Inspection on 07/02/06 for Milton House

This inspection was carried out on 7th February 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 06/07/06

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 Joan Browne Unannounced Inspection 7th February 2006 09:30 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 DS0000022999.V280561.R01.S.doc Version 5.1 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. DS0000022999.V280561.R01.S.doc Version 5.1 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) milton@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 DS0000022999.V280561.R01.S.doc Version 5.1 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. That the home is also registered to provide care for 1 (one) Service User under the age of 30 until the 31st of July 2005. 12th September 2005 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. DS0000022999.V280561.R01.S.doc Version 5.1 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 7 February 2006. The inspection consisted of examining a number of records including risk assessments, care plans, medication administration record sheets (MARS). A tour of the building was carried out. 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. Feedback was given to the manager on the findings of the inspection. What the service does well: What has improved since the last inspection? Health and safety management systems have been developed. The home has recruited to the vacant staffing posts. Staff training profiles have been updated. The home’s fire risk assessment has been reviewed. Swing top bins in areas of the building have been replaced with the foot pedal type to prevent the spread of cross infection. DS0000022999.V280561.R01.S.doc Version 5.1 Page 6 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. DS0000022999.V280561.R01.S.doc Version 5.1 Page 7 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 DS0000022999.V280561.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: Standard 3 was assessed at the previous inspection DS0000022999.V280561.R01.S.doc Version 5.1 Page 9 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, 9 & 10 There has been some improvement in the presentation and the detailing of information in plans. However, further improvement is needed to ensure that residents’ needs would be fully met. Regular auditing of medication administration record sheets is needed to ensure that the safeguards in place to protect residents’ health are adhered to. Staff approach indicated that residents were being treated with respect and dignity. EVIDENCE: The care plans for two 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. Personal lifestyle summary sheets contained more detailed information. However, there is still a need for all staff to describe fully the level of assistance and support required to meet individuals’ needs. DS0000022999.V280561.R01.S.doc Version 5.1 Page 10 It appeared that all staff were not aware of a problem identified in a particular resident’s care plan relating to a particular fruit that had the potential to cause harm. The following information was noted in the particular resident’s care plan: ‘do not let X eat chunks of apple they get stuck in her throat.’ However, in the daily log entry for 03.02.06 the following information was noted: ‘X was coughing choking at teatime when she was eating her apple staff helped her to calm down.’ It was evident that staff were not restricting the individual’s choice. However, the entry could have been better described. All staff must be aware of the information detailed in the care plan. Information recorded in a particular resident’s risk assessment summary sheet appeared contradictory and derogatory. For example, the following information was noted: ‘X needs lots of encouragement to do tasks for herself.’ ‘X will try and help as much as she can but is also very demanding and childlike’. Staff are reminded to write with a positive slant. Good recording practice is to be discussed regularly in supervision, staff meeting and training. Scribbled over entries were noted in the daily log report. Tippex correcting fluid was used to correct entries recorded in error. It is required that the content in care plans be audited regularly by the manager. Records of audits undertaken should be kept for inspection purposes. The use of tippex must cease. Further training in care planning and report writing for staff is required. The medication administration record sheets (MAR) were examined and two gaps were noted. There was no explanation recorded on the MAR sheets to denote reason for omission. It is required that monthly auditing of MAR sheets is carried out and copies of audits undertaken are kept for inspection purposes. The manager stated that all staff who administer medication had undertaken update training and their competencies had been assessed. Staff are expected to knock and wait for a reply before entering residents’ bedrooms. Residents spoken to confirmed that staff respect their privacy and dignity. It was documented in individuals’ 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’ letters are given to them unopened however, 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. DS0000022999.V280561.R01.S.doc Version 5.1 Page 11 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): 13 Residents are able to sustain appropriate contact with friends, relatives and the local community. EVIDENCE: Residents are encouraged to maintain contact with relatives and friends. There are no restrictions on visiting. Visitors are able to visit at anytime within reason. Residents are able to entertain visitors in their bedrooms if they wished to or in the communal areas. Visitors are made to feel welcome by staff and are offered tea or coffee. It was noted that a particular resident has a volunteer who visits him weekly. Another resident also receives weekly visits from a befriender. DS0000022999.V280561.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: Standards 16 and 18 were assessed at the previous inspection. DS0000022999.V280561.R01.S.doc Version 5.1 Page 13 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, 21, 24 & 26 The home is well maintained, pleasantly decorated and furnished to meet the needs of residents. This provides residents with an attractive, safe and homely place to live in. EVIDENCE: The home is situated on the ground floor in a two-storey building. The environmental health officer recently inspected the building and requirements made had been actioned. There were no outstanding requirements from the fire officer’s visit. The building is well maintained and meets the collective needs of residents. There are sufficient numbers of shower and toilet facilities that are adequately maintained to meet residents’ assessed needs. Residents’ bedrooms were personalised with family pictures and mementos that reflected the characters of individuals. Some residents had purchased DS0000022999.V280561.R01.S.doc Version 5.1 Page 14 small items of furniture such as chest of drawers, televisions, videos and radios. All bedroom doors are fitted with locks. However, some residents chose not to be issued with keys. On the day of the inspection the home was clean and free from offensive odours. The laundry area was clean and tidy. The floor and walls were free from dust. There was a cleaning rota in place and it was evident that it was being followed. It was noted that general waste bins in some areas of the building had been replaced with the foot pedal type to prevent the spread of cross infection. DS0000022999.V280561.R01.S.doc Version 5.1 Page 15 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 There were sufficient numbers of staff with appropriate skills to meet residents’ needs. Arrangements are in place to ensure that staff achieve an NVQ qualification. This would ensure that competent staff are caring for residents. Recruitment records seen indicated that there is an appropriate system in place to protect residents. An ongoing training programme was in place for staff, thus ensuring that staff are trained and competent to do their job. EVIDENCE: Since the last inspection more permanent staff members have been employed. The staffing rota indicated that four staff cover the morning shift. The manager is supernumerary to the rota. Three staff members cover the afternoon shift. Two care staff cover the night shift. There is a full time domestic staff who works five days a week. The manager stated that the dependency levels of residents were being kept under review. On the day of the inspection staff were providing extra support to one particular resident whose physical and mental health were deteriorating. The home’s staff were aware of their limitations to meet the individual’s needs. Arrangements were being made to find a more appropriate specialist unit that would be able to meet his needs. DS0000022999.V280561.R01.S.doc Version 5.1 Page 16 Staff were working towards achieving National Vocational Qualification (NVQ) at level 2. 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 the qualification. An inspection of the NSE’s centrally held recruitment records were carried out recently. The records of the recently appointed staff members working in eight of the NSE’s establishments were looked at. All necessary documentation for compliance with Regulation 19 and Schedule 2 of the Care Homes Regulations 2001 was in place. It was noted that the manager had signed off the record of personal information sheet for all new members of staff. Training profiles for staff members were examined. Records indicated that mandatory training for staff members were up to date. All new members of staff were undertaking the Skills for Care foundation training course. DS0000022999.V280561.R01.S.doc Version 5.1 Page 17 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, 32, 33 & 38 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 were in order. However, the practice of recording accidents in an A4 book needs to be reviewed to ensure residents’ confidentiality and the data protection act are not breached. EVIDENCE: DS0000022999.V280561.R01.S.doc Version 5.1 Page 18 The registered manager has over twenty-nine 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 is open and transparent. Regular staff meetings are held. Staff confirmed that the manager communicates a clear sense of direction and they are encouraged to contribute and make suggestions. Residents were complimentary about the manager and staff caring attitude. 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. A resident survey was recently conducted, which highlighted that residents would like to have more daily activities provided and to have more outings arranged. The manager has put an action plan in place and has applied for residents to attend the day centre more often. A request for a volunteer driver has also been made. All staff receive regular training updates in moving and handling, fire training and evacuation, food handling and hygiene and infection control. There was evidence that the boiler and central heating system were serviced on 9 November 2005. The portable hoists and overhead track hoists service records were up to date. The yearly portable appliance test on electrical equipment was up to date and evidence was available to confirm that the water system had been chlorinated to prevent the risk of legionella. Control of Substances Hazardous to Health (COSHH) sheets were in place for all cleaning liquids and substances used in the home. The practice of recording accidents sustained by residents in an A4 note book needs to be reviewed as this pose a breach of the Data Protection Act 1998. The first-aid box was checked and contained all the contents listed on the checklist. All food stored in the refrigerator was appropriately dated and labelled. DS0000022999.V280561.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 2 DS0000022999.V280561.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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) 10(1) Requirement The registered manager must ensure that staff receive ongoing training in care planning and report writing. The registered manager must ensure that scribbled over entries are not recorded in care plans. The use of tippex correcting liquid must cease. The registered manager must ensure that care plans are audited regularly. Records of audits undertaken should be kept for inspection purposed. The registered manager must ensure that MAR sheets are monitored regularly. Copies of audits undertaken should be kept for inspection purposes. The registered manager must review the practice of recording accidents sustained by residents in an A4 book. Timescale for action 30/07/06 2 OP7 28/02/06 3 OP7 10(1) 31/03/06 4 OP9 10(1) 31/03/06 5 OP38 10(1) 28/02/06 DS0000022999.V280561.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000022999.V280561.R01.S.doc Version 5.1 Page 22 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 DS0000022999.V280561.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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