CARE HOME ADULTS 18-65
Miltoun House Albion Terrace Guisborough TS14 6HJ Lead Inspector
Jackie Herring Unannounced Inspection 9th February 2006 10:00 Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 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 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Core and Cluster Home 18 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. 26th September 2005 Date of last inspection Brief Description of the Service: Miltoun House is an 18-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.V267925.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and was completed in one inspection day, four and a half inspection hours in total. Residents records were examined along with some health and safety record, the new medication arrangement were looked at and nine residents were involved in discussion about Miltoun House. The manager and one staff member were also involved in discussions. A very good inspection in which the inspector was extremely warmly welcomed and it was evident that the resident were very comfortable and were well able to talk freely abut life within Miltoun House. What the service does well:
Miltoun and Brunswick are extremely well managed offering a high standard of care to the residents and is a very supportive and enabling environment for the staff to work, which ultimately impacts upon the quality of care and quality of life for the residents. The staff are very knowledgeable and can competently meet the needs of the residents. Residents are clearly very happy and said, “They are really good to me here, it is my home, they really look after me well, and I am well here”. During a small group discussion, residents said, “I am happy here, I like living here, it is a nice, nice place, the staff understand my needs and understand what I am trying to say, it has a lovely atmosphere”. Resident’s records are well written, very personal and individual and residents are fully involved in their individual assessment of need and plans of care. It is very clear the good relationships exist between staff and residents and resident spoke informatively about their keyworkers and co-keyworkers and the support given. A staff member said of their role as keyworker, “It is to support the residents as much as possible, not do for them, but encourage them to live their own lives and take their own responsibilities but be their as a safety net”. The environment continues to be safe, well maintained and homely and residents said, “I am very happy with my room, it is very comfortable and I have my own belongings”, “Just look around you, it is kept beautifully clean and it is lovely, warm and cosy”. There is a good range of quality assurance systems in place and a consultative and inclusive environment is promoted. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 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.V267925.R01.S.doc Version 5.1 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.V267925.R01.S.doc Version 5.1 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): 2 It is evident that assessment of resident needs and aspirations are paramount to any admission to Miltoun House. EVIDENCE: Four sets of resident’s records were examined during the inspection and they contained a copy of the care management assessment and also the pre admission assessment, which had been completed by staff of the home prior to admission. It was clear from the details obtained that individual needs are fully assessed and that the home can well able provide the care and environment to meet those assessed needs. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 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, 8 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 Miltoun House, as a result their independence is promoted and care needs are clearly met. EVIDENCE: In the four sets of residents records examined, they contained very detailed information about individual needs, how to meet the needs and by whom. The care documentation was very personal and individual to the particular resident and it was clear that the resident had actively been involved in the process of discussing needs. During discussion with residents, they confirmed that they were actively involved in discussion with their keyworker or co-keyworker about their care needs, plans for the future, areas for risk management and activities. Whilst there was some evidence of review of assessment of need and care plans, this needed to be recorded in more detail. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 10 The documentation contained a very good life history, had clear links to multi agency involvements and clearly demonstrated that individual residents mental health, emotional and physical health needs were being met. Individual aspirations were also recorded and risk management strategies were in place to support independence and personal development and growth. Examples of this included road safety with one resident riding a bike in which all agencies had signed up to the risk management plan. Residents spoke of a very consultative environment in which there was very good communication, with everyone being treated very much as an individuals who were able to express views and opinions. It was confirmed that there were opportunities for both informal and more formal discussion with residents menu meeting and also general meetings taking place and minutes of these meetings being available on the notice board. An open door policy was described by the manager who said that the residents were very vocal, which was encouraged. One resident said, “I am very happy here, you have your independence, you make your own choices and have your freedom”. Another resident said, “I liked it here right from the beginning, the staff are very nice, nothing is too much trouble, you are supported well and you have your freedom, “Everything is good here, it’s a very good place to live, if you are poorly you get looked after well and you can come and go as you please”. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 11 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): None of these standards were examined during this inspection. EVIDENCE: Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 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): None of these standards were examined during this inspection. EVIDENCE: Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 13 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): None of these standards were examined during this inspection. EVIDENCE: Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 14 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, 30 Residents continue to benefit from a well-maintained, comfortable and homely environment in which to live. EVIDENCE: Miltoun House continues to offer residents a very warm, homely and comfortable environment to live, which is extremely clean and well maintained. Residents spoke highly of the housekeeper and about the standards that were maintained throughout the house. It was also confirmed through discussion with the manager that the housekeeper carried out her own environmental audits across all of the homes in the company. One resident took pride in showing their bedroom to the inspector and it was observed to be very personalised. The resident said, “I am very happy with my room, it is very comfortable and I have my own belongings”. Another resident said, “Just look around you, it is kept beautifully clean and it is lovely, warm and cosy”. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 15 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): None of these standards were examined on this occasion. EVIDENCE: Whilst these standards were not examined on this occasion, during discussion with a staff member they spoke positively about their job role and extended job role. It was felt that there was a very good training and that staff really benefited from this. Staff also confirmed that they had a good understanding of mental health needs and staff felt well able to meet the needs of the residents. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The manager and management team provides very good leadership to the staff team and continuously strives to improve standards within the home ensuring that resident’s needs are well met. Good systems are in place for the handling of resident’s personal allowances and there is also a good range of quality assurance systems. Good service and maintenance arrangements are in place and in good order ensuring health and safety is promoted. EVIDENCE: Although only Miltoun House was visited during this inspection, from discussion held with the manager, it is clear that both houses continue to be well run and well managed. The manager also discussed plans for staff development in respect of succession planning, which was underway. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 17 One staff member said, “the needs of the residents are met very well with the support of staff, everyone has their own individuality and all compliment each other”. The management of the home was described as very supportive, one in which individual responsibilities are promoted and much encouragement given. Residents who were spoken to spoke extremely highly of the home, one resident said, “They are really good to me here, it is my home, they really look after me well, and I am well here”. During a small group discussion, residents said, “I am happy here, I like living here, it is a nice, nice place, the staff understand my needs and understand what I am trying to say, it has a lovely atmosphere”. It was also confirmed that resident and staff questionnaires are used as part of quality assurance. The last time this was carried out it was identified that residents were unaware of the complaints procedure, which has now been addressed. Quality assurance systems were discussed in detail with the manager and it was clear that they are natural ongoing processes, which are undertaken by different staff members for their different areas of responsibility and underpins all aspects of care, safety and training ensuring a very good quality service to the residents. During discussion with one of the staff members, he spoke enthusiastically about his extended job role as health and safety representative and fire warden. He had developed new documentation in regard to the effective recording of hot water temperatures and developed a new system for key management in the event of a fire. The resident’s personal finance systems was looked at and found to be a well managed, well-recorded and robust system. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 4 X 3 X X 3 X Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations The six-month review of care plans should be recorded in more detail. Miltoun House DS0000000128.V267925.R01.S.doc Version 5.1 Page 20 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
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