Inspection on 14/07/05 for Nottingham Neurodisability Service Hucknall - Millwood

This inspection was carried out on 14th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nottingham Neurodisability... 18/03/09

Nottingham Neurodisability... 01/04/08

Nottingham Neurodisability... 20/09/07

Nottingham Neurodisability... 06/11/06

Nottingham Neurodisability... 08/12/05

Nottingham Neurodisability... 31/01/05

Nottingham Neurodisability... 02/08/04

Nottingham Neurodisability... 03/03/04

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

CARE HOME ADULTS 18-65 Nottingham Brain Injury Rehabilitation Unit Millwood Hankin Street Hucknall Nottingham NG15 7RR Lead Inspector Stephen Benson Unannounced 14/07/05 9.30 am 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 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 Stationary 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. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Nottingham Brain Injury Rehab Unit Millwood Address Hankin Street Hucknall Nottingham NG15 7RR 0115 9680202 0115 9642747 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons Homes (Ikeston) Ltd Steve Ault CRH 20 Category(ies) of PD 20 registration, with number of places Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 1st March 2005 Brief Description of the Service: Millwood is a care home providing personal care and accommodation for 20 younger adults who have an acquired or traumatic brain injury. The home is owned by Four Seasons which is run as a small business. The home is one of 3 registered homes on the same campus located in a residential area of Hucknall close to shops, pubs, the post office and other amenities. The home was opened in 1995 and consists of a purpose built 2 storey building. All of the home’s bedrooms are single, and 11 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has a small patio area and there is ample car parking space available. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted for 4 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, care staff on duty and care practices were observed. No visitors were seen during the course of the inspection. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well: What has improved since the last inspection? What they could do better: The home has a locked door policy but details of this are not included in the home’s statement of purpose or service user guide and there is not a record made of this restriction in the care plan. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 6 A risk assessment should be carried out where a resident refuses to take prescribed medication for a medical condition. Residents said they were not happy with the food provided. Residents do not make use of all the available health checks for promoting good health and could not remember when they last had their eyesight tested. Security is causing concern to one side of the home following a theft and a resident said it would be good to provide net curtains which would provide greater privacy. 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. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) 1, 2 and 4 New residents are fully assessed prior to admission and given information about the home. The restriction placed on residents by the homes locked door policy has not been included in the prepared information about the home and is not incorporated into the admission process. EVIDENCE: The manager or deputy manager goes to assess potential residents in their current setting and completes the homes assessment form. One recently admitted resident said that the manager had visited him in his previous placement and he had then come to visit the home. A completed assessment was seen in his care plan, which was detailed and identified the resident’s needs. A further assessment is carried out at the time of admission to ensure there have not been any changes. New residents are given copies of the homes statement of purpose and service user guide, however these do not state that the home has a locked door policy. A resident said he had not been aware of this prior to admission, although the manager recalled telling him so. Additionally there was no record made within the care plan explaining the reason for this restriction on liberty being in place. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 8 Care plans are completed to a good standard and involve residents. The effect of the home’s locked door policy has not been addressed within care plans. EVIDENCE: Care plans were well completed clearly explaining how residents needs are to be met and how difficulties should be managed. In one plan a problem was identified in the daily log section of a resident refusing to take their medication, which had then had a care plan prepared. Care plans are reviewed at least monthly and updated as required. Residents sign to say whether they wish to be involved in their care plan reviews or not. Residents said that they have discussed their care plans. Care plans included a number of examples where residents have made decisions for themselves, although one resident at times refuses to accept medical treatment for a chronic medical condition and there should be a risk assessment prepared for this. The restrictions placed on residents as a result of the home’s locked door policy have not been incorporated into care plans and there should be an assessment for each resident to establish whether this limitation is necessary. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 10 One resident described a number of instances where she had felt excluded or not able to express her opinion. It was not possible to substantiate the validity of these at the time, however the manager agreed to arrange a one to one session to go through these things with her. There were risk assessments seen in care plans supporting residents being able to take responsible risks, including using the kitchen and going swimming. A resident said how much she enjoyed the swimming. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) 12 and 17 Residents are able to choose how they spend their time. Residents are not happy with the current catering arrangements. EVIDENCE: Residents are able to choose how they spend their time within the home from a number of daily activities. Where required residents have allocated one to one staffing so that they can pursue their interests. One resident has expressed an interest in a computer course and staff are looking into this. Standard 17 was not inspected and food is prepared in a central kitchen for the three homes on the campus. Residents spoken with said they were not happy with the food. The manager said that one resident had written to him complaining about the food, which he had passed onto the kitchen and a separate menu had been prepared. The manager should review the current meal arrangements to ensure that residents are offered a healthy diet they enjoy. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) 19 Residents presenting health needs receive attention but their well being could be better promoted by making use of available health checks. EVIDENCE: There are procedures in place to monitor the well being of residents with regard nutrition and tissue viability. Residents are encouraged to be responsible for their own healthcare. Residents are registered with a local dentist but could not recall the last time they had an eye test. Greater use could be made of general health checks. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) None EVIDENCE: Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 standard(s) 24 Areas of the home do not provide a safe and private environment. EVIDENCE: One side of the home is close to a busy road and there are some concerns about the security of the home following a recent theft from a room and ways of reducing this risk must be introduced. Additionally passers by can easily see into residents’ rooms and residents said that net curtains would be good. The manager described a number of improvements to the home underway including new carpets and landscaping outside areas. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 Residents are supported and protected by the homes recruitment of permanent staff but not by the use of an unregistered agency. EVIDENCE: The correct procedures are followed in the recruitment of new staff. Where shifts cannot be covered from the existing staff team agency staff are used to provide both nurse and care staff. One of the agencies used is not registered to provide nurses, and the manager must ensure that agency staff are only sought from agencies correctly registered. Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 17 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 2 3 x 3 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x x x 2 Standard No 31 32 33 34 35 36 Score x x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Nottingham Brain Injury Rehabilitation Unit Millwood Score x 2 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 18 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 1 Regulation 4 Requirement Include details of the home’s locked door policy in the statement of purpose and serviced user guide and include the reason for the restriction upon residents liberty within their care plan Prepare a risk assessment for the resident who refuses medical treatment Ensure that residents are offered a healthy diet they enjoy Timescale for action 1st October 2005 2. 3. 4. 5. 6. 7 17 19 24 34 13 16 13 23 19 1st August 2005 1st September 2005 Arrange for residents to have 1st October access to general health checks 2005 Increase the security and privacy 1st October of the home 2005 Ensure that when using an 1st August agency they are correctly 2005 registered 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 8 Good Practice Recommendations Arrange for a one to one session for the resident who said C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 19 Nottingham Brain Injury Rehabilitation Unit Millwood she felt excluded Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nottingham Brain Injury Rehabilitation Unit Millwood C03 C53 S59002 Millwood V238539 150705 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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