Inspection on 06/07/06 for Milton House

This inspection was carried out on 6th July 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milton House 07/02/06

Milton House 12/09/05

Milton House 14/02/05

Milton House 03/08/04

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

CARE HOMES FOR OLDER PEOPLE Milton House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ Lead Inspector Gill Wooldridge Unannounced Inspection 2:30 6th July 2006 X10015.doc Version 1.40 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 DS0000022999.V301956.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 Older People. 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 DS0000022999.V301956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494 601432 01494 871927 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) www.epilepsynse.org.uk The National Society for Epilepsy Mrs Mary Hooba Care Home 13 Category(ies) of Physical disability (13), Physical disability over registration, with number 65 years of age (0) of places Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Home is to be registered to provide care for 5 (five) Service Users under the age of 65. 7th February 2006 Date of last inspection Brief Description of the Service: Milton House is one of a number of residential and medical facilities that comprise the Chalfont Centre for Epilepsy. It provides personal care and accommodation for thirteen residents that suffer from epilepsy. The home has thirteen single bedrooms and two lounges. None of the bedrooms have en suite facilities. Accommodation at the house is all on ground floor level. It is situated in Chalfont St Peter not far from the village shop. Public transport and amenities are easily accessible. There is an established staff team who are supported by a range of health professionals employed on site. The fees for this service range from £696.28 to £1,655.22 per week. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, which took place on 6th July 2006. The inspection consisted of examining a number of records including risk assessments, care plans, medication administration record (MAR) sheets and the care of three residents was tracked. A tour of the building was carried out with permission gained from residents to view their bedrooms a number of bedrooms, were viewed from the corridor. The requirements and recommendations from the previous inspection were discussed. Residents and staff were spoken to. Overall, residents were satisfied with the care that they were receiving and felt safe living in the home. They also felt that staff respected their privacy and dignity. Seven written responses were received at/or following the inspection from residents these were generally favourable and some issues that the residents raised were discussed with the manager. Residents in their discussions agreed that issues could be discussed with the manager for action. Health and social care professionals and relatives praised the home for their commitment and caring staff. Feedback was given to the manager on the findings of the inspection. What the service does well: Residents are encouraged and supported by staff to be independent. The home has a flexible visiting policy. Residents are able to invite friends and relatives to the home. Health care support for residents is good. Residents’ privacy and dignity is promoted within the home. Residents’ bedrooms provide single room accommodation. Residents appear confident of their position within the home. The house provides residents with a comfortable and homely environment. Staff training is in place and residents’ benefit from well informed staff. The home has its own transport facility. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 6 Staff and residents benefit from a supportive manager who recognises the value of staff personal development which should benefit residents care. Some residents have benefited from a holiday and other holidays are planned. What has improved since the last inspection? What they could do better: Discussions with residents (the proposed new admission and the established group) must be recorded to ensure there has been an appropriate consultation period. the use of an advocate is advised to ensure that the process is transparent. Staff discussions regarding the assessment must be recorded to ensure that the staff team can meet any prospective residents needs. Good practice guidelines must be in place to support the assessment process. The detail described by staff in working with residents should be included in the care plans. The manager needs to develop an audit system to ensure all the care plans are of an overall standard. Person centred planning should be introduced and staff trained to support the residents’ care. One care plan for a recently admitted resident must be in place within 7 days of the inspection. The lack of footplates on residents wheel chairs whilst inside their home may pose a risk to them. This practice must be supported by a detailed risk assessment. Staffing levels must be reviewed to ensure residents needs are fully met. The odour in one bedroom must be addressed by an increased cleaning schedule (the manager has agreed this will take place) if this does not remedy the problem then the proprietor must replace the carpet. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 7 The carpets in the corridors are starting to wear these must be replaced as part of a refurbishment plan to ensure the home maintains its pleasant environment. Some skirting boards and the edges of walls are in need of redecoration. A further pedal bin must be purchased to aid infection control. 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 DS0000022999.V301956.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. The information regarding recent admissions to the home was available and showed some clear detail. The process needs to be supported by clear guidelines for staff to follow and record to demonstrate the residents involvement in the process. EVIDENCE: The home has had two recent admissions in the last few months. One resident described the home as ‘fifty fifty’. The paper work seen showed that staff had assessed the residents. The assessment form is a tick box system and should be developed further. Good practice guidelines for staff should be in place to support the assessment process and this should include the practice described by the manager. It is acknowledged that there is an assessment policy in place however, it does not appear that the policy incorporates gaining residents views. The manager stated that the residents care managers were involved in the move supporting Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 10 residents and consultation with the residents previous home had taken place. Records seen supported the manager’s comments however, this information needs to be organised to show an audit trail. Nor was there evidence to support that the staff team had discussed the admission to ensure that the staff team could meet these residents needs. It is acknowledged that the residents care manager and health professionals had supported the process although a full assessment from the psychologist was dated 2004. The information sent by the care manager was received after a resident had been admitted to the home, although a review had taken place in February. Staff and the manager had not recorded trial visits and that the established resident group had been consulted regarding these new admissions. Discussions with residents regarding any proposed new admission should be recorded to ensure there has been an appropriate consultation process. The use of an advocate is advised to ensure that the process of assessment is transparent. The new residents had moved from a nursing home and the manager confirmed that they did not require nursing care. However, it is apparent from the daily records that there needed to be an increase in staffing levels to support these residents needs. The manager confirmed that the home would hold a formal review after six months. It is apparent that residents do not have a contract until the review takes place. Contracts seen for established residents were signed and dated. It is recommended that staff discuss the contract with residents and maintain records of this. The manager confirmed that the home does not provide intermediate care. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. There has been improvement in some care plans. There now needs to be an overall standard for the home to ensure all care plans describe fully the needs of residents. One care plan was not in place this has the potential to place residents at risk. Generally medication recording has improved. Some good practice guidelines and continued audit should further support staffs practice to ensure medication is administered appropriately. Further work is needed to update residents risk assessments to ensure measures are in place to protect residents from harm. Observations of and residents comments indicated that they were being treated with respect and dignity. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plans for three residents were examined, and their care tracked. It is acknowledged that there has been some improvement in the presentation and the recording of information in plans and some good practice was noted. Personal lifestyle summary sheets contained more detailed information including residents’ religion and residents had life plans to support their care. However, there is still a need for all staff to record fully the level of assistance and support that they described and this should be included in the care plans. Staff described that some care plans are still work in progress. The manager needs to develop an audit system to ensure all the care plans are of an overall standard. Not all care plans were signed and the review process needs to be clearly stated to meet the standard. Person centred planning should be introduced and residents and staff trained to support the process. Senior staff have supported the process of care planning as has formal training in report writing. There were some writing over and scribbled out entries noted in the daily records. However, overall there has been a marked improvement. Guidelines regarding report writing were noted on the notice board and staff confirmed that they had been trained in good recording practice. One care plan for a recently admitted resident was not available and this is a major shortfall this care plan must be in place within 7 days of the inspection. the manger has confirmed to the commission that this care plan is now in place. It was noted that whilst one resident was admitted on the 9th March of the care plan was not in place until the 21st May 2006 this is not acceptable. Care records, staff and the manager stated that on occasions staff from other homes on the site were called to support Milton House to help support one resident. This is satisfactory as a short term measure but in the long term the homes apparent inadequate staffing levels must be permanently addressed. Any event that effects the welfare of residents must be reported to the Commission under Regulation 37. The manager and staff stated that one resident has two to one staffing. Residents looked well cared for and described the care as good. Seizure descriptions were in place however, there was no written detail regarding staffs actions. Not all residents had a social and recreational care plan this must be remedied. It is acknowledged that residents are offered ad hoc activities. Some residents described wishing to go out more. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 13 The lack of footplates on residents’ wheel chairs whilst inside their home may pose a risk to them. This practice must be supported by a detailed risk assessment. Some other risk assessments were dated’ 2003 and 2004., these must be updated and involve the resident in the process. On the white board in the office staff were reminded to use the correct hoist for one resident. The manager stated that corrective action was in place through the purchase of new slings. The medication administration record (MAR) sheets were examined and some gaps were noted. These were discussed with the manager. Gaps were explained, as the residents were on holiday. A system for these omissions must be in place, as must a system for staff to sign for prescribed creams. The manager has an audit system in place and stated that she addresses any practice issues with staff and records seen supported her practice. The manager stated that all staff who administer medication had undertaken update training and their competencies had been assessed. The controlled drug register was examined and it was difficult to track the medication held in the home with the records. The manager had completed an audit trail following the second day of the inspection. The manager stated that she would develop a system in the coming weeks. Residents photographs on the Medication Administration Records sheets should be supported by the residents or their representatives written permission. Discussions with the manager took place regarding residents self medicating, residents appeared unwilling to try to manage their medication. However, the manager has agreed to discuss this further with residents and staff. PRN management plans should be in place to ensure staff described practice in supporting residents when they are agitated is documented. Staff were observed to knock and wait for a reply before entering residents’ bedrooms. Residents spoken to confirmed that staff respected their privacy and dignity. It was documented in individual care plans that independence should be promoted and residents should be encouraged to choose what clothes they wished to wear. It was noted that some residents were able to choose their own hairstyles and put on their make up. Their preferred term of address was also recorded in the care plans. Residents care plans indicated that they are bathed or showered daily. This is noted as good practice and was confirmed by the residents. One resident’s preference for male staff to provide personal care was noted in their care plan. The manager described that male staff are not always available to provide personal care. The recruitment of more male staff to ensure this residents wishes are complied with is advised. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 14 All residents preference regarding gender care should be recorded in the care plans. Residents described that letters are given to them unopened and they are encouraged to discuss hospital appointments with staff members to ensure that transport arrangements are made. The home has a telephone facility where residents can make and receive calls in private. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Residents are able to maintain appropriate contact with friends, relatives and the local community. Residents have some opportunity for personal development as they choose. Staffing levels do not enable residents any spontaneity or to choose to go to a range of appropriate activities or out socially. EVIDENCE: Residents described having visits from friends and family members. Residents photographs supported their comments and they enjoyed sharing photographs of new family members and family celebrations. The manager confirmed that key workers encourage residents to maintain contact with their families by sending cards and presents to celebrate birthdays etc. There appears to be no restrictions on visiting. Visitors are able to visit at anytime within reason. Visitors spoken with described a friendly home where their relatives are well cared for and where independence has been promoted. Residents described entertaining their visitors in their bedrooms if they wished to or in the communal areas. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 16 Residents described social activities including Bingo, themed meals, reading having a BBQ, cookery course, art and occasional trips out. Several residents described a recent holiday and this included a balloon ride and boat trip with trips on the coach to different seaside towns. The residents spoken to obviously enjoyed the holiday. One resident raised a concern and this was passed on to the manager for action. A number of residents described different activities at the day centre on site although they expressed the need for more activities organised by the home and day centre. There is apparently a shortage of staff at the day centre and staffing levels in the home are not sufficient to meet all the residents social and recreational needs. Residents described in their feedback that there are not enough activities. It is acknowledged that the resident group presents some physical and emotional demands on staffing. Staff and the manager described that normally there are not enough staff on duty to facilitate a regular programme of evening activities or any spontaneity for example, going to the pub, or cinema, which may be the residents choice. Staffing levels must be reviewed to ensure residents social and recreational needs are met. All residents must have an activity or recreational needs care plan to support their care. The world cup football competition was ongoing interest for a number of residents at the time of the inspection. Residents often choose to spend time in their rooms listening to music or in communal areas watching television or listening to the radio. Some residents had chosen to go to bed early. Points of motivation and institutional behaviours are often challenges for staff. Autonomy and self determination must be further encouraged to ensure resident take a full and active part in running their home and their lives. Residents meetings must be encouraged. Support and risk assessments need to be in place to encourage self-medication and encourage residents to hold their own money. These issues should be discussed in the residents and staff meetings. It is strongly recommended that the staff team further facilitate befrienders, volunteers, and/or advocates to increase residents’ social contacts if they choose. Some work has been done in this area. Residents were seen to be offered regular drinks with some residents having fluid charts to support their care. Meal times are planned and the evening meal is at 4.30pm, this appears to be the residents choice however, this needs to supported in the residents care plan. Residents described having several choices to choose from at meal times and confirmed that and staff discuss the Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 17 menu with them. One residents feedback comment was that the food was sometimes not cooked. The manager confirmed that, when this occurred she would send the meal back she should also record the residents comments and her actions to support her practice. From comment cards and discussions with residents they generally praised the food. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The clear awareness of staff regarding adult protection protocol should ensure residents safety. Residents concerns should be recorded and actions recorded and taken to ensure staff are acting on the residents views appropriately. EVIDENCE: The manager confirmed that no one had formally complained and no formal complaint had been received at the Commission. It is evident that residents are able to raise concerns, however, these concerns are not recorded and clearly actioned formally through the homes complaints system. Staff confirmed that they were aware of the complaints system. Residents feedback indicated that they were not always sure who to speak to if they were not happy or if they needed to make a complaint. The manager should ensure that residents are reminded of the process if they wish to complain. Two residents money and records were checked and these tallied, the home was keeping in excess of the amount advised by the policy, the manager stated she would ensure some money was returned to the bank. Some residents keep small amounts of money safely. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 19 Adult protection was discussed fully with staff spoken with and they could describe different types of abuse and how abuse may manifest itself in residents behaviour. Staff could also clearly describe what actions to take if they suspected any actual or alleged abuse and were aware of the homes whistle blowing policy. The manager was able to demonstrate her awareness of Bucks County Council Adult Protection Protocol. Staff who were awaiting training in the coming weeks were knowledgeable and the training should support their knowledge and described practice. It is strongly recommended that the manager discuss ‘abuse’ at staff meetings. It is strongly recommended that the manager explore training in adult protection for residents. Residents described not hearing staff shout and said that staff were ‘kind’, ‘friendly’ and ‘helpful’. In one accident report it indicated that there may be concerns for residents this should be reported under PoVA. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. The home is well maintained, pleasantly decorated and furnished to meet the needs of residents. This provides residents with a generally attractive and homely place to live in. EVIDENCE: The home is on the ground floor in a two-storey building and the residents described their home as ‘this is one of the cleanest houses’. Residents appeared relaxed and comfortable in their home. During a tour of the home which included viewing all the residents bedrooms (with their permission) a number of issues were identified. • One bedroom had a slight odour and the manager confirmed that she would increase the cleaning schedule. If this fails to remedy the problem then the proprietor must replace the carpet. DS0000022999.V301956.R01.S.doc Version 5.2 Page 21 Milton House • • A pedal bin should be purchased for the staff wc. Residents personal care items should be stored more discretely. The manager stated she would find some discreet storage by the end of the month. The proprietor must replace the corridor carpets which are showing signs of wear. Touching up of skirting boards is required and corners where paper and paint have been removed must be remedied. Bedroom 5 B needs re decoration. The bath not used at present must be made available for residents to use. The proprietor must remove the board with a bolt to ensure residents are not accidentally locked in any bathroom and fit an appropriate lock to ensure residents privacy. • • • • • On the day of the inspection the home was generally clean and tidy. Residents’ bedrooms were personalised with family pictures and mementos that reflected the characters of individuals. Some residents had purchased small items of furniture such as chests of drawers, televisions, videos and radios. All bedroom doors are fitted with locks. However, some residents chose not to be issued with keys. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. There were in sufficient numbers of staff to support the care of all the residents. Arrangements are in place to ensure that staff achieve an NVQ qualification. This should ensure that competent staff are caring for residents. An ongoing training programme was in place for staff, this should ensure that staff are trained and competent to do their job. EVIDENCE: Two residents have recently been admitted to the home the staff team described the challenges of working with some residents and this was supported by records seen in the daily log. The normal staffing levels are four staff on duty in the morning and three in the afternoon. The increased needs of residents and the frailty of some others including one resident who was being nursed in bed and one was feeling unwell after their holiday. Indicate that staffing levels are not sufficient to meet residents physical, emotional and social needs. The manager described some sickness in the staff team and that residents had been supported by two relief staff. It is not clear that they had documentation to support their induction although these records may be held Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 23 centrally. The manager must ensure that she records all staffs induction regarding the philosophy of the home, introduction to residents care, familiarity with the building and fire safety. Some staff have achieved and some are working towards achieving National Vocational Qualification (NVQ) at level 2 and 3. The manager explained that the home has not been able to achieve the minimum ratio of 50 care staff holding NVQ at level 2 because several staff members have moved on after acquiring their qualification. The manager appears keen to rekindle the initiative and emphasis on NVQ training. The personnel files were not inspected during this inspection as the Commission Regulation Managers’ visit the human resources department unannounced twice a year to inspect staff recruitment records. No shortfalls were identified during the last visit regarding Milton House. The manager stated that staff meetings had not taken place for some time. Communication was discussed with staff and the manager and staff meetings are an ideal forum for communication and discussions pertinent to residents care. Records indicated that mandatory training for staff members was up to date. A training matrix now supports the staffs training profiles. All new members of staff would undertake the Skills for Care foundation training course. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. The manager has achieved the required level of formal professional qualification to demonstrate her fitness for the role. Arrangements are in place to ensure that the home is run in the best interests of residents. Residents have been involved in some aspects of quality assurance thus ensuring an improvement in the service delivery. Overall the health and safety records seen indicated they were in order. The systems for auditing accidents and risk management plans need to be improved which should benefit residents care. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has many years experience working with the client group at a senior level and is qualified to manage the home. She is a trained nurse, with a diploma in Orthopaedic nursing and has recently achieved her registered managers award qualification. She regularly attends training courses to update her knowledge, skills and competence. The management approach of the home appears open and transparent. Staff were aware of the organisation’s commitment to equal opportunities. Monthly Regulation 26 visits take place by a member of the board of Trustees. Further developments of audit systems must be achieved to ensure inconsistencies are kept to a minimum and that this ultimately benefits residents care. Two residents money was checked and this tallied with records seen. The last fire drill indicated that one resident was left in the lounge. The manager stated that she would ensure that staffs duty of care would be documented. Other health and safety records viewed or indicated on the Pre inspection questionnaire appeared in order. The accident book indicated that there had been approximately 11 accidents in the last three months. The manager is reminded to inform the Commission of any event that effects the well being of a resident must be reported to the Commission under Regulation 37. One incident should have been reported to the residents care manager under PoVA. The manager is strongly recommended to ensure that risk assessments are updated following any trip or fall and management plans put in place as appropriate. Challenging behaviour training for all staff is advised. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 18 (1) (c) (i) Requirement The registered manager must ensure that staff receive ongoing training in care planning and report writing. Timescale not exceeded. The registered manager must ensure that care plans are audited regularly. Records of audits undertaken should be kept for inspection purpose. previous timescale 31/03/06 not met. Risk assessments must be in place with regard to residents using wheel chairs without footplates. The manager must ensure that all staff comply with the homes medication policy and ensure codes are used for times when residents are on holidays and when prescribed creams are used. The proprietor and manager must ensure that they maintain the property to ensure that residents live in a homely comfortable and safe environment ensuring that the DS0000022999.V301956.R01.S.doc Timescale for action 30/07/06 2 OP7 10 (1) 30/11/06 3 OP7 13 (4) 31/08/06 4 OP9 13 (2) 30/09/06 5 OP19 23 (2) (b) 31/10/06 Milton House Version 5.2 Page 28 6 OP27 18 (1) (a) 7 OP38 13 (4) issues described in the environmental standards are actioned. The proprietor and manager must ensure that staffing levels are reviewed to ensure residents needs are fully met. The manager must ensure that all accidents are supported by a reviewed risk assessment and or a management plan. 30/11/06 30/10/06 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 Refer to Standard OP3 Good Practice Recommendations it is strongly recommended that good practice guidelines for staff be kept in place to support the assessment process and this should include the practice described by the manager. It is strongly recommended that the staff and manager record trial visits and that the established resident group and proposed new residents are consulted. Staff should access an advocate for the proposed resident if they choose to support any transition and ensure that the process of assessment is transparent. It is strongly recommended that person centred planning is introduced for residents and staff. It is strongly recommended that staffs actions regarding seizure description be recorded fully. It is strongly recommended that all residents have a social and recreational care plan. It is strongly recommended that residents permission is recorded when they have their photographs taken in regard to care records. It is strongly recommended that residents are encouraged to self medicate and hold their own money if they choose. It is strongly recommended that the staff team further facilitate befrienders, volunteers and or advocates to increase residents contact if they choose. DS0000022999.V301956.R01.S.doc Version 5.2 Page 29 2 OP3 3 4 5 6 7 8 OP7 OP7 OP7 OP9 OP14 OP14 Milton House 9 OP16 10 OP27 It is strongly recommended that the staff team facilitate a forum to encourage residents to raise any concerns and remind residents of how to complain recording any outcomes. It is strongly recommended that the manager holds regular resident and staff meetings to support the care of residents. Milton House DS0000022999.V301956.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000022999.V301956.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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