Inspection on 25/04/06 for Milton Keynes Community Care Services

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton Keynes Community Care... 24/04/08

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 Nichola Cahill Unannounced Inspection 17th April 2006 09:30 Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 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.V287686.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 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.V287686.R01.S.doc Version 5.1 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 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) SCOPE Linda Jillian Ambrose 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.V287686.R01.S.doc Version 5.1 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. 21st February 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. There are currently fifteen properties accommodating thirteen service users registered at this service. 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 a tenant of Milton Keynes Council. The properties are located within a mile radius of the staff base. The properties are accessible to Milton Keynes centre and local shops via the red route, which is specifically adapted for wheelchair users. The current charge for fees is dependant on individual assessment and range from £480 per week to £1400 per week. Information regarding the service provided is contained within the statement of purpose and service users guide. Both documents are available on request. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a summary of the unannounced key inspection for Milton Keynes Community Care Services carried out on 25th and 26th April 2006 by Nicky Cahill and Gill Gentles. The inspection took place over a period of fourteen hours, this includes the pre-planning. The inspection consisted of meeting with five service users individually, visiting three flats and attending the service users meeting with seven service users, the manager and administrator. Service users shared their care plan information and discussed their thoughts on the quality of the service and improvements made. Documents were viewed concerning health and safety, staff recruitment and training, complaints and protection and medication. The manager and staff were available for discussions throughout the visit and four members of staff completed questionnaires. An assessment was made against all key standards and requirements made at the previous inspection visit. A feedback of the findings from the inspection was given to the manager, Linda Ambrose. The Commission would like to thank the service users and staff for their assistance throughout the inspection visit. What the service does well: Potential service users receive a pre-admission assessment and are invited to be admitted on a trial basis. This will ensure that the service is appropiate to the individuals assessed needs. Care plans provide staff with a clear outline of individuals needs, service users are supported in taking risks and day to day decisions regarding lifestlyes and apsirations are activley encouraged. The service meets the individual needs and choices of service users. Individual support is given by the staff team to ensure that service users are able to maintain appropriate and fulfilling lifestlyes in and outside of the service. Appropriate support is given to ensure that service users receive support with personal, emotional and health care needs. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 6 Recruitment practices in place protect the safety of service users. The service has the appropriate policies and procedures in place to ensure that service users are able to air concerns and complaints and are protected against abuse. The manager has been proactive in meeting previous requirements made on the service and in developing the staff to meet and improve standards of care. The service is run in the interests of service users and allows them to be empowered in their choices and aspirations. What has improved since the last inspection? What they could do better: Care plans could be improved by providing details of how staff will support service users to full fill their lifestyle choices and aspirations. This includes swimming, shopping, social visits and visits to health care services. Care plans were not entirely well presented with much crossing out and pages falling from files. Medication practices protect the safety of service users, however, some areas may not adeqautely promote individuals independence. Comfortable, homely flats are provided which suit the needs of the individual service users, however, further improvements would enhance the facilities available. Shortfalls in staff training do not ensure that staff are aware of current practices and there for may put service users at risk. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 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. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 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.V287686.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Potential service users receive a pre-admission assessment and are invited to be admitted on a trial basis. This will ensure that the service is appropriate to the individuals assessed needs. EVIDENCE: This service has not admitted any new service users for a number of years. There are presently two vacancies, which have received preliminary enquiries. The pre-admission procedures are clearly described in the policy in place. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans provide staff with a clear outline of individuals needs, service users are supported in taking risks and day to day decisions regarding lifestlyes and apsirations are activley encouraged. The service meets the individual needs and choices of service users. EVIDENCE: Service users have a care plan in their own home, which reflects their current needs. A copy of this plan is also in place in the homes office. The care plan includes an outline of care needs, risk assessments and health and safety information. Care plans could be improved by providing details of how staff will support service users to full fill their lifestyle choices and aspirations. This includes swimming, shopping, social visits and visits to health care services. Care plans were not entirely well presented with much crossing out and pages falling from files. Recommendations for improvement have been made in this area. Care plans were discussed with some service users during the inspection. Some service users expressed their concern that they had been asked to have Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 11 risk assessments carried out that were not in line with their assessed needs. It was clear from discussions that they also did not wish to have a list of what they had eaten and the temperature of their food kept on a daily basis. It was felt that this was an infringement on their individual rights. It was confirmed by the manager and through documentation, that such issues had been discussed in the service users meetings. Service users are fully supported through a risk assessment process to take risks as part of their independent lifestyle. It was recommended that individual’s wishes and feelings were documented within their care plans with regard to the recording of meals and any other documentation that was felt to be inappropriate. Service users are able to make their own decisions and are fully encouraged to do so through individual discussions, service user meetings and care planning. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Individual support is given by the staff team to ensure that service users are able to maintain appropriate and fulfilling lifestlyes in and outside of the service. EVIDENCE: Service users are fully supported in accessing education and occupation, with one service user currently studying with the Open University. Encouragement is given to access the local community and maintain relationships with family, friends and partners. From discussions with service users during the inspection it was confirmed that some would use the local pubs and leisure facilities. There is also access to services for individuals with specialist needs. Daily routines are planned around the service users individual needs and choices and were clearly described within the care plans. Service users purchase their own food with some able to prepare meals themselves in their own flats, with assistance given where required. All service Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 13 users have a budget of £32.00 per week for their food purchases; this is written into their contracts. It was pleasing to note during the service user meeting that some service users are encouraged to share taxi’s to go food shopping in order to minimise cost, some will shop via the Internet and others will use the local shops. Staff support service users in ensuring that they store and prepare foods safely and appropriate risk assessments are in place. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Appropriate support is given to ensure that service users receive support with personal, emotional and health care needs. Medication practices protect the safety of service users, however, some areas may not adeqautely promote individuals independence. EVIDENCE: From discussions with service users, staff and from documents viewed it is clear that service users are fully supported in their personal, physical and health care needs. Service users have a key worker who will accompany them to external appointments were necessary and will support them in accessing other services. The key worker role is new to the service; however, all service users were clear about who their allocated key worker was and what their role would be. Key workers had been allocated extra time to spend with service users on a weekly basis to ensure that care plans were up to date and that service users received time to attend to writing letters, payment of bills, cleaning and leisure time if they wished. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 15 Service users had clearly chosen their own GP and would access other services at a time that suited their own needs. Such choices were written within care plans. Medication is supplied by a major pharmacist who will deliver four weeks supply, blistered into easy to use packs for individual service users. All service users have their own supply of medication within their own flats, which is kept in a lockable tin. A member of staff on duty holds the key to each tin. It was noted that service users were more than capable of having their own key within their flats should they wish, this would empower them to have some control over their own medication. It is recommended that practices be reviewed to ensure that the service users wishes are taken into account with regard to the safe keeping of their medications. The service has a robust policy and procedure in place for the safe handling and administration of medications. The supplying pharmacist regularly audits them. Records were viewed to confirm this. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service has the appropriate policies and procedures in place to ensure that service users are able to air concerns and complaints and are protected against abuse. EVIDENCE: Service users felt that they were empowered in airing their concerns and complaints and were very clear that they would know who to contact and what their rights were in this area. At the service user meeting in March 2006, service users attending were shown a video regarding how to make a complaint; they were all given a copy of the organisations procedures. An independent advocate is available for any service users wishing to use this service. Service users are protected from abuse by appropriate staff training, an awareness of the reporting procedures in place and from the support of the manager and staff team. Service users are able to voice their own concerns if necessary. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Comfortable, homely flats are provided which suit the needs of the individual service users, however, further improvements would enhance the facilities available. EVIDENCE: Standard 24 was not fully assessed, as all of the flats were not visited during this inspection. Three of the flats were visited, with the fourth visit cancelled due to works being carried out. The flats visited were pleasantly decorated and reflected the individual occupant. Service users discussed that assistance had been given with choice of colours, furnishings and other decoration. At the time of the visit all flats had been fitted with a new sprinkler system to ensure the safety of service users in the event of a fire. During the service users meeting it was discussed that where workman had left orange pipe work, the manager would arrange for these to be painted within the next few weeks. A plan of further redecoration was available and evidenced on going works to further improve some of the flats. The two vacant flats were presently being Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 18 re-decorated in preparation for any new admissions; however, flooring would not be laid until after consultation with the new service users. None of the properties have been decorated externally and garden areas were looking a little overgrown. This was being addressed by the service, however, was a time consuming and costly exercise due to the number of flats. It was noted some service users would not be able to use their garden areas during the summer months due to uneven patios and paths. A requirement has been made for improvements in this area. Service users have assistance with the cleaning of their flats and a cleaning schedule is in place for each property, which is completed by the cleaning staff and checked and signed off by a senior member of the staff team. The standard of cleanliness in all of the flats seen was good and it was clear that service users receive appropriate support. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Shortfalls in staff training do not ensure that staff are aware of current practices and there for may put service users at risk. Recruitment practices in place protect the safety of service users. EVIDENCE: Service users are supported by an experienced staff team, most of whom have, or are completing, an NVQ in care. The training records viewed would indicate that some mandatory training is not up to date and staff to not attend many specialist-training courses in line with service users identified needs. A requirement has been made for improvements in this area. Recruitment practices are thorough and all appropriate documents are in place. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service is run in the interests of service users and allows them to be empowered in their choices and aspirations. EVIDENCE: The manager, Linda Ambrose, has been in post since September 2004 and was registered by the Commission in 2005. Ms Ambrose has achieved a level 4 NVQ in Care management. The manager has been proactive in meeting previous requirements made on the service and in developing the staff to meet and improve standards of care. Service users reported that, “The service has really improved”, “Staff are great”, “We are listened to” The manager and staff team have worked extremely hard in developing this service to benefit service users. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 21 The service has not received a major quality audit since the last inspection visit. However, service users have been invited to attend regular meetings and have been invited to comment on the running of the service. Quality standards have been produced in consultation with four staff and five service users and will be measured for compliance by the service users on 17th May 2006. As a result of this an action plan will be produced for further improvements to the service according to service user feedback. The manager is receiving visits from her line manager to monitor the service. Aprils visit was in progress at the time of this inspection. A copy of the report was received. The organisation is reminded that this visit must be unannounced. Safe working practices were observed. These would include the recording of the dangers of cleaning chemicals, water temperatures, use of equipment and safe moving and handling techniques. Service users discussed their frustrations regarding the water temperatures not being hot enough for washing up after a meal. It is recommended that the manager and service users liaise with the local health and safety officer regarding a possible resolution to this issue. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 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 2 X 3 X 2 X X 3 X Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 23 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 YA24 Regulation 23 Requirement It is a requirement that the organisation ensure that service users are able to safely access their garden areas and that they are maintained appropriately. It is a requirement that all staff receive mandatory training and training in specialist areas of care in accordance with the individual needs of service users. Timescale for action 31/07/06 2 YA35 18 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA7 Good Practice Recommendations It is recommended that further improvements are made to the presentation and content of care plans. It is recommended that individual’s wishes and feelings are documented within their care plans with regard to the recording of meals and any other documentation that was felt to be inappropriate. It is recommended that practices be reviewed to ensure that the service users wishes are taken into account with regard to the safe keeping of their medications. DS0000015066.V287686.R01.S.doc Version 5.1 Page 24 3 YA20 Milton Keynes Community Care Services 4 YA42 It is recommended that the manager and service users liaise with the local health and safety officer regarding a possible resolution to this issue regarding water temperatures. Milton Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 25 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 Keynes Community Care Services DS0000015066.V287686.R01.S.doc Version 5.1 Page 26 - 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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