CARE HOME ADULTS 18-65
New Mill House Mill Street Honiton Devon EX14 1AQ Lead Inspector
Teresa Anderson Unannounced Inspection 10:30 9 January 2006
th New Mill House DS0000021988.V259021.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 New Mill House DS0000021988.V259021.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. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 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.V259021.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005 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 it 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. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. As the inspection of National Minimum Standards take place over two visits, this report should be read in conjunction with the report dated May 2005. This inspection took place between 10.30am and 12.30pm. It was undertaken by two inspectors, one who inspected the services generally and the Pharmacy Inspector who inspected the way in which the home manages medication. During this inspection the inspector(s) saw all of the communal areas, spoke with 2 members of staff and with 2 of the 5 residents (others were out and otherwise engaged) and inspected records in relation to medication. What the service does well: What has improved since the last inspection? What they could do better:
The systems for managing medication require reviewing to ensure safe practice. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 6 The home will continue to work with East Devon County Council to ensure that service users have safe access to the courtyard area. Until this has been achieved, this area will remain out of bounds. 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.V259021.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 New Mill House DS0000021988.V259021.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): (3) Service users benefit from a work force that has the skills necessary to help them to identify and meet their goals and aspirations. EVIDENCE: Service users said that the staff at New Mill House ‘really care’. They are helped to set their own goals and to reach these goals. They talked of both the practical and emotional help they are given. The service users are looking forward to moving onto independent living and were clear that the staff at New Mill House had a strong supportive role to play in achieving this. Care plans include goal sheets which staff help service users to complete and which are reviewed regularly. Staff report that they feel they have the necessary skills, training and support to help service users achieve their goals. New Mill House DS0000021988.V259021.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): These standards were inspected and met or exceeded at the inspection in May. EVIDENCE: New Mill House DS0000021988.V259021.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) Service users are free to choose, and are supported to participate in, a range of educational and occupational activities that enrich their lives. EVIDENCE: Service users talked of the freedom they have to go out and to do what they like. The only restrictions they could identify are lack of personal finances and the limitations that their mental health problems present. Activities undertaken include voluntary work, joining the local gym, ‘Side by Side’ and making use of local amenities. Service users had recently been out Christmas shopping and out for a Christmas meal. One resident felt that they could do more outings. Whilst maintaining confidentiality, this information has been relayed to the manager. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 11 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): (20) Although all medication is stored securely the record keeping for medicines has the potential to leave service users at risk of harm. EVIDENCE: This part of the report is written by Brian Brown – Pharmacy Inspector. All medication is stored securely and within the temperature guidelines. Service users where appropriate are encouraged to look after their own medication and records are kept to show when these medicines are supplied. The records of current medication for some of these service users were not clear as to their current medication. Although the receipt of regular medication is recorded there were instances when interim medication had not been recorded on receipt into the home. The medication policy did not reflect fully the current practice in the home and had not been reviewed since 2002. The book containing records for homely remedies did not indicate to whom the medicine had been supplied or administered nor did it record the receipt of these medicines. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 12 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): These standards were inspected and met at the inspection in May. EVIDENCE: New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 13 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): 28. Service users do not benefit from the use of any outside garden/patio areas. EVIDENCE: During past inspections a requirement has been made that the outside courtyard garden be made safe. It has been unsafe because an adjacent property is poorly maintained and there is a possibility that falling debris could harm staff and/or residents. The home is working closely with East Devon District Council to bring this matter to a conclusion. In the meantime, this area is out of bounds to staff and residents. It is therefore considered ‘safe’ but does mean that residents do not access to any outdoor space. Residents say they miss this and are looking forward to reclaiming this part of their home. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 14 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) Service users benefit from a staff group who are well trained and have the skills necessary to support them. EVIDENCE: Service users describe the staff as ‘really caring’ and say ‘they don’t just do a job’. They provide both emotional and practical support and help them to identify and reach their goals. All service users are confident that staff are helping them to move towards living more independently through the development of new skills and coping strategies. Staff say they feel well supported and are offered advise when needed. More than 50 of the work force have or are studying to NVQ Level 2 or above. The deputy manager is studying for the Registered Managers Award. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 15 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 and 39) Service users benefit from the leadership skills of a well-qualified and experienced manager whose work is underpinned by a strong commitment to ensuring that New Mill House is fit for its purpose. EVIDENCE: Service users obviously enjoy the company of and respect the Registered Manager. They were extremely complimentary about her and understood her role. The Registered Manager is well qualified and experienced to manage a service such as New Mill House. She demonstrates a clear understanding of the aims and objectives of the service and consistently achieves these. She has communicated an ethos and put in place strategies which promote the inclusion of service users and ensures their views are heard. These include questionnaires, residents meetings and opportunities for giving feedback. The residents benefit from a significant amount of one to one care planning time, which is a time when opinions and views can be heard in confidence. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 16 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 3 x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 2 x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x x x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
New Mill House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x x x DS0000021988.V259021.R01.S.doc Version 5.0 Page 17 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 YA20 Regulation 13 (2) Timescale for action The registered person shall make 13/02/06 suitable arrangements for the recording, safekeeping and safe administration of medicines received into the care home. This refers to the need to record the receipt of all medicines into the care home. It also refers to the need to have clear records for the receipt and administration of homely remedies in the home. Requirement 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 e kept up to date and reviewed.
New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 18 2. YA28 It is recommended that all staff administering medication receive training, be assessed as competent to administer medication and that this assessment of competence be regularly reviewed. It is recommended that service users have outdoor space that is proportionate to the number of service users and staff. New Mill House DS0000021988.V259021.R01.S.doc Version 5.0 Page 19 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
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