Inspection on 24/04/08 for Milton Keynes Community Care Services

This inspection was carried out on 24th April 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton Keynes Community Care... 25/04/06

Milton Keynes Community Care... 21/02/06

Milton Keynes Community Care... 05/07/05

Milton Keynes Community Care... 14/02/05

Milton Keynes Community Care... 07/07/04

Milton Keynes Community Care... 27/01/04

Milton Keynes Community Care... 20/10/03

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

CARE HOME ADULTS 18-65 Milton Keynes Community Care Services 1 Fletchers Mews Neath Hill Milton Keynes Bucks MK14 6HW Lead Inspector Joan Browne Unannounced Inspection 24th April 2008 11:00 Milton Keynes Community Care Services DS0000015066.V362146.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 Keynes Community Care Services DS0000015066.V362146.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 Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Keynes Community Care Services Address 1 Fletchers Mews Neath Hill Milton Keynes Bucks MK14 6HW 01908 660364 01908 231407 karen.fairbrother@scope.org.uk www.scope.org.uk SCOPE 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) Care Home 15 Category(ies) of Physical disability (15), Physical disability over registration, with number 65 years of age (2) of places Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for 15 people with a physical disability with up to two people over the age of sixty-five years. Linda Ambrose That the registered manager, Linda Ambrose, is only granted to manage the registered part of the scheme. 25th April 2006 Date of last inspection Brief Description of the Service: Milton Keynes Community Care Service is registered as a care home. The service consists of a staff base at the resource centre and individual properties situated around the Neath Hill estate. Staff provide personal care and support to service users in their own flats by prior arrangement or on request, via a twenty - four hour intercom system. Milton Keynes Council owns the properties. Scope, the organisation, is tenants of Milton Keynes Council. The properties are located within a mile radius of the staff base. And are accessible to Milton Keynes centre and local shops via the red route, which is specifically adapted for wheelchair users. The weekly range of fees are £812.00- £2000.00 Milton Keynes Community Care Services DS0000015066.V362146.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 that the people who use this service experience adequate quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Joan Browne on the 24 April 2008 and lasted for eight and a half hours; commencing at 11:00 hours and concluding at 19:30 hours. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service. This document, which includes information from a variety of sources, was not received in good time. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document is referred to throughout the report. The manager was in attendance throughout the visit. Service users spoken to were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered by speaking with a number of service users, and with care staff. Further information was gathered from records kept at the service. All service users were Caucasian and reflect the population of the area in which the home is situated. A number of requirements and recommendations of good practice were issued on this visit. Please see Choice of Home Outcomes, Individual needs and choice outcomes, Personal and Healthcare Support outcomes, Environment outcomes and Staffing Outcomes for full disclosure. The final part of the inspection was spent giving feedback to the manager about the findings of this visit. The inspector would like to thank all the service users and care staff that made the visit so productive and pleasant on the day. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Improvement must be made in the recording, handling, safe keeping and safe administration of medicines into the home. This is to ensure that people’s health and welfare are protected from any risk of harm. All staff must undertake safeguarding of vulnerable adult training with regular update. This will ensure that people using the service are looked after by staff who have been appropriately trained to protect them from any potential harm and abuse. Mandatory and specialist training for all staff must be updated to ensure that people using the service are supported by staff who have been appropriately trained to perform their role. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 7 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 Keynes Community Care Services DS0000015066.V362146.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 Keynes Community Care Services DS0000015066.V362146.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): 1 &2 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to this service. Prospective people to use the service are provided with a pre-admission assessment and a trial period to ensure that the service is able to meet their needs and aspirations. EVIDENCE: The service’s statement of purpose and service user’s guide required updating. We were told that work was in progress to update the documents in a more user-friendly format. A recommendation is made in this report to ensure that the documents are provided in a format suitable for people using the service such as large print, video or audio. We were told that all pre-admission assessments are undertaken by two members of staff usually the manager and a support worker. Individuals’ needs are assessed to ensure that the service is able to meet all identified needs. The files for the two service users recently admitted were examined and demonstrated that pre-admission assessments had been undertaken. It was evident that service users and their relative and representative were involved in the assessment process. We were told that the service is led by service users as to how they wish to take up the placement. A trial period is offered followed by a review. Statement of terms and conditions of occupancy was Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 10 seen in individuals’ files. Those service users spoken to confirmed that they chose to live at the service and had been provided with a trial period. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 11 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The staff promote people’s rights and choices by enabling them to make decisions about their life and finances. EVIDENCE: Each service user has a care plan in their flat reflecting their current care needs and how needs should be met. A copy of the plan is also kept in the home’s office. The standard of recording in the two plans examined was variable. We were told that all care plans were currently being reviewed to ensure that care provided was person centred. Service users spoken to confirmed that they were involved with the development of their plans as well as reviews. However, some service users felt that there were times when changes to their care needs occurred and there is a delay in implementing the new changes. This mean that individuals are not always provided with the appropriate level of care. The home has identified as an area for improvement in its annual quality assurance assessment (AQAA) the following: “ improve Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 12 response times to effect action as a result of service users’ choices. Improve clarity in communication to staff team members where changes occur e.g. a service user care plan or increase in needs.” By having these measures in place should ensure that changes to individuals’ care needs would be implemented without delay. The manager was able to demonstrate how service users were involved in decisions about their lives and the service. Service users are invited to attend monthly tenants meetings. However, some choose not to attend. Minutes of the meetings are circulated to individuals. Letters are written to service users informing them of any changes to the service. Key working time is allocated to service users to provide them with the information, assistance and support they need to make decisions about their lives. We were told that all service users have access to an independent advocate and were managing their own finances. Risk assessments were seen in service users’ files for activities such as, moving and handling and social activities. Detailed action planning was in place to minimise any identified risks and to promote individuals’ independence. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 13 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People using the service are given individual support by staff to ensure that they are able to maintain their own personal interests and activities and to enjoy a fulfilling lifestyle. EVIDENCE: On the day of the inspection there were no service users involved in distance learning training or attending the local college. One service user was doing voluntary work in a children’s nursery and was enjoying working with the children. Several service users were accessing the day service facility and one was being paid as a volunteer receptionist. Service users are seen as part of the local community. They are supported by the staff team in accordance with their assessed needs and individual care plans to go on shopping trips to the city centre, visit restaurants, pubs and cafes as well as to follow their personal interests and activities. Some service Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 14 users spoken to said that they miss not having the use of the organisation’s vehicle at their disposal. Service users are able to keep in touch with family and friends and friends visit and spend time with them. They are allocated key working time, and are able to choose how to use the time allocated to them. They are supported to have appropriate personal relationships. Service users spoken to were confident that their rights as citizens were recognised and promoted. Staff are expected to ring service users’ door bells and announce who they are and request to be let in when entering individuals’ flats. Service users’ preferred form of address was recorded in individuals’ care plans. Those spoken to during the visit said that they ‘were very happy with the service provision and the accommodation provided.’ One individual commented ‘I don’t want to leave ever.’ The following additional comments were noted: “I was desperate to get away from the rules and regulations of residential living after I left school. I wanted a place I could call my home.” Service users are responsible for some housekeeping tasks such as, laundry, and cooking. They are able to smoke in their flats if they wish to. Individuals are supported by staff to prepare their own meals daily. All meals are cooked in service users’ flats and they choose what they wish to eat. Each service user is given a weekly allowance to purchase food provisions. Risk assessments were in place for the storage and preparation of meals. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 15 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The service ensures that staff assist people with their physical and health care needs in the way they prefer. Inconsistent practice in the safe handling and recording of medication could present the risk of harm to people using the service. EVIDENCE: Care plans seen detailed the level of personal care and assistance that staff should provide to individuals. Times for getting up, going to bed, bathing, preparing meals and outside activities were recorded. Aids and equipment to maximise independence were provided. Service users are registered with a general practitioner (GP) of their choice. Those who are able to visit the GP when required. They have regular dental, chiropody and optical checks and are able to access specialist treatment via the GP. We were told that three service users were self-medicating their own medication. The remaining service users were being assisted by staff with their Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 16 daily administration of medication. The medication administration record (MAR) sheets were checked and a large number of unexplained gaps were noted. We observed that staff were not using the appropriate codes as indicated on the MAR sheet when medication was refused or not given. Amendments to the frequency and dosage of medication on the MAR sheet was not countersigned by a second person and there was no audit trail of written evidence recorded to indicate that the general practitioner had given instructions to amend the frequency and dosage of medication. We observed on a specific MAR sheet that a course of antibiotic treatment was completed. However, the staff member making the entry did not sign and date the entry. The controlled drug register was checked and medication in stock corresponded with the register. We observed that tippex correcting liquid was used to correct an entry made by error. This is poor practice and should cease. The controlled drug register is a legal document and can be used as evidence in an internal or external investigation. The audit trail of controlled medication was not clear. On a specific date there was only one signature recorded in the controlled drug register. This means that the practice of administering controlled medication is not consistent. Two staff’s signatures should be evident when controlled medication is administered. We noted that a particular service user was prescribed for Morphine medication, which is a controlled drug and is a strong analgesic. Staff were secondary dispensing the medication and taking it to the service user’s flat. This practice could pose a risk to them and the service user. Advice must be sought from the pharmacy on best practice. In the interim the practice should be assessed for the risk it present to the person using the service and to staff and action taken to minimise any identified risk. A requirement is made for the home to review the medication storage cupboard to ensure it complies with current legislation. There was no evidence available to indicate that staff had undertaken formal training in the safe handling and administration of medication. A further requirement is made for all staff responsible for the administration of medication to be trained in the safe handling and administration of medication to ensure that service users are looked after by staff who are competent and appropriately trained. To comply with best practice guidelines the home should retain a list of staff members authorised to give medication, which includes a record of their approved initials. There was evidence seen indicating that a record is maintained for medication disposed of. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 17 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staff may not be familiar with the home’s policies and procedures on safeguarding of vulnerable adult, which could lead to inconsistent practice within the service and people using the service could be potentially at risk of harm or abuse. EVIDENCE: The home has a complaints policy and procedure. The home reflected in its Annual Quality Assurance Assessment (AQAA) that within the last twelve months it had received ten complaints and they were satisfactorily resolved within twenty-eight days. The AQAA also reflected that the organisation had recently updated its complaints resolution procedure. The complaints record was examined and demonstrated that the procedure was recently updated. Complaints recorded were satisfactorily investigated with a clear audit trail of the outcomes. Service users who responded to the Commission’s survey said that they knew how to make a complaint. The Commission has not received any complaints about the service since the last inspection. The home’s AQAA reflected the following information: “Adult protection is of paramount importance and all staff members receive training from our designated adult protection advisor. Protection issues are dealt with effectively through use of Local Authority procedures. Scope’s protection team also advises on these issues and investigates and makes recommendations accordingly where police or Local Authority input ends.” Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 18 We noted that there were no written evidence in three recently recruited staff members’ files that were appointed in July and August 2007 to confirm that these individuals had been provided with safeguarding of vulnerable adult training. We were told that some staff were due to undertake safeguarding of vulnerable adult training in May 2008. We spoke to staff members and found that they had limited understanding in this important area, which could lead to inconsistent practice within the service. It is required that all staff must undertake safeguarding of vulnerable adult training to ensure that service users are cared for by staff who have been trained to protect them from any potential abuse. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 19 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People live in clean, comfortable, pleasant and hygienic flats. Maintenance work needs to be addressed in a timely manner to ensure that the environment is fully able to meet and promote people’s diverse needs. EVIDENCE: The home’s Annual Quality Assurance Assessment (AQAA) states “that individuals’ flats are maintained to a standard maximising the safety and comfort of service users. Specialist equipment is provided where necessary. Hygiene and the cleanliness of the home are maintained to high standards.” We visited two flats and we observed that one flat was in need of redecoration. Paintwork on the walls and skirting boards was chipped and the wallpaper was lifting. We observed that the curtain in the bedroom was of a light material and as a result was causing some inconvenience to the service user. The service user raised concerns about the ramp at the back, which could pose a hazard. The manager told us that maintenance tasks were prioritised and redecoration was an ongoing task. To ensure that the environment is fully able to meet and promote individual’s diverse need it is required that the flat Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 20 is redecorated. We observed in the second flat that the kitchen draw was broken and needed to be repaired. The shower hose was perished and needed replacing. A requirement is made for maintenance work to be carried out. Additional comments made on maintenance issues were as follows: “I would like scope to provide a handy person for house repairs.” Service users who responded to the Commission’s survey said that the home was ‘always’ or ‘usually’ fresh and clean. Additional comments made were: “Scope provide a cleaner who visits once a week and the carers always clean up after themselves.” Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, & 35 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s recruitment procedure needs to be improved to ensure that people using the service are protected from being cared for by persons who are not fit to do so. EVIDENCE: The service provides the following staffing numbers daily to support service users. Six staff in the morning working 07:00- 15:00. Five staff in the afternoon commencing at 14:00 and finishing at 22:00. Two staff cover the night shift commencing at 22:00 and finishing at 07:00. Information reflected in the home’s annual quality assurance assessment (AQAA) indicated that within the last twelve months one full-time staff had left the employment. We were told that staff were on long term sick, and the home was depending on temporary and agency workers to cover some shifts. Regular staff meetings and one to one supervisions had not been taking place. Since the appointment of the new manager there has been an improvement and the frequency of staff’s meetings had increased. Work was in progress to re-establish a structured supervision framework. Service users who responded to the Commission’s survey said that staff ‘always’ or ‘usually’ listen and act on what they say. However, some service Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 22 users felt that communication could be improved and the service provided by agency staff was not satisfactory. The following additional comments were noted: “Communication is sometimes not very good and messages don’t get passed on.” “The agency staff we have had and on occasions still use seem to regard us as conduit for money and are a bit slap dash which I find disconcerting and insulting.” The home’s annual quality assurance assessment (AQAA) reflected the following information: “Recruitment and selection of staff is done through robust procedures ensuring the quality of staff members employed.” This information was found not to be accurate. The three most recently employed staff’s files showed that a thorough recruitment procedure was not followed. There was no record of interview notes. There was no evidence to confirm that gaps in employment history had been explored. References were not obtained from individuals listed on the application form. The authenticity of references had not been checked. One reference seen was written on an A5 ‘spiral’ note pad. A second reference was sent electronically. Recent photographs to confirm proof of identity were not on files. A requirement is made in this report for the home’s recruitment procedure to be improved to ensure that service users are protected from being cared for by persons who are not fit to do so. Information in the AQAA stated the following: “Statutory training and various other relevant courses are provided in-house or sourced externally.” Examination of staff records reflected some inconsistency. In files examined there was no record of some staff having undertaken induction training. There was no evidence that a training matrix was in place. The manager told us that staff had been asked to identify their training needs. It was evident that the manager was aware that there were some gaps in the training programme and individuals’ training needs and was working to address the shortfall. A requirement is made in this report for mandatory and specialist training for all staff to be updated. This should ensure that service users are looked after by staff who have been appropriately trained to perform their role. It is further recommended that equality and diversity training is included in staff induction and continuing training to ensure that the staff team is trained to support, recognise and respond appropriately to service users’ diverse needs. The home should develop a training matrix to ensure that there is a record of training undertaken by staff and it is up to date. Information reflected in the AQAA indicated that fourteen of the twenty-four care staff working in the home had achieved the national vocational qualification (NVQ) in direct care at level 2 or above. This means that the home had achieved the minimum ratio of 50 of the staff acquiring a national qualification. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 23 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Although the service aims to provide a consistent service improvement in medication and recruitment practice is needed to ensure that people using the service safety is protected and promoted. EVIDENCE: The manager was recently appointed and has been in post since February 2008. She has nineteen years experience working in the care sector and has worked in the position as a support worker, senior worker, team leader and acting manager. She holds a national vocational qualification (NVQ) in direct care at level 3 and the registered managers award and is working towards achieving the NVQ qualification at level 4. She was able to demonstrate how she updates her knowledge and skills by attending formal training courses such as, health and safety, disciplinary procedures and adult protection. From Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 24 discussion with the manager she was keen to improve and develop systems to monitor practice and compliance with the plans policies and procedures of the home. The annual quality assurance (AQAA) was not returned to us by the date it was requested. This was no fault of the new manager. However, she completed the document after requesting for an extension. The evidence to support the comments made were satisfactory. There were areas where more supporting evidence would have been useful to illustrate what the service was planning to improve. There was evidence seen indicating that regular regulation 26 visits had been undertaken. Service managers were carrying out these visits. The manager told us that service users’ views were actively sought and regular meetings are held for them, which their advocate attends. She is aware of areas that the service need to improve but a plan of action for undertaking the work was not in place at the time of the inspection. Review of information reflected in the annual quality assurance assessment (AQAA) demonstrated that health and safety checks were routinely carried out which included fridge and water temperatures in service users’ flats. Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 25 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 3 2 3 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 2 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 X 33 3 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 2 X X 2 X Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 26 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 YA20 Regulation 13(2) Requirement Timescale for action 30/06/08 2 YA20 3 YA20 4 YA23 Arrangements must be made for the recording handling, safekeeping and safe administration of medicines into the home. This is to ensure that people living in the home health and welfare are protected from any potential risk of harm. 13(2) The home must review the controlled medication storage cupboard to ensure it complies with current legislation. 18)1)(c)(i) All staff responsible for the administration of medication must be trained in the safe handling and administration of medication. This is to ensure that people using the service are looked after by staff who have been appropriately trained to look after their health care needs. 18(1)(c)(i) All staff must undertake safeguarding of vulnerable adult training to ensure that people using the service are looked after by staff who have been appropriately trained to protect them from any potential harm and abuse. DS0000015066.V362146.R01.S.doc 31/07/08 30/06/08 31/07/08 Milton Keynes Community Care Services Version 5.2 Page 27 5 YA30 23 6 YA34 19 Schedule 2 7 YA35 18 Maintenance work identified in the body of this report must be undertaken to ensure that people live in an environment that is safe and well maintained Recruitment procedures must include the obtaining and keeping of the required documentation, including proof of identity, interview record, evidence of gaps in employment history being explored, to obtain references from previous employer. This is to ensure that people who use the service are protected from being cared for by persons who are not fit to do so. It is a requirement that all staff receive mandatory training and training in specialist areas of care in accordance with the individual needs of people using the service. This is a repeat requirement. 31/07/08 30/06/08 30/06/08 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 YA1 Good Practice Recommendations The statement of purpose and service user’s guide should be provided in a format suitable for people using the service such as large print, video or audio. A system should be in place to ensure that all staff are aware of changes to individuals’ care plans. This is to ensure that care provided to people using the service is consistent. When there are changes to the dosage and frequency of medication there should be a clear audit trail of the changes. The person making the entry should date and DS0000015066.V362146.R01.S.doc Version 5.2 Page 28 2 YA6 3 YA20 Milton Keynes Community Care Services sign it including a witness. 4 5 YA20 YA20 When antibiotic treatment has been completed the person making the entry should date and sign it. Tippex correcting liquid should not be used in the controlled drug register because the register is a legal document and can be used in an internal or external investigation. A risk assessment should be developed on the current practice that is in place when administering Morphine medication for the risk it present to the person using the service and to staff and action taken to minimise any identified risk. Equality and diversity training should be included in staff induction and continuing training to ensure that the staff team is trained to recognise and respond appropriately to people’s diverse needs. The home should develop a training matrix to ensure that there is a record of training undertaken by staff and it is up to date. 6 YA20 7 YA35 8 YA35 Milton Keynes Community Care Services DS0000015066.V362146.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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