on the number of staff on duty being insufficient at times to fully meet the needs of the people living at the home. Through speaking with people at this visit, many supported this view specifically in the evenings. On examination of the staff rota, this showed that only one staff member was on duty between 8 pm and 10 pm. In view of the comments concerning the lack of activities and with the needs of some people living in the home already described in this report, this indicates that this is insufficient. Work needs to be undertaken to review the deployment of staff so that people receive the support that they need. A review of the number and deployment of staff must be carried out. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 20 Training records showed that staff had undertaken training in the statutory areas including fire safety and medication. However many staff had not undertaken training in the specific needs of the people who live at the home including challenging behaviours, only 3 of the 11 staff employed had undertaken this. Through discussion with staff and management this was confirmed and a requirement has been made. The homes recruitment policy and procedures was clear. References are taken prior to staffs’ commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Certificates of qualifications are present within staff files. Therefore a previous requirement has now been met at this inspection. Several of the people living at the home made positive comments on the skills of the staff team, one person said “they seem very nice”. Other people felt that not all staff had the same level of competency and they felt that they could not always meet their needs, one social worker said, “they don’t seem to understand their responsibilities sometimes to change practice, to do things differently so you get people wanting to move out”. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 21 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 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health and safety systems are sufficent to reduce the risks associated with this area for the people living at the home. EVIDENCE: Staff and training records showed that heath and safety training had taken place including fire safety and food hygiene. The most recent inspection by the Fire Service showed that the home met the required standards.. As assessed previously the policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Approved contractors had undertaken servicing of equipment and Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 22 site visit paperwork to evidence that theses had been carried out were seen. Regular checks relating to water temperature for example had been recorded on charts. Stocks of aprons and gloves were noted to be available for staff to use, in relation to infection control. No staff at this visit were seen to use these items inappropriately, their use was only seen to be made in the area where they were needed, for example at the evening meal to reduce the risk of cross infection. The home carries out consultation with the people in different forms. Staff confirmed that on a day-to-day basis people are asked for their views and these decisions are then integrated into the care plans. More formal methods such as residents meetings had taken place in the past and minutes were available for inspection, but the home recognised that the views of all residents could not be sought in this way and many did not wish to be involved. Everyone spoken with reported that they found the manager to be a very good listener and all felt that she was very easy to talk to and that they trusted her. Staff said that they found the manager to be both organised and approachable. At the last inspection we reported that it was not clear the hours that she worked in the home as she was not part of the staff rota that was viewed. Staff had stated that she worked predominantly Monday to Friday, subsequent written confirmation was then received by the home to state that her details were now entered onto the rota and this made clear the hours that she worked. However on checking this at this visit although her name was entered onto the rota, the word ‘flexible’ was entered, so in fact it was not clear the hours she was working within the home. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 23 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 1 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 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 X Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 24 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. (Previous requirement with a timescale of 30/09/07, not able to be assessed at this inspection) Timescale for action 04/07/08 2. YA6 15(2) Care plans must have 31/08/08 sufficient guidance to staff in how to meet the individual needs of the person to ensure continuity of care. All assessed needs must have a plan in place. (Previous requirement with a timescale of 30/09/07 not met in full) There must be multi agency 31/08/08 agreement alongside the individual’s agreement if a restriction or change is made. The change must not be as a result of not dealing with other DS0000014937.V367972.R01.S.doc Version 5.2 Page 25 3. YA7 12(3) & 13(6) Milton House 4. YA9 5. YA12 6. YA17 7. YA20 8. YA23 9. YA24 10. YA33 matters in the home. The reasons must be documented, to ensure a person is not subject to unsuitable restrictions. 13(7) There must be multi agency agreement if a restriction is in place or measures taken to safeguard people living at the home and others. The reasons must be documented, to ensure a person is not subject to unsuitable restraint and that it is in accordance with the Mental Capacity Act. 16(2)(m)&(n) A programme of activities and recreation must be available, including evenings to meet the diverse needs and interests of the people living at the home. 16(2)(g)&(i) The storage of food must be carried out safely and the provision of food must be varied to meet the individual tastes of people living in the home. 13(2) Medication audit systems must be sufficient to identify errors in a timely manner and so action can be taken to rectify the error to safeguard the people living at the home. 13(6) The Commission for Social Care Inspection must be informed of all safeguarding matters and there must be appropriate action and support by staff and management to protect people from abuse by others living at the home. 13 & 23 Action must be taken to improve the standard of accommodation to assist in creating a homely environment for people to live in. 12 & 18 The number of staff and their deployment within the home DS0000014937.V367972.R01.S.doc 31/08/09 30/09/08 31/08/08 31/08/08 31/07/08 30/09/08 31/07/08 Milton House Version 5.2 Page 26 11. YA35 18(1) must be sufficient to meet the individual needs of the people living in the home. All staff must be trained for the specific conditions and needs of people including challenging behaviour who live at the home to improve standards and ensure consistency of care. 30/09/08 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. Refer to Standard YA37 Good Practice Recommendations The Registered manager should enter the hours that she will be actually working in the home onto the rota, so people know exactly when she will be available. Milton House DS0000014937.V367972.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V367972.R01.S.doc Version 5.2 Page 28 - 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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