Inspection on 08/12/05 for Nottingham Neurodisability Service Hucknall - Millwood

This inspection was carried out on 8th December 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... 14/07/05

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 Cntr Millwood Hankin Street Hucknall Nottingham NG15 7RR Lead Inspector Steve Keeling Unannounced Inspection 8th December 2005 09:30 Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.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 Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.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. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nottingham Brain Injury Rehabilitation Cntr Millwood Hankin Street Hucknall Nottingham NG15 7RR 0115 9680202 0115 9642747 Address 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) Four Seasons Homes (Ilkeston) Ltd Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 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 homes 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 Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 3.5 hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion two residents notes were case tracked. Also as part of the case tracking process, staff members within the home are informally interviewed to further evidence the quality of care afforded to the service users. At the time of the inspection a total of 17 residents were accommodated at the home. It was evident that the management and staff within the home are very committed to providing a high standard of care for the service users. The manager and staff within the unit were very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well: Prospective new residents are assessed prior to admission to the home to ensure that their needs can be met and are given written information appertaining to the homes facilities. It is evident that service users are very satisfied with the health care provision afforded to them at the home. All service users spoken with stated that staff within the home always respected their privacy and dignity. Care plans clearly identified the support resident’s needs to achieve optimum health and well-being and the care plans are reviewed regularly. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.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 Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.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): 1 Prospective service users are provided with appropriate information prior to admission so as to make an informed decision in relation to the homes suitability in meeting their needs. EVIDENCE: Prospective residents are given copies of the homes statement of purpose and service user guide, however it was identified at a previous inspection that the statement of purpose did not state that the home has a locked door policy. It was evidenced that the statement of purpose now includes the homes locked door policy to ensure that service users can make an informed choice as to the homes suitability in meeting their needs. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.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): 7. 9. Service users are encouraged to take part in varied social activities often beyond the homes immediate environment in an attempt to promote a more independent lifestyle. EVIDENCE: In supporting the service users to promote an independent lifestyle and take risks, Millwood House adopts a multidisciplinary team approach to health promoting interventions and the rehabilitation process. Members of the multidisciplinary team includes a consultant psychologist, qualified nursing staff, social workers, physiotherapists, and an occupational therapists is about to be appointed at the unit to further enhance the rehabilitative potential of the service users. Millwood House also offers service users the opportunity to participate in varied in house social and rehabilitative activities, which are to be coordinated by a very enthusiastic psychology assistant and a newly appointed social activities coordinator. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 10 Service users at the unit are encouraged to gain further independence by utilising a newly refurbished, purpose built kitchen facility in which they can prepare food and drinks with the supervision of staff members. Transport is utilised to take service users to parks, local areas of interest, the coast, local public houses, cinemas and theatres within the area. Should the service users wish, they would be accompanied into Hucknall town centre to shop or browse. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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): 13. 15. 16. 17. It was evident that service users are able to exercise appropriate choice in relation to how they spend their days. Service users are also encouraged to maintain appropriate personal, sexual and family relationships within the home and within the broader community. Service users stated that the food provided in the home is not varied and on occasions is bland. EVIDENCE: It was established through informal discussions that service users are able to choose how they spend their time within the home, which includes a choice as to when they wish to go to bed and rise in the mornings. It was evident that the manager of the unit is very keen to raise the profile of the home by promoting and fostering a greater interaction with the local community. The manager of the unit stated that it his intention to ensure that the newly appointed social activities coordinator builds on existing links within the community to encourage further integration. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 12 On the day of the inspection service users were being taken to relatives within the community with the aid of the homes mini bus, it was established that fostering appropriate relationships for service users is encouraged so as to satisfy the service users physical and psychological needs. Food is prepared in a newly refurbished, exceptionally clean, central kitchen for the three homes on the campus. Residents spoken with said that the food is often bland and uninteresting, although a perusal of the daily menus indicated that a satisfactory choice of meals is available at the home. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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. All attempts are made to facilitate personal choice within the home to promote physical and emotional health. No service users are currently responsible for self-medication but is was established that this process could be facilitated if after assessment the service users were deemed safe. EVIDENCE: It was established that the manager of the unit encourages service users to take baths and showers as they wish. It was established that care staff within the home would respect the service users wishes in relation to the provision of personal care. If gender specific carers were requested by the service users to perform personal care in response to religious and cultural requirements the manager of the home specified that the requirement would be accommodated. Given the complexity of the needs of some residents within the home a “one to one” monitoring process is in operation for some service users. This close therapeutic relationship between carers and service users allows for the Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 14 identification of specific needs, which carers are encouraged to discuss at hand over times or with the manager of the unit in an attempt to establish service users physical and emotional needs. To further aid the identification of needs it is the intention of the manager to instigate a “key worker” system at the home, whose responsibilities, under the supervision of the manager, would be to ensure that all identified needs of the service users are addressed effectively and that the care plans are reviewed appropriately. At the time of the inspection no service users were responsible for the selfadministration of medicines. It was established that should a service user wish to be independent in the administration of medicines the manager in conjunction with the multidisciplinary team, would perform a risk assessment, if the service users was deemed as being safe, self-medication would be facilitated. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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. Millwood House operates an effective complaints procedure in which the service users concerns are addresses effectively and sensitively. It is evident that staff employed at the home is aware of issues appertaining to adult protection and the procedures to be followed if abuse is suspected. EVIDENCE: Millwood House benefits from clear policies and protocols provided by Four Seasons (Ilkeston) Ltd in relation to the reporting of concerns and complaints. The complaints procedure is evident within the service users statement of purpose for service users and their representative’s perusal. At the time of the inspection no complaints were being investigated at the home and no complaints have been received at the Commission for Social Care Inspection. Service users spoken with at Millwood stated that they felt safe and protected in the home and that the staff employed at the home are attentive to their needs. Through discussions with service users it was established that they felt confident that the manager at Millwood would be approachable, sensitive and professional in relation to the reporting of concerns and complaints should any be identified. It was also established that the manager of the home operates an open door policy and is keen to address any concerns as they arise. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 16 It was established that staff employed within the home were aware of the procedures to be followed if they suspected a service users was being abused. Staff interviewed on the day of the inspection could identify the key elements of the reporting process thus ensuring the safety of the service users. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. 30. Millwood House offers a homely, comfortable and safe environment for service users. Millwood House is maintained effectively, clean, hygienic and is currently benefiting from a comprehensive refurbishment. EVIDENCE: Millwood House has an ongoing routine maintenance programme and a dedicated handyman deals with any shortfalls within the homes environment effectively. The temperatures of water outlets are monitored on a monthly basis and emergency lighting and fire alarm checks are performed on a weekly basis. Shower temperatures are monitored and the handyman at the unit also chlorinates all showerheads within the unit to control Legionella contamination. All mobility equipment within the unit is covered by service contracts to ensure service user safety. The handyman, as part of the induction process performs fire-fighting training for all new staff members. The home has a high standard of cleanliness and all areas smelt fresh. The majority of carpets in the corridors have been replaced and it is the intention Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 18 that all the carpets in the service users rooms will be replaced with a non slip flooring to aid the cleaning process so as to make the service users rooms more aesthetically pleasing. The case tracking process evidenced that the service users bedrooms were very comfortable and homely, personal possessions are evident such as family photographs, televisions and stereos and it was established that the service users can choose colour schemes within the rooms when they are redecorated so as to satisfy and encourage personal choice. To promote security and safety for the service users and staff, and to satisfy a requirement from the last inspection, it is the intention that a Closed Circuit television (CCTV) system will be installed in the New Year, in the interim a security firm is employed to patrol the grounds throughout the night. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 19 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): 34. 35. The recruitment practices utilised at the Millwood House unit is appropriate and meets the standards identified within the Care Standards Act (2000). The quantity and skills mix of staff employed at Millwood House is sufficient to meet the needs of the service users. EVIDENCE: Staff files examined evidenced appropriate documentation to ensure the vulnerable service users are protected. The staff files examined contained Criminal Records Bureau checks (CRB) and two satisfactory references, it was established that no members of staff are employed at the home until the aforementioned checks have been undertaken and are satisfactory. Staff employed at the home is sufficient to meet the needs of the service users and an appropriate skill mix was evidenced. It was evidenced that the manager is not included in the nursing rota so as to allow him time to effectively manage the unit. On the morning of the inspection nine carers, and two qualified nurses were on duty. Throughout the afternoon period, nine carers and two qualified member of staff were on duty and six carers and one qualified nurse covered the night period. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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): 39. 42. It was established that no formal service users consultation process in evident at Millwood House and as such service users views in relation to the development of the home could not be established. An examination of staff files highlighted shortfalls in statutory training that could compromise service users safety if not addressed effectively. EVIDENCE: Through discussion with service users it was evident that they felt confident in the managers ability to manage the home effectively and felt assured that any concerns would be addressed effectively and efficiently. It was established that service users are not afforded the opportunity to express opinions and concerns within an open forum such as a residents meeting. Residents meetings are intended to identify issues relating to the care provided to service users at the home so that any issues of concern can be discussed and addressed effectively. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 21 Residents meetings could also provide a forum to discuss plans for the development of the home so as to include service users in this process. It was also evident that staff interviewed at the time of the inspection also believed that a residents meeting would aid the communication process not only for the service users but also for staff employed within the home. The manager of the unit confirmed that the consultation process is somewhat lacking and intends to address the shortfall in the New Year by initially reinstating staff meetings and possibly creating a residents forum. An examination of staff files identified minor shortfalls in the provision of refresher courses for statutory training. It was established that the manager of the unit is in the process of addressing the shortfall and intents to purchase educational interventions once appropriate providers have been sourced. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 x Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 23 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 17 Regulation 16 Requirement Timescale for action 01/04/06 2. 39 24 (3) 3 42.2 13 (6) The registered person promotes service users health and well being by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. Feedback is actively sought from 01/04/06 service users (with support from independent advocates as appropriate) about services provided through e.g. anonymous user satisfaction questionnaires and individual and group discussion, as well as evidence from records and life plans and this informs all planning. The registered person shall make 01/04/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 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 17 Good Practice Recommendations Service users information board located in the manager’s office should not specifically identify physical conditions as service users confidentiality is compromised. Nottingham Brain Injury Rehabilitation Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Cntr Millwood DS0000059002.V272159.R01.S.doc Version 5.0 Page 26 - 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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