Inspection on 04/07/07 for Milverton Road Care Home

This inspection was carried out on 4th July 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milverton Road Care Home 30/03/09

Milverton Road Care Home 04/07/06

Milverton Road Care Home 05/10/05

Milverton Road Care Home 13/10/04

Milverton Road Care Home 19/04/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Milverton Road Care Home 70-74 Milverton Road Bestwood Park Nottingham NG5 5RH Lead Inspector Joanna Carrington Unannounced Inspection 4th July 2007 11:00 Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milverton Road Care Home Address 70-74 Milverton Road Bestwood Park Nottingham NG5 5RH 0115 916 0720 0115 916 0748 H2M059wyndham@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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) Ms Faye Wyndham Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for Learning disability (LD) - 6 Date of last inspection 4th July 2006 Brief Description of the Service: Milverton Road is a small home for adults with learning disabilities. Mencap is the registered provider. Mencap rent the premises, which are owned by New Era Housing Association. The detached property has been converted from three terraced houses. It is not accessible to wheelchair users. The home is sited within a residential community with access to a variety of local facilities and is within walking distance of Arnold town centre. Alternative communication methods are used with most service users and varying support is given to enable individuals to maintain some independence. The fees are £332.12 per week. Inspection reports and any other reports on quality monitoring at the service are available to service users and other stakeholders by request. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit took place on 4th July 2007. Inspections focus on outcomes for people that use the service. In order to do this the main method of inspection used was ‘case tracking’ which meant two service users were selected and their care was tracked through discussion with them and with staff, checking their care records and observing practice. The inspector did not have the tools and skills to be able to communicate with all people that use this service, therefore staff members were observed in this area. One service user and two staff members were spoken with and the manager was present for discussion and feedback. A brief tour of the premises took place to assess environmental standards and a sample of staff records were also looked at to make sure staff are trained and that checks were carried out on staff before they started working at the home. Information about a home that is collected before the inspection is also used to make judgements about a service. This information could include notifications, information from other professionals and users of the service or their relatives, and also from any surveys that are sent out. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the registered manager identifies from their own quality monitoring what the service does well at and what they need to work on. At the time of this inspection the registered manager had not been given the required time to fill in the document. The completed document will therefore be used to inform the next inspection. What the service does well: Prospective service users do not move to the home until their needs have been assessed and there has been opportunities for them to be introduced and ‘test drive’ the home. Care plans and risk assessments are thorough and provide detailed information on how service users’ needs are met. Specialist health care professionals such as psychiatrist and learning disability nurse are called on to help meet specific health care needs and support with dressing and personal hygiene is flexible to suit individuals’ preferences. Service users have a good lifestyle. They can go to day centres if they want and they are supported in maintaining relationships, to access the community and to participate in activities and pursue their own interests. A service user spoken with said that he likes going train spotting with his key worker. The staff team were observed giving service users choices and having the necessary skills to communicate with service users. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 6 The staff team get good training, which is important for protecting the health and safety of service users and also to ensure their needs are met. There are good systems in place for quality monitoring, which help ensure the home is run well and in the best interest of service users and service users are assured that their concerns and complaints are taken serious and acted on. 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. The summary of this inspection report can be made available in other formats on request. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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 Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a robust admissions procedure in place, which ensures that the home is suitable in meeting the needs of prospective service users. EVIDENCE: There have been no new admissions to the service since the last key inspection. There were pre-admission assessments by the placing authority seen on the files of both case tracked service users. A service user spoken with confirmed that they had a series of tea visits to the home before they moved in. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for ensuring service users’ needs and choices are met and that residents’ are as independent as possible. EVIDENCE: Both case tracked service users have comprehensive support plans in place covering all aspects of heath, personal and social care needs. These are written in the first person, which supports the fact that service users’ own their respective care plan and the information in it. The format also uses pictures to make the information more accessible to service users. There is a section in the file for recording when support plans have been reviewed and if there are any amendments; it was evident on one file that regular reviews have taken place, however the plan for continence had not been updated to reflect the level of support now given. The other support plan had been completely rewritten, which does not provide a picture of whether the service users needs have changed or increased. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 10 It was apparent from discussion with staff and from observation that service users’ are supported to exercise choices and have control of their lives. Staff members spoken with showed they understand the communication needs of service users. There are communication tools such as picture cards and individuals’ communication books with signs and symbols to enable service users to communicate their own choices. The registered manager explained that house meetings do not work for the people that live at this home. Instead service users are consulted about different things on a more informal basis. Staff members reported spending time with service users looking through recipe books for menu planning and looking at paint charts, when deciding what colours to paint the bathroom. Currently, time spent with service users in this way is not recorded in daily records or evidenced anywhere. Issues of risk are an integral part of support plans and clearly identify when restrictions are necessary. For example, having to be accompanied in the community due to poor road safety awareness. There are also accompanying risk assessments that have been put into place that enable service users to be more independent. For example, taking a taxi to go and visit family. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users’ experience a fulfilling quality lifestyle that meets personal expectations and respects their rights. EVIDENCE: On the day of the inspection all of the service users were out at their day centres. A staff member went to pick up a service user from their day centre because they were not feeling well. A service user spoken with said he has an interest in trains and he has been out with his key worker to go train spotting. A staff member spoken with talked about the Milverton Road rambling group which staff and service users have set up. Both service users spoken with confirmed that they are able to spend time in the garden when they want and enjoy growing their own plants and vegetables. For service users that have some mobility difficulties there are Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 12 raised gardens so that they can have their own flowerbeds. There is also a sensory section with plants of different textures and smells. A service user spoken with was looking forward to seeing his mum, who was visiting that evening. A support plan seen for one case tracked service user states “My key worker sometimes takes me to see my brother at [not specified for confidentiality]. We go by bus which I enjoy” Support plans make reference to respecting individuals’ privacy and dignity and staff were observed interacting with service users in a respectful and meaningful manner, giving them choices and helping each other prepare tea. Menu records show a variety of healthy nutritious meals with always two choices available. Service users were observed looking forward to their meal, which was either chicken casserole with carrots and leeks or omelette, chips and salad. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users health and personal care support is of a good standard. Medicine management however places service users at risk of harm. EVIDENCE: Both case tracked service users have a Health Action Plan which includes a section on communication so that staff members understand how individual service users will express they are feeling unwell. The plan also records when the service user has had their health checked and when they are next due appointments. Records seen indicate service users are up to date with routine dentist and optician visits. A case tracked service user has recently been referred to the occupational therapist to be assessed for equipment to enable them to get in and out of the bath. A service user spoken with reported that he goes to bed when he wants to and chooses to have help with a shower every night. His support plan states Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 14 “I usually have a shower in the evening. I don’t like to have a bath.” In response to the recommendation made in the last key inspection report staff members are now monitoring the remaining quantities of medication that is administered on a daily basis. The remaining quantity of an audited drug counted tallied with what had been signed as received and given. The quantity of a ‘when required’ medication was not correct. According to the medication administration record only four tablets had been given. Ninety-six should have remained when only eighty-seven were counted. A major error with this medicine was that the label on the box was missing because it had been cut out. This means it cannot be identified from the box who this medication belongs to. The registered manager was informed of this and reported the medication would be returned to the pharmacy as a matter of urgency and a new box of medication requested for the service user. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are assured that their complaints, concerns and allegations are taken seriously and acted on but service users are not being fully protected from other service users behaviour. EVIDENCE: There have been no complaints made since the last key inspection. The complaints procedure is displayed in an accessible form in the care home to enable service users to access it. A service user spoken with confirmed he would speak with the manager if he had concerns about anything and he felt confident that it would be followed up properly. Daily records for a case tracked service user show that there have been some incidents, going back as far as April in which the service user has assaulted other service users. There is a support plan in place for how staff members should manage any threatening or challenging behaviour, however the plan was not very specific and staff members spoken with said they want more robust strategies in place. Care records for this service user already show that the social worker has been notified and referrals have been made to a specialist team and to a psychiatrist. The specialist team are due to visit the home to help plan strategies with staff. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 16 A service user spoken with reported that there are times when he feels frightened by this service user. There are currently no strategies in place for protecting this service user or any others. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some improvements to the environment now mean service users live in a comfortable, safe and homely environment. EVIDENCE: There have been a few changes since the last inspection. Bathroom flooring has now been replaced. Service users have chosen a new colour for the bathrooms and quotes are being obtained for the painting. The communal lounge has been redecorated and there is a new sofa and suite. The exterior to the building in the garden has been painted to make it more attractive and in keeping with the garden. The garden is well maintained and is accessible and enjoyed by all residents. The premises were clean and hygienic throughout. appropriate to the needs of service users. The laundry facilities are Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are good staffing arrangements, which help ensure service users are in safe hands and that their collective and individual needs are met. EVIDENCE: More than half of the staff team are qualified to at least NVQ (National Vocational Qualification) Level 2 Social Care. All staff members spoken with reported that training opportunities are good and that as well as attendance of mandatory courses there is also specific training relevant to the individual and collective needs of service users. This was evident in training records. A staff member spoken with talked about the LDAF (Learning Disability Award Framework) training she did as part of her induction and what she learnt about the rights of people with learning disabilities. Staff said they feel supported by the manager and on staff files there were copies of supervision records. There was also evidence of two written references and a Criminal Record Bureau disclosure on the staff file looked at. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The requirement to notify the Commission of incidents is still not being met, which means the home cannot be effectively regulated and has the potential to place service users at risk. However, conduct and management of the home is of a good standard, which helps ensure the home is run in service users’ best interests and protects their health and safety. EVIDENCE: At the last inspection a requirement was made to ensure that any event in the home, which adversely affects the wellbeing or safety of any service user is notified to the Commission. At this inspection the incident records seen and from talking with staff indicated there have been further incidents of vandalism and trespassing, which have not been notified. The assaults between service users, as mentioned under section Complaints and Protection were also not notified. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 20 The home receives a full service review from the provider Mencap every three years then on an annual basis a ‘light touch’ review is undertaken which is to review the home’s continuous improvement plan. A manager of another Mencap service has recently visited the home to meet with service users, audit support plans and observe practice. Feedback surveys are presented with pictures so they are more accessible to adults with a learning disability and these are sent out to service users every year. Comprehensive risk assessments were seen for the prevention of Legionella and records show that measures such as monitoring the temperature of water tap outlets are in place and carried out. The home has an up to date fire risk assessment and the fire records show that fire alarms are tested weekly as required. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 1 X 3 X 3 X 1 3 X Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 22 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 2 Standard YA6 YA20 Regulation 15 13(2) Requirement Care plans must be amended to reflect any changes to how needs are met. Quantities of remaining medication must be accounted for in the home. This is for an audit trail to ensure service users are being administered their medication as prescribed. Medication labels must not be cut out of boxes of medication. This is so that medication prescribed to service users is easily identified and ensures no other service users are given this medication by accident. There must be robust strategies put in place for managing service users’ challenging behaviour and in protecting all other service users from this behaviour. Vandalism and trespassing and assaults between service users are incidents that must be notified to the Commission. This is an outstanding requirement from the previous inspection, initial timescale 04/07/07 not met. Timescale for action 30/08/07 30/07/07 3 YA20 13(2) 05/07/07 4 YA23 13(4) 31/08/07 5 YA41 37 30/07/07 Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 23 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 YA7 Good Practice Recommendations Use daily records for positive interaction with service users and when service users have exercised choices / been consulted on day-to-day aspects of the service, for example meals, activities and holidays. Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milverton Road Care Home DS0000002254.V340327.R01.S.doc Version 5.2 Page 25 - 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. 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