Inspection on 26/09/05 for Miltoun and Brunswick House

This inspection was carried out on 26th September 2005.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Miltoun and Brunswick House 09/02/06

Miltoun and Brunswick House 02/03/05

Miltoun and Brunswick House 12/07/04

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

CARE HOME ADULTS 18-65 Miltoun House Albion Terrace Guisborough TS14 6HJ Lead Inspector Jackie Herring Announced Inspection 26th September 2005 09:30 Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 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 Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 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. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Miltoun House Address Albion Terrace Guisborough TS14 6HJ 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) 01287 636567 01287 280522 Mrs Jane Dexter-Smith Mr R Dexter -Smith Mrs Linda Breckon Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Core and Cluster Home 19 places Miltoun House 3 places Brunswick House, 85 Redcar Road The variation is for five named individuals until such time as the placements are no longer required. 2nd March 2005 Date of last inspection Brief Description of the Service: Miltoun House is a 19 bedded care home for people with Mental Health problems. It is a large end terraced house with a purpose built extension There is access to large front garden with open aspect and an internal courtyard garden with seating. All but one of the bedrooms are single rooms, eight of the single rooms have ensuite facilities and one of the rooms is below the minimum room size. Miltoun House is situated in a private terrace of houses just off a busy road leading to Guisborough town centre. The shops, public transport and other community facilities are within walking distance of the home. All service users have single bedrooms. Brunswick House is within a short walking distance from Miltoun House. The house is a mid terrace and provides accommodation for three people with a Mental Health problem; it has three single bedroom none with ensuite facilities and has a lounge, separate dining room and kitchen facilities. The bathroom and W/C are on the first floor and a games room with pool table is provided on the second floor. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced inspection and was completed within one inspection day, eight inspection hours in total. Residents were interviewed and other residents were involved in informal discussion about life in Miltoun House and Brunswick House. There was also detailed discussion with the manager and also informal discussion with the staff. A tour of the premises was undertaken, the home’s medication procedure and practice was inspected and the inspector spent time talking to staff members and residents and seeking their views. Indirect observation took place throughout the day with interactions between residents and staff being noted. The inspector was made very welcome into the home and the initial introduction was carried out by one of the residents. This was an extremely positive inspection. What the service does well: Miltoun House and Brunswick House provide a safe, well maintained and homely environment. The goals for both houses differ to some extent, in that one offers more of a rehabilitative type of care for a younger group of adult with mental health needs, whilst both also offer home for life for a number of more longer standing residents who live there. Both houses provide extremely good care, which is negotiated and consultative. Staff are well trained and have a clear understanding of the full range of care needs for individual residents. It is very good at making plans to meet people’s needs and providing good quality care. A lot of work is done with other professionals to support residents and the home works hard to make sure that residents changing needs are met and staff spoke positively about these relationships. Miltoun and Brunswick Houses provide residents with a lifestyle that allows for independence, choice, and personal development and firmly believed their needs were met. One resident said, “If I had been anywhere else, I would not have survived, I am always thankful to have been here”, “The best thing about Miltoun House is the love, trust, support and most importantly, they understand my needs”. Another resident said, “I think I am rather lucky” and described the personal achievement that had taken place over the years, such as moving into Brunswick House and leading a very independent life, whilst still having a level of support”. Healthcare needs, both physical and psychiatric needs are well met by the home. There is a good range of social and recreational needs, which are very much individualised. Holidays are enjoyed by all are as the regular outings. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 7 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 Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 8 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): None of these standards were examined during this inspection. EVIDENCE: Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 9 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, Residents are well aware of their assessed needs and care plans, they are active in decision making both on an individual basis and in aspects of life in both houses, as a result their independence is promoted. EVIDENCE: Although the individual residents plan of care were not examined during this inspection, through discussions with residents, it was confirmed that they were fully involved with their assessment of needs and individual plan of care. They discussed the relationship with their keyworker and said that their individual keyworker worked through their plans of care and that they signed up to and agreed with these plans. Residents discussed the control they had over their own lives and were able to describe an environment and culture that was open, consultative and one in which everyone’s views were responded to. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 10 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, 14, 15, 16, 17 The lifestyle of residents within Miltoun and Brunswick is very much individualised and is underpinned by appropriate social and recreational activities as well as the opportunities for personal development. Residents’ benefit from maintaining personal relationships and have their right respected. Meals are provided to a good standard within a suitable environment. EVIDENCE: During discussion with residents and staff they said the there were opportunities to be involved with a range of activities. A number of resident were attending day care facilities, which they said they enjoyed. They also accessed the local churches and shops. A report was submitted during the inspection, which described the more organised activities that had taken place during 2005. They included details of holidays for one group of residents to Scarborough and for the younger men, a holiday at the Carlton Outdoor centre. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 11 There has been a very active programme of activities and outings including going out for bar meals, trips to the dales, a coast drive, a day in York, a couple of days in Flamingoland, to name a few. There have also been regular trips to the cinema and regular visits to the pub and regular outings. An arts and craft afternoon has recently commenced and the residents were very animated about it. Both houses are part of the natural local community and the residents access all of the local amenities and facilities. Residents spoke positively about relationships and friendships within the houses. Residents firmly believed they were treated with respect and very much as individuals. One resident said, “you make your own decisions, I decide what time to go to bed, what to have to eat, I pretty much please myself”. Residents also described having their keys to the front door of the house or their own rooms, also described managing their own finances and having their rights fully respected. A copy of the menus was made available prior to the inspection. Residents were very satisfied with the meals, confirmed they had choices and also stated that there were involved in the menu planning. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 12 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 Residents receive personal and health care support appropriate to their needs and preferences, which ensure their privacy and dignity is respected and independence promoted. The medication systems are in the main robust, some additions to the records keeping would enhance this further. EVIDENCE: Life within both houses in one in which individuality, independence and choice are the underpinning believes. This was demonstrated through discussion with residents and staff, where a flexible approach to life was described. All of the bedrooms are used as single bedrooms and resident have their own key for their rooms. During the inspection, residents were consulted about accessing their rooms; of the rooms visited, there was clear evidence of individual preferences and personalities. One resident stated that they were extremely pleased with their rooms, which contained tea/coffee making facilities and an ensuite bathroom; they described it more of a bed-sit. It was confirmed through discussion that staff only came into individual rooms after discussion and agreement. Some residents described how they did their own laundry and looked after their personal areas, with support from the housekeeper. Residents talked positively about the support and guidance they were given to meet care needs. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 13 Residents described visiting the GP if needed, attending clinics for any injections they needed, having support from Consultant Psychiatrist and CPN. The staff views were that the houses are very well supported by the Multi Disciplinary Team and they were very positive relationships. A small number of residents currently self medicate and they are provided with the appropriate storage for this. Residents were knowledgeable about their individual medicine systems and one resident was delighted to now be able to independently manage their medication. The self-medication system was examined at Brunswick House and found to be well managed, with excellent record keeping and checking mechanisms. A random sample of medication records were examined at Miltoun House and on the whole, the systems were managed effectively, there was the need however to develop the recording system further. This related to the matching up of medication ordered and the need to have a record of the actual medication received. During discussion with the staff, they described how this process was completed, however there was no evidence of this. It was also confirmed that staff undertake appropriate training to undertake the responsibility of administration of medication and training was witnessed by indirect observation during the inspection. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 14 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 Residents are aware that if they had any concerns or complaints, these will be dealt with quickly and effectively and robust procedures are in place to protect residents from abuse. EVIDENCE: Staff were aware of the complaints procedure and knew about the topic of protection of vulnerable adults. They confirmed they had received up to date training on the topic of abuse and were clear about the actions they would take. Residents stated, “If I had any concerns, I would speak to my keyworker about them, I am confident that they would be sorted out”. This was also stated by other residents and they talked about open, supportive relationships with the staff team, manager and owners. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 15 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): 24, 25, 26, 30 Residents of both houses benefit from a well maintained, comfortable and homely environment in which to live. EVIDENCE: Both House were most certainly conducive to meeting the needs of the residents. They were observed to be clean, odour free, bright, airy and extremely homely with sufficient internal communal space and there was a real sense of comfortable family homes. The resident’s bedrooms were spacious and well appointed. They were extremely personalised and decorated to the individuals’ choice and taste and were in keeping with gender and age. The furnishings were of a very good quality. A number of residents took pride in showing there rooms to the inspector and there was clear evidence of personalisation of individual bedrooms and it was obvious that residents were encourage to stamp their own personalities and interests in their own rooms. This included one resident’s interest in Dr Who and another resident who had a keen interest in music and guitars. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 16 The housekeeper works with individual residents in Miltoun House who are enabled and encouraged to take care of their own personal rooms. The pre-inspection questionnaire specified that maintenance arrangements such as servicing of the fire equipment were in place and up to date. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 17 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, 33, 34, 35, 36 Robust recruitment and selection procedures and regular training opportunities ensure that residents are appropriately supported and protected by a competent and qualified staff team. EVIDENCE: A random sample of staff files was examined and they contained all of the required information. Staff were clear about their job role and there was also discussion with the manager and proprietor that job descriptions were under review. There was the impression of a very happy staff team and it was observed that people were valued and personal growth and development encouraged. Training was seen as a strength and succession planning was also being undertaken. The staff supervision systems was examined and found to be robust. Staff received client specific training as well as mandatory training and NVQ training. It was confirmed through discussion with the proprietor that 71 of the staff are trained to NVQ level two, which is commendable and a number of staff have attained level three. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 18 A minimum of two staff are on duty at Miltoun House at all times, however, it was evident from discussion with the manager that staffing levels were regularly increased depending upon the social, recreational and other needs of the residents, for example Wednesday evening outing and Saturday outings; visits to GP; hospital appointments and individual shopping. Residents spoke very highly of the staff teams and said, “It’s a good staff team, a band of dedicated people, they are people who know me and understand me”. “The staff are very friendly and respectful, it is an extremely supportive relationship which is reciprocal”. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 19 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, 42 Residents benefit from a well managed home, which provides consistently high standards with sound leadership and support to the staff team ensuring residents needs are met. EVIDENCE: The manager has been at the home for numerous years and has obtained the required qualifications, although certification for this had not been received to date. During discussions, the home was described as well managed and wholly inclusive. Residents and staff firmly believed they were valued as individuals and clearly had a voice within the home, which was responded to. During the inspection, staff were observed to interact positively with the residents and it was very clear from the observations that good staff/resident relationships had been developed Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 20 Details of Health and Safety were made available through the pre inspection questionnaire and these were found to be up to date and it was confirmed that all staff receive an individual copy of the policies and procedures, which was evidenced during the inspection. Health and Safety was discussed and a key individual is responsible for taking care of the Health and Safety of both houses. Staff were fully aware of checks, such as weekly fire checks and drills and confirmed that these were carried out. Policies and procedure were observed to be accessible to staff and residents should they be required. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 21 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 x x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x x 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Miltoun House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 x DS0000000128.V253542.R01.S.doc Version 5.0 Page 22 NO 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 OP9 Regulation 13 Requirement The medication records must include details of all of the medication received into the home. Timescale for action 26/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP42 Good Practice Recommendations Consideration should be given to monitoring the water temperatures on a regular basis. Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 Miltoun House DS0000000128.V253542.R01.S.doc Version 5.0 Page 24 - 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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