Inspection on 10/08/06 for New Mill House

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Mill House 09/01/06

New Mill House 24/05/05

New Mill House 30/09/04

New Mill House 21/05/04

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

CARE HOME ADULTS 18-65 New Mill House Mill Street Honiton Devon EX14 1AQ Lead Inspector Stephen Spratling Key Unannounced Inspection 10th August 2006 10:00 New Mill House DS0000021988.V300108.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 New Mill House DS0000021988.V300108.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. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Mill House Address Mill Street Honiton Devon EX14 1AQ 01404 47556 01404 47556 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) The Parkview Society Ms Sarah Emilia Carcillo Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: New Mill House is an end terraced building in the town of Honiton, East Devon. Western Challenge Housing Association owns the property and the service is managed by The Parkview Society. The home provides respite and short term residency and care for up to 6 younger adults who have mental health problems. The aim of the service is to support service users to move on to independent living. The house is laid out over 2 floors. There are 5 bedrooms with washbasin facilities on the upper floor and one bedroom on the ground floor. At the back of the property is a conservatory and small courtyard garden. There is easy access to the town of Honiton and local amenities including bus and rail services. Parking is available for the house vehicle and there is on street parking near by. The six places at this home are currently “block purchased” by Devon Social Services. Inspection reports are made available on the home notice board. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection site visit the inspector sent out 16 questionnaires, seeking people’s views about the home. Questionnaires from three residents, six care staff and four from visiting professionals (care managers, Doctors, Nurses and an Occupational Therapist) were returned. This inspection site visit was unannounced and took place over five and a half hours on Thursday 10th August 2006. A short follow up meeting with the home manager was held on 17th August 2006 to allow the inspector to see staff recruitment records. On the day of the site visit there were five people resident at the home and during the course of the day the inspector spoke with three of them, three members of care staff and the manager. He looked closely (case tracked) the care of three residents and at various documents/records maintained e.g. maintenance records and recruitment records. The inspector also walked around the shared areas of the home and looked in some private rooms. What the service does well: To make sure New Mill House is the right place for prospective residents, people have opportunity to visit the home and good detailed assessment information is gathered before they are admitted. Once admitted, staff work closely with residents to develop detailed care plans which identify the goals of their stay and how they may be helped to achieve these goals. Residents and community professionals are routinely involved in reviewing and updating care plans. Residents say they are treated with respect, are free to spend time as they choose and benefit from the support they receive to be active and to become more independent. The importance of residents’ personal and family relationships is recognised. Residents are provided with the resources and support they need to choose and prepare food they like. Staff are recruited properly, well trained, employed in sufficient numbers and have the qualities and skills they need to be able to care for residents to a high standard. One resident described them as “kind and caring” another said that the staff are “good listeners”. Though there is room for improvement, the home does provide a generally comfortable and homely place for residents to live. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 6 The home is properly managed in the best interests of residents. 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. New Mill House DS0000021988.V300108.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 New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents can be confident that the home’s good assessment and admissions practice will help to ensure that the their needs can and will be met. EVIDENCE: Care records read for three residents all contained clearly presented and detailed assessment information; they reflected the residents’ involvement in the assessments and contained copy of other Health/Social Care professionals’ assessment information. These contributed to providing a clear picture of residents’ care needs at the time of admission and identified goals and potential risks of their stay at the home. Two care staff completing commission questionnaires indicated they would like more information about new service users before they are admitted to the home; these concerns were not raised by staff spoken with on the day of the site visit. The staff reported that residents are encouraged to visit before moving in. One resident confirmed they had visited before moving saying they “knew what to expect” and one person’s records contained a summary of pre-admission visits they had made. New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs are properly assessed and plans implemented as to how they should be met. Residents are free to choose where and how they spend their time, and are supported to develop their capacity for independence. EVIDENCE: All three residents’ files seen contained detailed care plans, which reflected information gathered through assessments. All showed evidence of residents’ involvement and the residents spoken with confirmed that they are involved in developing their own care plans. Care plans read identified clear goals as agreed with residents and the regular, recorded, reviews demonstrated progress that residents were making to achieve their goals and resulted in the further development of the care plans. Residents spoken with and completing questionnaires confirm they are free to do what they want. One person spoke about how staff had supported them to manage their anxieties about going out in public to the point that they were now able to go out unescorted. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 10 Staff were able to describe how they try to support residents to be independent. Residents confirmed that they share responsibilities for chores around the home, with support from staff as required. New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from being supported to take part in community-based activities and develop their self-confidence & skills to be independent. The importance of residents’ personal and family relationships is recognised and residents benefit from good levels of support to maintain these relationships Residents benefit from being provided with the resources and support they need to choose and prepare food they like. EVIDENCE: All three residents spoken with described receiving appropriate levels of support from staff to access the local community and community services. Residents mentioned local shopping trips, regular attendance at church and a local drop in centre amongst other community-based activities. They confirmed New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 12 that though staff encourage them to be active, they do not make them feel pressured and respect the choices they make. Care plans read reflected residents’ individual goals, most of which were about achieving greater levels of independence, and described how they should work towards these goals and how staff should assist. One review with professionals from outside the home indicated that the resident concerned had made “significant progress” in re-establishing their capacity for independence since moving to the home. One professional wrote on a commission questionnaire “I have… been very pleased with the progress of my client since being placed there.” Residents confirmed that they each take it in turns to shop and cook meals, that menus are decided collectively by residents and that they are happy with quantity and quality of the food they have. One resident described the food as “excellent”. Residents were seen helping themselves to drinks without reference to staff. Staff and residents confirmed that visitors are welcome at the home. One resident described the support staff had/were providing to help them reestablish and maintain a relationship, which is very important to them. New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be treated with respect and that they will receive the help they need to regain/maintain their health and independence. Medications are managed in such a way as to promote the independence of residents however weaknesses in record keeping have the potential to leave them at risk of harm. EVIDENCE: All four health and social care professionals who returned commission questionnaires indicated that they believe their advice is acted upon and that medications are appropriately managed. All indicated their “satisfaction with the overall service provided”. Residents confirmed they have open access to their GPs and support from other health care professionals; one person said they had been to their GP on the day of the inspection. Medical advice was seen incorporated into care plans New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 14 and a record of Care Program Approach (CPA) multi-disciplinary review meetings was available in residents’ records. Residents spoken with confirmed that their privacy is respected by staff. Medications managed by the home are securely and appropriately stored. Record of prescribed medications received and disposed of is kept properly. Two of the three residents being case tracked were managing their own medication. The record for one of them, who is given a month’s supply of medication at a time, indicated that this person had been given two months’ supply in space of nine days, staff checked this and found that it was a recording error. The other two records seen were satisfactory. The medication cupboard contained a supply on “homely remedies” (none prescription medications) but records of when and to whom they are given was not clear. The homely remedies policy has not been reviewed as recommended following the last inspection though the manager said this review is planned. On the day of the inspection the manager removed all homely remedies from the home and confirmed the policy will be reviewed as a matter of urgency. New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their complaints and concerns will be listened to & acted upon, and that staff would act appropriately to protect them if they were being abused. EVIDENCE: The home’s complaints procedure is posted up on the home’s notice board and provides clear information including contact details of the commission. Of the three residents completing commission questionnaires, two indicated that they were not sure how to complain though all three say know who to speak to if they were unhappy. Of the three residents spoken with none had any complaints and all indicated their confidence in staff to listen to them and act on concerns they may have. Five of six staff completing commission questionnaires indicated that they are aware of protection of vulnerable adults procedures. Staff spoken with reported that training about this subject is booked for all staff in October of this year and all three were aware of the importance of reporting any suspicions of abuse. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and homely place for residents to live, though the poor state of the fitted kitchen means it is not possible to maintain high standards of hygiene. EVIDENCE: The inspector walked around all the shared areas of the home and went into two of the bedrooms; all areas seen were clean and homely and comfortably furnished. One of the bathrooms had been recently decorated by one of the residents and a previously dangerous building preventing use of the courtyard has now been made safe meaning residents again have access to this area. The kitchen was generally clean though some of the units are worn out with cracks making them impossible to clean properly. The manager reported that this work is planned for the beginning of the next financial year. Residents indicated that they are generally happy with accommodation and that it is generally clean though one resident did indicate that they thought sometimes it could be cleaner. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 17 All three staff spoken with confirmed that they think maintenance issues are dealt with reasonably promptly. New Mill House DS0000021988.V300108.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Kind, suitably trained & skilled care staff, employed in sufficient numbers, ensure that residents are treated with respect and get the care & support they want and need. Thorough procedures followed for vetting and recruiting care staff help to protect residents from people unsuitable to care for them. EVIDENCE: All four health and social care professionals who returned commission questionnaires indicated that they think staff at the home demonstrate a clear understanding of residents’ needs. Residents speak highly of care staff with one person describing them as “very kind and helpful” another saying they think the staff are “genuine and caring” and another commenting that they find the staff to be “good listeners”. Residents confirmed that staff are always available when needed, with one person saying that a staff member will accompany them out every day if that is what they want. Residents also described how being at the home supported by care staff was helping them to work towards their goals. Two described how New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 19 staff had helped them develop their self-confidence and to do things independently that they had previously been unable to do. Staff spoken with demonstrated a respectful approach to residents and a good knowledge of residents’ needs. Evidence of care staff input into residents’ care plans and care plan reviews was evident and showed an understanding of their role being to support residents to do things for themselves and develop their independence. Of six staff completing commission questionnaires, all confirmed that they had an induction when they first started working at the home and all confirmed that the home provides funding and time to receive relevant training. Staff spoken with had attended a variety of training courses including course on medication management, health & safety, first aid and food hygiene. They reported that requests for training are acted upon for example the training about caring for people with obsessive compulsive disorders had been booked for the near future in response to staff request. In a pre-inspection questionnaire the manager indicated over 50 of the current staff group have NVQ2 or above. One of the staff spoken with was studying for NVQ3 and another (the deputy manager) had NVQ 3 and was studying for the Registered Managers Award. The inspector selected and looked at the recruitment files of three staff members; they all contained the pre-employment checks required. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. This home is effectively, efficiently and safely managed, in the best interests of residents. EVIDENCE: Staff spoken with were positive about the support they receive from the manager and the deputy. All six staff completing commission questionnaires confirmed that they receive regular formal one to one supervision with a senior. Staff described the staff team as very supportive of each other. One person completing a questionnaire indicated they would have liked more support when they first started work at the home. All three residents spoken with described having confidence that the home is well run. The inspector saw that clear and appropriate systems/policies & procedures are in place to promote the safe running of the home. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 21 Trustees of the Parkview Society visit the home regularly to monitor the quality of the service and notes completed following these visits were seen by the inspector. The service has an ‘annual plan’ and is subject to various regular audits which are aimed at assuring and improving the quality of the service. The inspector saw that an “environmental (safety) audit” was completed in July 2006 and the home’s fire risk assessment had been updated in April 2006. Fire extinguishers around the house were marked as having been serviced within the past 12 months and a log book indicated that the fire alarms are tested weekly as recommended by fire officers. The inspector was shown a Gas safety certificate date November 2005 and electricity installation certificate dated June 2006. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13 (2) Timescale for action The registered person shall make 10/10/06 suitable arrangements for the recording, safekeeping and safe administration of medicines received into the care home. This refers to the need to ensure clear records for the receipt and administration of homely remedies in the home, if they are to be used at the home. 2. YA30 23 (2) (b) The registered person must 10/04/07 having regard to the number and need of the service users ensure that the premises to be used as a care home are of sound construction and kept in good order. The kitchen needs to be refurbished Requirement New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 24 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 YA20 Good Practice Recommendations It is recommended that the medication policy for the home be reviewed and clarified. It is recommended that the list of current medications for those service users looking after any part of their own medication be kept up to date and reviewed. New Mill House DS0000021988.V300108.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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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