Inspection on 05/07/05 for Milton Keynes Community Care Services

This inspection was carried out on 5th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

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

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

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 Maureen Richards Announced 5, 6, 12 & 13 July 2005 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 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 Stationary 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 H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Milton Keynes Community Care Services Address 1 Fletchers Mews, Neath Hill, Milton Keynes, Bucks, MK14 6HW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01908 660364 SCOPE Linda Ambrose Care Home 18 Category(ies) of Physical disability (18), Physical disability over registration, with number 65 years of age (2) of places Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for 18 people with a physical disability with up to 2 people over the age of 65 years. 2 Linda Ambrose That the registered manager, Linda Ambrose, is only granted to manage the registered part of the scheme. Date of last inspection 14 February 2005 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 eighteen 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. The properties are owned by Milton Keynes Council. Scope, the organisation, are tenants 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. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over four days. Two inspectors facilitated the inspection. Two days were spent visiting service users’ properties and the remainder of the time was spent in discussion with the registered manager, formal one to one meetings with four staff, examining records and viewing policies and procedures. All of the key standards and supplementary standards were assessed at this inspection and the progress made in meeting requirements from the last inspection was also established. What the service does well: What has improved since the last inspection? Some service users plans include a date of implementation and personal care plans shows evidence of service user involvement review and update. The safe storage and cooking of service user’s food has improved. Food is being labelled as it is opened and service users are made aware that out of date food should be disposed of. Out of date food is not been cooked by staff and food records indicate that food is generally being cooked to a safe temperature. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 6 The most significant improvement since the last inspection is in the level of cleanliness and presentation of individual service users properties. Cleaners have been employed specifically to provide cleaning of each property each week. A detailed cleaning schedule has been developed and the cleaning staff tick what tasks they have carried out. The senior staff team are responsible for checking that the cleaning has been carried out as indicated on the cleaning schedule. The manager and staff team have worked hard in achieving this standard of cleanliness in all of the properties. This level of cleaning must now be maintained and developed on. Redecoration and refurbishment of properties have commenced and a draft management agreement with Milton Keynes Council is in place. Attempts have been made to improve the initial appearance of the outside of properties with hanging baskets and potted plants in situ at the outside of properties. The manager and staff team have been proactive in meeting a high number of requirements from the previous inspection and can see the benefits of the changes to the service users and staff. What they could do better: Staff recording of information in service users’ files is of poor quality and training should be provided to enable staff to develop this skill. Effective monitoring of systems and records should commence. Service user plans must be further developed to ensure that all of the required information is completed and to ensure that information within the plan does not contradict other guidelines. Moving and handling risk assessments must be kept updated to reflect actual practice to prevent risk of injury to service users and staff. Individual service user risk assessments must be updated to specifically outline the behaviours that lead to a risk and clear guidelines must be put in place and followed to manage identified risks. The manager must be trained, supported to address bad practice and failure by staff to follow guidelines and procedures to ensure the health and safety of service users and staff. Service users files kept at the staff office must be kept secure. Challenging behaviour training must be accessed for staff to ensure that staff deal with challenging behaviour situations in a safe and consistent way. An effective system of recording outbursts of aggression should be put in place. Nutrition training for staff should be provided. The keyworker role should be further developed for staff to become more actively involved in the development of service user plans and formally contribute to service users reviews. All concerns should be logged and addressed as complaints. The manager should be included on the rota and the rota should indicate when she has assisted in providing personal care calls. The manager must ensure that safe recruitment practices are followed in relation to the appointment of all staff. The staff induction checklist for new staff should be signed off by the manager. The manager must ensure that all staff have up to date safe mandatory training including adult protection training. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 7 The organisation must develop an effective quality monitoring tool and ensure that monthly monitoring visits are carried out, reported on and a copy of the report sent to the Commission. Health and safety practices in relation to the storage of cleaning materials must be followed. Accident reporting and responses to accidents must improve to safeguard service users. Specific risk assessments and risk assessments relating to staff tasks must be developed. A system should be put in place to check driving licences of staff who are responsible for driving the organisation’s vehicle. During the visits to service users properties it was noted that internal doors were being wedged open. A requirement was made at the previous inspection for this to be addressed. The manager has been in discussions with the fire authority but to date this requirement has not been fully complied with. The policy and procedure manual should be reorganised and made more accessible and other files including risk assessments should be reorganised. 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 H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 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 standard(s) 1 & 3 The statement of purpose and service user guide is kept updated and provides service users and prospective service users with the relevant information to enable them to make a decision as to whether the service can meet their needs. The service has not had any new admissions however, there is an assessment process in place to ensure that prospective service users needs and changing needs of current service users can be met. EVIDENCE: The service has a statement of purpose and service users guide in place, which has been developed in line with standard 1.2. Both of those documents were reviewed and updated in May 2005 to indicate the staff changes within the service. A copy of the service users guide is given to service users and included with their service users plans, kept at their homes. A requirement was made at the previous announced inspection that the organisation must ensure that the service users guide includes the correct contact details for the CSCI local office. The service users guide has been updated to reflect this. A contract is included as part of the service users guide. The contract does not specifically outline the fees paid by individuals. Service users are informed of their contribution by letter or email during April of each year. Some service users files contained a copy of this letter, whilst others did not. The manager Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 10 should ensure that a copy of the letter, or email to notify of fees to be paid, is kept on file to support this. The manager confirmed that the outcome of inspections is discussed at service users meetings and copies of inspection reports are made available to service users if required. Some service users access the inspection report from the Commission’s website. No service users are currently being admitted to this service and as service users move on or deregister, the service is being reduced to a more manageable size. The manager confirmed that, if any new service users were being admitted needs would be assessed prior to admission and the necessary support, equipment and specialist input would be accessed on admission. As the current service user group’s needs change, specialist services are accessed as required. At the time of the inspection one service user’s needs were being reviewed with a view to moving on from the service, as the service felt no longer able to meet that individual’s needs. The service currently has no service user from a specific minority ethnic group however, the manager feels this would be established prior to admission and the necessary support and information accessed to meet that individuals needs. The service has a diverse staff team who would assist in understanding needs. Some service users use aids to assist their communication and other service users are able to communicate verbally. The manager confirmed that staff have some needs led training but Scope do not provide training on specific physical disabilities. The manager confirmed that prior to any hospital discharges the service users needs would be reassessed to ensure that they can continue to meet that individual’s needs and to ensure that any necessary specialist input or equipment is accessed prior to the person being discharged. The manager confirmed she would not offer a place to someone whose needs they cannot meet and the service does not accept respite or emergency admissions. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7,8,9 & 10 Detailed personal care plans are in place, which show evidence of being reviewed and updated. Some information and guidelines within the service users plans were incomplete and or contradictated other guidelines which could potentially put service users at risk. Service users are supported to make decisions. They are consulted and participate in all aspects of life in their home, which allow them to live as independently as possible. Risk assessment guidelines and moving and handling guidelines are not being followed, which puts service users and staff at risk. Policies are in place to ensure the confidentiality of service users is maintained however, service user files are not kept secure which compromises service users confidentiality. EVIDENCE: Five service users plans were viewed at this inspection. The plans include personal details information, including contact details for health professionals and specialists involved with individuals and an assessment of abilities. The majority of the files seen did not have the information on health professionals Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 12 completed and some of the assessments of abilities were now out of date and contradicted other information within the plan. Information on likes, dislikes and allergies was not completed on some plans. Each service user plan included a personal care and physical support needs plan. These were detailed and specific as to the care required in supporting individuals during each call. These showed evidence of being reviewed and personal care plans showed evidence of being updated as service users needs changed. A duplicate copy of this plan is kept in service user homes, which is signed by the service user and shows evidence of their involvement in the development of the personal care and physical support needs plan. As personal care and physical support needs plans are being updated they include the date of implementation. Requirements made at the previous inspection for service user plans to include a date of implementation, evidence of discussion and involvement of the service user, date and evidence of a written review has been complied with. Further work is now required to develop service user plans and to ensure that all relevant information is completed and that information within the plan does not contradict other guidance. Overall, the recording within service users plans was found to be poor with inappropriate descriptions used, which were evidential of bad practices. Recording practices showed gaps in entries although the manager stated that she monitors service users plans and a central record is kept to confirm this. However, the manager should consider directly recording monitoring visits on service users files rather than maintaining a central file that does not immediately confirm monitoring checks. Service users live in their own properties and make their own decisions on dayto-day issues. Staff provide support as required to assist them with their decisions. Staff support service users to make telephone calls and assist with communication, as required. Information on advocates is available and displayed at the resource centre. Service users make their own decisions and choices and decisions are only made by others and the organisation for health and safety reasons. Service users manage their own money. One service user has a friend who supports him to manage his money but this is currently being reviewed and his funding authority is to take responsibility for managing his money. One service user gets themselves into financial difficulties and requires the support of the staff to deal with this. This must be outlined within a risk assessment framework. Scope do not act as appointee for any of the current service user group. There are no limitations on facilities as service users live in their own homes and have access to all areas of their homes. Service users feel there are restrictions on their choices and human rights from requirements made by the Commission at previous inspections to bring this service up to the standards required of a Registered Care Home. Service users are actively involved in the day to day running of their homes. Service users are invited to contribute and comment on draft local policies. New policies, day to day issues and changes within the service are discussed at Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 13 service users meetings. Service users meetings are held monthly and minutes seen confirm this. There is a low attendance of service users at those meetings despite service users being informed by letter or by e-mail. Minutes of the meetings are distributed to all service users after the meetings. Service users are involved on interview panels and in the decision making process at the end of the interview. Service users plans included moving and handling assessments and generic and specific risk assessments. All risk assessments showed evidence of being reviewed, however one moving and handling risk assessment showed evidence of being reviewed but had not been updated to reflect the change in two staff now being required to meet this individual’s moving and handling needs safely. This is unsafe practice and puts staff and service users at risk. One file included a risk assessment on the management of aggression. This risk assessment did not outline the form of aggression. The action is for staff to leave the flat and to record on the log book. Handwritten notes written on scrap paper, found in the file, indicated that staff had not actually followed those guidelines. In one case the staff member’s behaviour escalated the situation and in the other incident the staff member decided to confront the service user and the staff member responded verbally in an inappropriate way to the service user. Both of those situations put the staff and service user at risk by their actions and not following agreed guidelines should have lead to appropriate action being taken against the staff member by the organisation, which did not happen and was not even discussed as being an issue with the person concerned. The manager confirmed that incidents are now recorded on an incident form and not on torn and loose sheets of A4 paper. The manager confirmed there have been no further incidences since the introduction of the incident reports to confirm this. This risk assessment must be updated to outline what form of aggression is displayed and how it is to be managed. The use of an ABC chart would be helpful in recording the outbursts of aggression as it records the antecedent to the behaviour, the behaviour displayed and the consequence of the behaviour. This would also be helpful in tracking incidences of aggression for discussion at reviews. The generic and specific risk assessments are filed together and the risk assessment on the management of aggression was not easily accessible and was filed among the generic risk assessments. Specific and generic risk assessments should be filed separately and made more accessible. The service has a local policy on responding to unexplained absences by service users. The organisation has a confidentiality policy in place. All staff sign to say that they have read and adhere to the rules on confidentiality. The service users guide makes reference to the rules on confidentiality. Service user files kept at the staff office are stored on a shelf. A requirement will be made to make service user records secure. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 14 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 standard(s) 12,13,15,16, & 17. Service users are able to access education and community facilities as required which enables them to develop their own interests and hobbies. Links are maintained with families and friends subject to service users wishes and within a risk assessment framework to ensure the safety of service users. Service users rights are respected, independence is promoted, and choices are taken into account, which allows service users to have some control over their lives, whilst ensuring their health and safety is maintained. Service users are actively involved in shopping for and choosing their meals, which allows them to have meals of their choice which in some cases is not nutritious and balanced and could potentially compromise their health. EVIDENCE: With the exception of one person who has a voluntary position within the resource centre, no person residing at the service is currently employed within a work placement and no service user currently attends a training scheme. Until recently one service user has been undertaking an Open University Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 15 Course. It was stated that key workers would support service users to find courses that would interest them. Service users undertake activities of their choice, some of which are of long standing interest. Some service users are funded for day care for some parts of the week and attend the resource centre. One service user visits local schools to educate the children about his lifestyle. Should service users require support to manage their benefits or have finance queries, a member of the administration staff is available to guide them. Staff support service users to orientate to the local community and the amenities found within Neath Hill as well as the more cosmopolitan amenities found within Milton Keynes town centre, which is a short distance from the service and accessible by wheelchair. The service also has its own transport, which enables service users to access routine healthcare and medical appointments. The communal transport, which was noted as bearing no livery, also enables service users to travel to their holiday destinations with comfort. The service is accessible to the local bus service, which accesses all parts of Milton Keynes and Bletchley. Service users are paid mobility benefits. Where people require support to access services, this is generally funded by their sponsoring authority and service users are provided with key time if this is funded by their sponsoring authority. Service users’ homes are situated throughout Neath Hill, which is a diverse community and are placed amongst a combination of local authority and privately owned homes. Service users confirmed that they had good relationships with their neighbours. Within the resource centre and prominently displayed, was information that enabled service users to access community based activities and service users are able to access information that is posted within the local centre at Neath Hill as well as in the town centre of Milton Keynes. Service users are politically active and are encouraged to exercise their civic rights. This was evidenced via recorded discussions held on the notes that pertain to service users meetings. It was apparent from discussions with the manager, staff and some service users that staff’s ethnicity presented as a real issue and the organisation really does have a duty to ensure that the principles of equality that apply to service users must also be promoted for the benefit of staff’s protection from abuse. All initiatives, activities and pastimes undertaken by service users are diarised so that sufficient staffing to support participation may be arranged. As service users live in their own homes there are no visiting times per se. Service users choose who they wish and do not wish to see and are able to invite friends and family to stay. During the last inspection of the service, where the Commission perceived a service user to be at risk as personal care calls were cancelled to facilitate visitors, a risk assessment with agreed control measures was confirmed to be in place. By virtue of the fact that service user reside in their own homes within a diverse community they are able to make friends and develop platonic and personal relationships with whom - ever they choose, without reference to the organisation. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 16 Service users have control over allowing admission and egression to their flats as the majority of front doors are fitted with electronic door closures. Some service users are able to open their own doors and all service users have keys to their properties. Service user’s personal care call times are agreed in line with packages of care, however these are flexible to within reasonable timescales. Service users would be expected to notify their carers should they require a variation in their call time. There is an expectation that staff make their presence known to service users prior to entering properties and all doors are fitted with an intercom system. Personal mail is delivered directly to service users and guidance is outlined within their plan of care as to the support required to manage their mail. Preferred forms of address are outlined within the plans of care. Service users choose when to participate in the local community. Some service users have pets and, to date, there are no restrictions on this. However, there are plans to change this arrangement and this will be clearly identified on the service users guide. In future, although cats will be permitted, dogs will be prohibited. The rules on smoking, alcohol and illicit drugs are outlined within their contracts. All properties have a small integral kitchen area, which are fitted with a range of base level and eye level cupboards and domestic white goods such as a cooker, fridge/freezer and microwave. All meals are prepared by staff or service users. Three meals, of service users choice, are served each day. As service users live in their own homes they are able to access, with staff support, drinks and snacks of their choice. The manager made assurances that service users’ nutrition is promoted although no staff training on nutrition was apparent but service users do have access to a dietician, as their needs dictate. The manager should consider providing staff with a personal development opportunity to learn about nutrition and ensure that it is facilitated by a qualified dietician. As part of the initiative to ensure service users’ nutrition the manager stated that she regularly checks food records and also stated that staff would make her aware of any difficulties in relation to service users eating habits. Food records indicated a high level of processed food in use although it was acknowledged that some meals may have been home cooked. Records need to indicate where the meals were home cooked. Food records were evidential of gaps in the recording practices although the majority of food temperature records recorded were within safe levels. There was a notable improvement in the storage of food and staff were indicating on labels placed on the products when they had commenced using them. There was no perceived overstocking of food and all were noted to be well within their sell/ use by date. Some service users purchase bulk ready prepared meals, which are nutritionally balanced. Some service users are assisted to eat and the level of support required is identified in the service users plan. The manager confirmed that there is time included within the calls to ensure that meal preparation and support to eat is Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 17 ample. At the time of the inspection the service had one service user on a reducing diet and one service user who required a teaspoon of salt in their diet each day to meet their special clinical needs. Eating aids are supplied as required and service users who have been unwell are supported in their dietary needs. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 18 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 standard(s) 18,19 & 20 Service users preference on personal care is taken into account and provided, which allows service users some control over their lives. Service users are supported as required to access healthcare provisions that meet their individual healthcare needs. The medication at the service is well managed, which promotes good health and safeguards service users. EVIDENCE: Service users plans outline the level of support required by individuals in meeting their personal care needs. Privacy and dignity is promoted by virtue of the fact that properties provide single accommodation, except where a couple are married. Gender preferences are observed when direct care is given and is factored into the individual call schedule. Rising and retiring are the prerogative of individual service users and the terms of intimate personal care is as advised by the service user. Personal hygiene is promoted and service users are supported to wear clean clothes. Individuality regarding hairstyles and make up is clearly promoted. Service users are able to choose which staff support them with their personal care and day to day running of their homes although as previously reported the organisation needs to maintain the issues Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 19 of staff ethnicity and the duty it has to protect staff on the organisational agenda. Each service user is allocated a keyworker who provide one to one key time to those service users whose sponsoring authorities finance this. The keyworkers are currently not involved in care planning and reviews. It is a recommendation of the report that keyworkers become involved and contribute to the care planning and reviewing process. Aids and equipment, as assessed, are fitted throughout the properties to ensure the secure and safe independence of service users. Service users have telephone and/or handsets fitted in their properties. Occupational therapy input is accessed via GP referral. No service user currently residing at Neath Hill has speech therapy input and one service user has had their swallowing and reflex needs assessed by a physiotherapist. The majority of service users attend to their own healthcare needs and are registered with a GP of their choice. Service users make their own appointments and take themselves to the surgery unaided unless the communal transport is required. Service users are supported by staff to arrange their own healthcare appointments and a record is maintained on individual files of the appointments they are supported to attend. The manager advised that the organisation does not arrange for service users to have minimum annual health checks as they take ownership of their own general healthcare. Service users who require general nursing are referred via the GP. A community psychiatric nurse supports those service users who require it. Continence advice is sought from a district nurse who is also the continence advisor. The manager stated that all service users have had a continence assessment carried out by the advisor however, the outcomes of the assessments are yet to be made available to the manager. Service users generally visit the GP at the practice therefore ensuring that their privacy and dignity is promoted and maintained. Should a home visit be required consultations take place within the privacy of individual properties which further maintains privacy and dignity. Medications are kept within service users’ individual properties and are held in secured metal containers. Access to medications is available to staff only for medications administered by staff. All medications administered are indicated by staff’s signature on a medication recording sheet which also records the date and the amount of medications delivered to the service and there - after to the service user. Recording practices were found to be very good with only one perceived gap evident. Some service users self-administer their medications and these were managed within a risk assessment process. Service users files contained a completed medication assessment form to ascertain what level of support was required by service users when administering their medication. However, of the five completed assessment forms seen, two overall conclusions contradicted the information recorded within the main body of the assessments. Where the main body of the assessment indicated that service users were or were not Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 20 capable of self administering medications the overall conclusion contradicted the findings, leading to confusion and potentially unnecessary risks to service users. Medications that are subject to control measures were noted to be appropriately managed with counter signatures in place. The manager stated that a record is kept of all medication disposed of. This aspect of the standard was fully assessed at the previous announced inspection of the service. There is a list of staff who have been trained and assessed to administer medications in line with the organisation’s policies and procedures. Staff training records evidenced that they are observed administering medications on three or four separate occasions before being assessed as competent to administer medications without reference to a team leader or senior staff member. The question of frequency of assessments was posed to the manager who stated that staff are reassessed on an ongoing basis as medicationrecording sheets are checked and any errors would be ascertained quickly and traced back to the staff member who had administered the medication. The manager described the procedure for managing poor practice in relation to medication practice. Bank staff do administer medications and are subject to the same assessments as permanent staff. One of the senior staff team is responsible for ordering medications and there are plans in place to cascade this knowledge to the residual staff team. Where there is a change to a service users medication mid cycle these are supported by handwritten guidance on the medication administration sheets and/or a letter from the GP to confirm the change. The organisation’s medication policy was developed in March 2004 and was reviewed in September 2004 and March 2005. The policy complies with the requirements of the standard. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 21 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 standard(s) 22 & 23 The service has a complaints procedure in place, which is accessible to service users, however the recording of concerns and complaints needs to improve to ensure that all concerns raised are addressed. The service has adult protection and whistle blowing policies in place, which safeguards service users against the risk of abuse, however staff practice in relation to the management of aggression potentially puts service users and staff at risk. EVIDENCE: The complaints policy and procedure has been updated to guide service users in the process of making their opinions known and who they need to refer their opinions to with an outline of the timescale for response. The complaints procedure is included within the service user guide. Although no complaints have been received by the Commission during the time under review one complaint was recorded as having been received by the service. Evidence suggests that complaints are responded to within twenty- eight days. The Regulation 26 visit report for April 2005 outlined a concern raised. Unfortunately, it was not possible to track the concern through to the complaint file and the manager explained that this was a discussion between the service manager and the service user and was not considered to be a formal complaint rather than an ongoing issue. A complaint referred to within the Regulation 26 report of 28th April 2005 was noted as having been made on the 29th April 2005. It is advised that the service manager concisely records all complaints. This means that the difference between a complaint and a comment needs to be defined and that all concerns are clearly dated. Staff training records indicate that some staff have had training on the management of complaints and comments, which took place in 2002, 2003 Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 22 and one member of staff in 2004. This training is rescheduled to take place again in August 2005. An adult protection policy is in place, which has been updated in line with interagency procedures. The manager confirmed that a copy of the policy is centrally placed within the staff room to ensure easy access to the information and for reference purposes. Two instances of adult protection have been reported over the last twelve month period. One remains unresolved since May 2005. Adult protection training is outstanding for three staff and updates are overdue for five staff. The manager confirmed that this is due to take place but no date is yet scheduled. Staff spoken with had a clear awareness of their duty to report instances of actual or alleged abuse. There is a behaviour management policy (including restrictive physical intervention) in place which was commenced in February 2004. As already outlined in standard 9, the service has one service user who displays aggressive behaviour. The recording of information on the service users file indicate that instances of aggression are not being managed effectively resulting in an unnecessary risk to the service user and staff. To date, no training is provided to guide staff on the management of challenging behaviour and reports assessed were evidential of the inappropriateness of staff responses resulting in an escalation of aggressive behaviour. It is a requirement of the report that training in the management of behaviours that challenge is arranged to take place to address practice deficits. The whistle blowing policy and procedure, which was commenced in August 2004 includes a flow chart to guide staff in the raising of concerns. The policy guides staff about the type of poor practice that should be reported and the levels of support staff making the report could expect from the organisation. The policy on the management of service users finances has not been updated since 1998 and it is believed that this document is now in the process of being reviewed. Service users assume responsibility for the management of their personal finances and the finance officer confirmed this to be the case. Staff are given personal copies of relevant policies and procedures. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 23 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 standard(s) 24 & 30 Individual properties are in the process of being refurbished, redecorated and updated to ensure that service users live in a safe, homely and maintained environment. The level of cleanliness in service users properties has improved, which ensures that the health and safety of service users is being maintained. EVIDENCE: Milton Keynes Community Care Services (MKCCS) is situated in the Neath Hill area of the new town of Milton Keynes, with easy access to the A5 and M1 motorway. MKCCS does not fit the conventional model for care homes in that, although it is registered as such, the younger service users who are provided with care and support live in their own properties, which are owned by Milton Keynes Council and rented by Scope. At the time of this announced inspection eighteen service users were being provided with care and support from staff who are employed by Scope, an organisation with charitable status. Fifteen properties are currently rented by Scope and there are plans in place to further reduce that number to thirteen properties. There are three properties Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 24 immediately adjacent to the resource centre and the remaining properties are dispersed throughout Neath Hill, a culturally diverse area of Milton Keynes. With service users’ permission all properties were visited over the course of two days. The general layout of the properties consist of: • • • • • • A sitting room/dining area Adjacent kitchenette Bathroom A large bedroom Some integral storage space A small airing area where most washing machines were housed. Some properties were surrounded by gardens and all were fitted with easy access, including ramp access and handrails. The general presentation of the properties had improved since the last unannounced inspection, which took place in February 2005. In partnership with the Council, the organisation has now, further to requirements, initiated a programme of redecoration and refurbishment of the properties. All properties are decorated and furnished to individual tastes and were clearly evident of the personalities, hobbies, interests and family contact maintained by service users. It was noted that some effort had been made to ensure that gardens were maintained and hanging baskets were placed in some properties, ensuring that visitors felt welcomed. No external decoration has taken place for some time although it was acknowledged that this may be undertaken as part of the general external refurbishment of properties. As properties are being redecorated and updated Scope appears to be working with service users to ensure that environments are made comfortable with some furniture being replaced. At the same time, Scope continues to promote individuality by enabling service users to retain the furniture that belongs to them, within a framework of health and safety. An enforcement notice was issued in March 2004 for doorways to be widened to allow service users easy access to all areas of their home. This was to be complied with by the 17th May 2004. The organisation has identified one person whom they have assessed as requiring this. A referral has to be made through the GP to the occupational therapy department for this. A copy of the letter to the GP was seen to confirm this. There is currently no time limit on how long it takes for the assessment to be carried out and therefore this enforcement notice, remains outstanding. Standards of cleanliness had generally improved. Since the last inspection of the service cleaning staff have been employed by the organisation through an agency and also via direct recruitment to the staff team. With the exception of one property, four hours per week are allocated to the cleaning maintenance of each property. On this occasion the general presentation of the properties was much improved and it was apparent that the regular dusting, polishing and vacuuming undertaken by the cleaning staff was beginning to ‘pay dividends’. There is still some progress to be made with this aspect of service delivery but a promising start has been made. There is now a cleaning schedule in place, Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 25 which is completed by the cleaning staff and monitored by the senior staff team. A senior member of the team has responsibility for overseeing a group of properties, making monitoring easier. The service has a health and safety manual in place and local health and safety policies and procedures are developed and discussed at service users meetings. One service user expressed dissatisfaction with the Commission’s requirements, which has led to the introduction of gloves and aprons for staff and in particular in the use of gloves to assist with eating. The service user was informed that this was not a requirement of the Commission and was a health and safety requirement imposed by Scope. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 26 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 & 36 The home has sufficient staff to meet service users needs. Some recruitment practices could compromise service users safety. Staff do not have all the required up to date mandatory training, which potentially could put service users at risk. Staff feel supported and are supervised in their roles, which should enable them to work effectively to benefit service users. EVIDENCE: At the time of this inspection the service had no staff vacancies. There are two team co ordinators and three seniors and the manager aims to have a senior or team co ordinator on each day time shift. There are two carers on waking nights. The team co ordinator or senior is identified as the shift leader on the rota and they are aware that they are responsible for organising the shift. The manager confirmed that she aims to have seven staff on the am shift with one person “floating” and five staff on the afternoon shift with one person “floating”. The person who is floating covers the unplanned calls, medication administration and any other specific tasks that they are responsible for. The staffing levels are reviewed and changed as service users needs changes and if there is a temporary reduction of service users on the service. The rota seen supports this. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 27 The service has two agency cleaners and one cleaner employed by Scope. Staff support service users with shopping and cooking as agreed, as part of their package of care. The manager is supernumery and therefore has allocated administration time available. She confirmed that she covers short notice sickness in providing personal care. The manager is not actually named or included on the rota to confirm this. The manager should include herself on the rota so that the rota accurately reflects the staff on duty to include the registered manager. The manager confirmed that the team co ordinators and seniors also have allocated administration time made available to them. The manager and team co ordinators provide back up on call. At the time of the inspection the service was not using any agency staff to provide personal care and have three named bank staff to cover short notice sickness and holidays. The manager confirmed that the sickness levels varied and that there was a “return to work interview” in place to attempt to address persistent sick leave. The service has had a high turnover of administration staff since the previous announced inspection last year and one member of staff has left since the unannounced inspection in February 2005. The service has a large proportion of staff employed from other cultural backgrounds, which reflects the cultural composition of the community but does not reflect the cultural composition of service users. There are no staff under 18 or under 21 years of age employed at the service. The manager and staff confirmed that monthly team meetings take place and staff are encouraged to contribute to the agenda for those meetings. Team meeting minutes were seen, which shows evidence of discussion on service user and organisational and local initiatives. The manager confirmed that staffing levels are reviewed to reflect needs, as they dictate. Four staff files were seen at this inspection. The staff files seen contained a personal detail information sheet, a photograph, next of kin details, signed confidentiality slip, job description, statement of particulars, application form, offer letter, copies of interview assessment and a copy of the staff member’s passport. Some files contained a completed medical questionnaire. All of the files seen included two references and three contained confirmation of CRB clearance. One staff file had a CRB from her previous post. This was agreed as being acceptable by the Commission, however Scope is required to carry out their own CRB check on this individual, as CRB’s are no longer portable. One file contained a home office letter to confirm residency, however another file had no confirmation or visa to confirm residency. This must be addressed and the manager must ensure that this information is obtained and maintained on file for all staff who require it. The service has two agency cleaners. The service had copies of two references for one of the cleaners and a CRB dated June 2003. The service has a copy of one reference for the other cleaner and a CRB dated June 2004, which was not carried out by the supplying agency. The manager must address this with the Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 28 agency and ensure that confirmation of two references and relevant CRB are obtained. Staff’s personal development files and a new staff member confirmed that all new staff complete two weeks induction. On the first week they are not included in the rostered numbers and familiarise themselves with key policies and procedures and on the second week they work alongside an experienced member of staff in providing personal care. Staff files include an induction checklist, which is signed off by the staff member. This should be signed off by the manager to confirm completion of induction and competency of the staff member. All new staff receive moving and handling training and assessment prior to providing personal care and are assessed in calls to each service user prior to doing those calls unsupervised. The training records seen indicate that updates on this training is now overdue for some staff. All personal care calls require the use of moving and handling equipment and therefore up to date training is essential to ensure the health and safety of service users and staff. The training records seen indicate that a high percentage of staff have had first aid training, which allows for a first aider on each shift. The majority of staff have had food hygiene training although refresher training and updates are overdue for some staff. The service has recently had fire awareness training but there is still a number of staff who require this training. A requirement was made at the two previous inspections that all staff must have up to date fire awareness training. This has not been fully complied with. The manager confirmed that disability equality training is scheduled to take place in August 2005. Each staff member has a training file kept in the office and which are accessible to staff at any time. Copies of certificates of training are kept on file and the originals are kept by the staff member. The manager does not carry out a training needs assessment, however the main aim for this year has been to commence NVQ training for staff. At the time of this inspection twenty care staff and seniors were working towards an NVQ award. The manager confirmed that Scope does not have an annual training and development plan. Mandatory training is provided as required and through external trainers. Scope does not provide any specialist training or user needs led training and this has to be accessed by each service, as required. The manager confirmed that she has a budget for training and can access the necessary training, as required. All staff spoken with confirmed that they receive formal supervision. The manager supervises the team co ordinators, seniors, handymen and administration staff and the team co ordinators are responsible for supervising the care staff. Staff receive at least six supervisions a year. The team co ordinators have attended supervision training. All staff receive annual appraisals although Scope has recently reviewed its appraisal system and staff are now assessed around core competencies. Training is being provided to aid staff’s understanding of this prior to the annual appraisals taking place. All staff are given a copy of the disciplinary and grievance Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 29 procedures on commencement of their induction. Induction records and staff files confirm this. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40 & 42 The manager continues to develop in her role in the management of this service, however the manager needs to be supported and trained as necessary to deal with poor staff practices to ensure the safety of service users and staff. Effective quality monitoring systems should be further developed to ensure that a high standard of care is being provided and maintained. Some health and safety practices compromise service users’ safety. EVIDENCE: The manager has recently been registered by the Commission as the registered manager for the registered part of the scheme only. The manager confirmed that the service manager is now responsible for managing the resource centre, as a condition of registration is attached to this registration that the registered manager is registered for the registered part of the scheme only. The manager has been in post since September 2004 and has achieved Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 31 an NVQ 4 award. The manager’s job description sets out her responsibilities as a registered manager. The manager confirmed that she is responsible for a budget and is involved in development of the annual budgets. The manager has been proactive in developing local policies and procedures and in ensuring that service users are made aware of any changes in procedures. Certificates and licences are displayed in the entrance to the resource centre. The organisation has insurance to cover staff who drive the minibus. The manager has a copy of staff licences on file. This file was disorganised with out of date information. There is no system in place to check staff’s driving licences on a regular basis and this should be addressed to ensure that staff who drive the organisation’s transport are legally able to do so. The manager and staff team have worked hard in meeting requirements in relation to the cleaning of the properties and in getting properties refurbished and redecorated. At the last inspection the manager felt unsupported by the organisation in managing this service. The manager answered “yes” and “no” when asked if she feels she is now being supported. She confirmed she has had one formal supervision since the last inspection in February. This supervision took place in April 2005. The manager confirmed that she recently attended a management training programme facilitated by Scope. She confirmed that she attends all mandatory training, although some of this training is now overdue. There were two incidents where staff did not follow guidelines and their actions puts themselves and service users at risk. Those incidents were not addressed appropriately by the organisation. Staff confirmed that they feel supported and are able to air their views through one to one supervisions and team meetings. Staff feel that their views are listened to and acted on. Staff confirmed that they can see the improvements within the service and can see the benefits of the requirements made by the Commission to develop this service. Staff confirmed that they feel the manager is approachable, although they stated that they do not see her out on the service, and been involved in the day to day running of the service. Under standard 33, a recommendation has been made for the manager to include herself on the rota, which may assist in addressing this. Senior staff have other responsibilities and are encouraged to develop in their roles. The service has an equal opportunities policy and disability awareness training is provided for staff, however as outlined in standard 13 staff are subject to abuse from service users in relation to their ethnicity and this is not being addressed. The service has a plan in place for the development of this service mainly linked to the improving of the environment. The team leaders and senior staff carry out monitoring visits to each property and the manager confirmed she carries out separate monitoring visits, which are recorded as ticks for each area monitored. A recommendation has been made under standard 6 for the Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 32 outcome of monitoring visits to be recorded on service users files so that it is more meaningful and easier to track. The organisation does not have an annual quality audit system. A recent service user questionnaire was carried out and the results published. Service users completed the questionnaires on their own or with staff support, if support was required. Staff and relevant professionals were not consulted as part of this process. A requirement was made at the previous announced inspection that the organisation must ensure that an annual quality audit takes place, which is carried out by someone independent of the service and seeks feedback from staff, service users, families and other relevant professionals involved with the service. This has not been complied with. The service manager is responsible for carrying out Regulation 26 visits. The Regulation 26 records indicate that no visit was carried out in May. Copies of the Regulation 26 visits are not being sent to the Commission following the visits and the copies of the reports for April and June were only received after an email and a letter was sent from the Commission to request them. This is in breach of regulations. Service users were informed of the announced inspection and a high percentage of service users completed comment cards. One service user requested to meet with the inspectors and other service user talked to the inspectors during the visit to their homes. Significant progress has been made in the development and progress with requirements since the previous unannounced inspection. The service has organisational policies and procedures in place and local polices are developed as required. Not all polices were viewed on this inspection. Some policies seen were overdue for review and some were in the process of being reviewed. The service has a policy folder, which was not easily accessible to staff and staff were unable to locate requested policies within this folder. The policy folder should be reorganised and made more user friendly and accessible. The service user guide includes the key policies and service users are informed of new polices at service users meetings. Service users are encouraged to contribute to the development of local policies. Organisational polices are dated but they are not signed by the organisation. Staff are asked to read policies and procedures as part of their induction, however some staff practices as outlined in standards 6, 23 and 42 indicate that staff are not always following policies, procedures and, in particular, guidelines for individuals included in service users plans, which puts service users and staff at risk. As outlined in standard 35 moving and handling and fire safety awareness training is outstanding for some staff. The manager confirmed that there is a first aider on each shift. There is a first aid box in each property and the manager confirmed that the contents of the first aid boxes are checked as part of health and safety checks. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 33 The majority of staff have attended food hygiene training and the majority of records seen indicate that food is cooked to a safe temperature and stored and labelled appropriately. The service has a system in place for the annual gas servicing of each property. Records are on file to support this. The service has records in place to confirm that moving and handling equipment has been serviced and a label is visible on the equipment to support this. The home has up to date records for each property of portable appliance testing. The service had a fixed lighting check carried out in each property in 2003. The council advises Scope that the fixed lighting check should be carried out every ten years. The fixed lighting check should be carried out every five years in a residential care setting and Scope will need to address this with the council. The service carries out a monthly check of the smoke alarm, a battery check of the alarm, shower head clean, water temperature checks, fire door check, window check and front door and door opener checks. Those records were found to be up to date. The majority of the properties have had thermostatic controls fitted to the water outlets and the water temperatures indicate that those are being maintained at a safe level. Service users continually express dissatisfaction with the water temperature and commented that, by the time their bath is full, the water is cold. One flat has not had a thermostat fitted and a risk assessment has been completed to indicate this is considered a low risk to those individuals. Some radiators have been covered and exposed copper piping has been covered. The service carries out a monthly intercom check, which the manager confirmed was meant to be daily, however there was lots of gaps in the recording of those daily checks. The manager confirmed that these checks were being carried out daily when they had problems with the intercom system and the checks were no longer required daily. The record should therefore be updated to indicate this. Services user files contain individual risk assessments in relation to health and safety issues. During the visits to services users’ properties it was noted that latex gloves were easily accessible to service users. A risk assessment must be carried on each individual to establish the risks of being able to access the latex gloves and causing injury to themselves. The service has a range of risk assessments in place, however there are no risk assessments in place regarding the risks to staff in the course of their work, for example, lone working. The manager should brainstorm with the staff team what activities they are involved in and a range of risk assessments must be put in place to reduce the risks posed by those activities. The service has COSHH data sheets in place. The manager confirmed that duplicate copies of this information is kept in the services users home, staff office and in cleaning cupboards. During the visit to properties it was noted that hazardous cleaning materials were left out. During the visit to properties it was noted that an overhead door closure has been fitted to the sitting room doors of some properties. In other properties door wedges were being used to prop this door open and door wedges were Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 34 being used to prop open the bedroom and bathroom doors in the majority of properties to allow service users access. The manager has liaised with the fire authority to get advice on using fireguards. To date this had not been confirmed in writing from the Fire Authority. An enforcement notice was served in March 2004 for the organisation to meet the requirements of the Fire Authority as outlined in their report of 24th January 2003. The manager advised this has not been fully complied with due to conflicting advise from the fire authority as to what is the most suitable system for this service. The manager continues to liaise with the fire authority on this and she must keep the Commission updated on the progress with this outstanding enforcement notice. The fire risk assessment on each service user file outlines that the sitting room door must be closed at night to reduce the risks to service users. Accident records are maintained on a pre printed proforma. Service users and staff accidents are filed separately in the same folder. The accident form should be completed by the person witnessing the accident and is signed off by the health and safety person and then signed off by the manager. The accident records seen indicated that not all accidents were responded to by the health and safety person. There was a delay in responding to some accidents and some accident reports were not signed off by the manager. In the staff accident section of the file there were accidents to staff, which also related to service users but were not cross-referenced in the service users section of the accident report file. One member of staff had injured themselves whilst providing personal care to a service user. This is a two-person call, which was carried out by one member of staff resulting in the injury. The health and safety person had outlined this on their section of the accident report form but no action was taken against the staff member for not following health and safety guidelines in relation to providing care to this individual. There has been four accidents concerning service users since the previous inspection in February 2005. Two of those accident reports were as a result of poor practice by staff. One of those accidents report indicated that a service user had fallen through the hoist straps and banged his head. The service user was checked for injury by the staff member and the decision was made not to seek medical advice or inform the on call person. There were no further monitoring checks put in place to observe this individual following the injury and no Regulation 37 form was completed to notify the Commission of this accident, which affected the well being of the service user. Regulation 26 visit reports indicate that accident reports and books are up to date, however the reports were found to be incomplete. Moving and handling issues resulting in accidents were not followed up on, medical advice was not sought and Regulation 37 reports were not completed. The manager is required to address those shortfalls as a matter of urgency. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 35 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x x Standard No 22 23 ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 1 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milton Keynes Community Care Services Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 x 1 x H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 36 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 6 Regulation 15 Requirement Service user plans must be further developed to ensure that all required information is completed and to ensure that information within the plan does not contradict other guidance. Moving and handling risk assessments must be kept updated to reflect actual practice. Service users risk assessments must be updated to specifically outline the behaviours that leads to a risk and clear guidelines must be in place and followed to manage identified risks. The manager must ensure that bad practice and failure to follow guidelines and procedures by staff is dealt with appropriately. Service users files must be kept secure. Challenging behaviour training must be provided for staff to ensure that staff manage challenging behaviour situations safely. The organisation must ensure that the statutory requirment to have doorways widened is complied with.( enforcement Timescale for action 30th September 2005. 2. 9 13 31st August 2005. 31st August 2005 3. 9 13 4. 9 & 37 13 31st August 2005 31st August 2005 30th September 2005. 30th October 2005 Page 37 5. 6. 10 23 17 13 & 18 7. 24 23 Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 notice of May 2004 not met) 8. 34 19 The manager must ensure that the schedule 2 information is obtained for all staff including agency staff working within the service. The manager must ensure that all staff have up to date moving and handling, fire awareness and abuse awareness training.( previous timescale of 31/03/05 in relation to fire safety training and abuse awareness training not met) The organisation must ensure that an annual quality audit takes place, which is carried out by someone independent of the service and seeks feedback from staff, service users ,families and other relevant professionals involved with the service. (Previous timescale of 31/06/04 not met). The organisation must ensure that monthly regulation 26 visits takes place and a copy of the report on the visit must be sent to the Commission following the visit. The manager must identiify what activities staff are involved in in the course of work and a range of risk assessments must be put in place to reduce the risks posed by those activities. Hazardous cleaning materials must be kept secure at all times.( previous timescale of 18.03.05 not met) The manager and service manager must ensure that all accident reports are fully completed and poor practice and moving and handling issues must be addressed with the staff concerned. 31st August 2005 9. 35 13 & 18 30th September 2005. 10. 39 24 30th December 2005. 11. 39 26 31st August 2005 12. 42 13 30th September 2005. 13. 42 13 15th August 2005 31st August 2005 14. 42 13 Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 38 15. 16. 42 42 12 37 17. 42 23 18. 42 13 19. 42 23 The manager must ensure that staff seek medical advice following injury to a service user. The manager must ensure that accidents which affect the well being of service users is reported to the Commission. The organisation must ensure that requirments from the fire inspection are acted on. ( enforcement notice served in March 2004 not met) A risk assessment must be carried out on each service user to establish their risks of being able to access the latex gloves and causing injury to themselves. The organisation must ensure that internal doors in service users properties are not wedged open. Where service users require doors to be kept open to allow them access to all areas of their homes then apporved self closing devices as approved by the fire authority must be fitted. ( previous timescale of 31.03.05 not met) 15th August 2005 15th August 2005. 31st August 2005 15th August 2005 15th August 2005 20. 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. 3. Refer to Standard 1 6 9 Good Practice Recommendations The manager should ensure that a copy of the letter or email to service users to notify of fees to be paid is kept on service users file to support this. The manager should consider directly recording monitoring visits on service users files. Specific and generic risk assessments should be filed separately in service users files and made more accessible. H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 39 Milton Keynes Community Care Services 4. 5. 6. 7. 8. 9. 10. 11. 9 17 18 33 35 39 37 6 The manager should consider the introduction of an ABC chart for recording outburts of aggression by service users. Nutriton training should be accessed for staff to ensure that staff can support service users to eat a balanced diet. The manager should consider involving and consulting with keyworkers in the development of care plans and in service users reviews. The manager should be included on the staff rota and the rota should outline when she has worked a shift in providing personal care calls. The staff induction checklist should be signed off by the manager as being satisfactorily completed. The policy folder should be reorganised and made more user friendly and accessible. A system should be put in place to check staff’s driving licences on a regular basis to ensure that staff who drive the organisations transport are legally able to do so. Report writing training should be provided for staff. Milton Keynes Community Care Services H53_H02_S15066_MKCCS_V227279_AI_5-13 07 05_Stage 4_MR_ces.doc Version 1.30 Page 40 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, 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. 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