Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 07/01/08 for PIA 4 Milverton Terrace

Also see our care home review for PIA 4 Milverton Terrace for more information

This inspection was carried out on 7th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care plans and risk assessments are in place at the home containing satisfactory levels of information to enable staff to support people safely and in the manner they like. People`s health needs are recorded in their care plans and staff provide support for people to gain access to support for health professionals to help with written guidelines and to monitor health conditions where necessary. In a questionnaire a relative comments, "my sister has very challenging behaviour at times, the staff handle the situation very well". They are a fantastic team. A health professional involved with the home reports "Given the varying levels of learning disability and needs of the clients, the team work hard to meet the complex needs of each individual". People are provided with support and transport to visit their relatives and several people went to see their relatives at Christmas time. Relatives are encouraged to take part in care reviews to help contribute to future plans with Social Services and other professionals. Suitable arrangements are in place for keeping track of medication in the home so that it can be accounted for properly and staff are trained to give out medication safely. There have been no complaints at the home since the last inspection. People`s relatives have been told how to complain if they need to do so. Staff are trained to recognise and report any allegations of abuse and these are followed up properly and referred to Social Services for investigation under the Safeguarding Adults Procedures. The service manager carries out regular checks of the home to identify any shortfalls in the way the home is operating. These reports are available in the home for the manager`s action. Satisfactory procedures are in place for ensuring that staff are properly vetted before they start work. This includes taking up references and Criminal Record Bureau checks to ensure staff are suitable to work at the home. Staff are provided with a good range of training to ensure they are equipped to carry out their work safely and give effective care. The manager reports that 65% of current staff now hold National Vocation Qualifications at level 2 or above and more staff are being trained. Staff are also being provided with equality and diversity training. This training helps them to see people as individuals with specific needs of their own.

What has improved since the last inspection?

Good work has taken place to improve the bathrooms so that they are better equipped and more accessible for people who need assistance to bath and shower. Some areas of the home have been redecorated to improve the home for people and repairs noted in the last report have been carried out. The lounge has been decorated and is comfortable and homely.Work has taken place to devise a paperwork format for staff to complete to show the progress that people are making at the home as part of their ongoing assessment. The acting manager said that this will be introduced shortly.

What the care home could do better:

Whilst care plans are in place for people, the home does not currently keep satisfactory records to show how people have been admitted to the home (e.g. visited beforehand, information given, etc). The service user guide has just been reviewed by the acting manager and she said that this will be issued to people very shortly and will include the terms and conditions of residency including fees, (in the form of a contract). Overall the home is comfortable though some areas would benefit from work to provide a more homely feel, e.g. pictures and personalising some bedrooms). The acting manager stated that she plans to re hang more pictures as some were taken down temporarily because they were being thrown about by someone settling into the home but this has now improved. One bedroom has an odour that needs eradicating and some of the furniture in some rooms would benefit from upgrading. There is a need to ensure that fire alarms are tested on a weekly basis and that emergency lights are tested every month to ensure that the fire safety equipment is operating properly.

CARE HOME ADULTS 18-65 PIA 4 Milverton Terrace 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA Lead Inspector Kevin Ward Key Unannounced Inspection 7th January 2008 07:55 PIA 4 Milverton Terrace DS0000004224.V357369.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 PIA 4 Milverton Terrace DS0000004224.V357369.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. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service PIA 4 Milverton Terrace Address 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA 01926 882831 02476 640146 dkelly@people-in-action.co.uk 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) People in Action Deborah Charlotte Kelly Care Home 8 Category(ies) of Learning disability (8) registration, with number of places PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the extra bedroom is only to be used by a service user coming to live at the property for a contracted period of six months or less. Service users residing in this bedroom must not use any other bedroom in the property during their stay in the home. Date of last inspection Brief Description of the Service: Milverton Terrace is a registered care home providing short-term care with the aim of supporting people with learning disability wishing to live, with support, in their own home and wider community. The parent company, People in Action provide 24-hour care and support for service users living in the home. The home is a large converted house, close to the town centre of Leamington Spa. Shared accommodation consists of a lounge, dining room and kitchen. There is also a bathroom, toilet, laundry and office on the ground floor. There are two service user bedrooms on the ground floor, which are suitable for wheelchair users. Other service user bedrooms and the staff sleep in room, and a shower/toilet facility are located on the first floor. There is a garden to the rear of the property. There is limited access to the front of the property for car parking. Entrance to the home at the front is via a series of steps up to the front door. There is wheelchair access to the property however at the side of the building. Current fees were not available in the service users guide at the time of this inspection. Any further information about current fees should be sought directly from the home. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service use 3 star. This means that people who use the service benefit from good quality outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Two of the people living at the home completed and returned and questionnaires were also returned by a visiting health professional and a relative, giving their views of the service. An annual quality assurance questionnaire was completed and returned by the manager in time for the inspection, providing helpful information about the home. The inspection included meeting all the seven people, currently living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how the person’s needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with the staff on duty and a team leader. Following the site visit further discussion took place with the acting home manager who is temporarily this position for the Registered Manager on maternity leave. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Care plans and risk assessments are in place at the home containing satisfactory levels of information to enable staff to support people safely and in the manner they like. People’s health needs are recorded in their care plans and staff provide support for people to gain access to support for health professionals to help with PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 6 written guidelines and to monitor health conditions where necessary. In a questionnaire a relative comments, “my sister has very challenging behaviour at times, the staff handle the situation very well”. They are a fantastic team. A health professional involved with the home reports “Given the varying levels of learning disability and needs of the clients, the team work hard to meet the complex needs of each individual”. People are provided with support and transport to visit their relatives and several people went to see their relatives at Christmas time. Relatives are encouraged to take part in care reviews to help contribute to future plans with Social Services and other professionals. Suitable arrangements are in place for keeping track of medication in the home so that it can be accounted for properly and staff are trained to give out medication safely. There have been no complaints at the home since the last inspection. People’s relatives have been told how to complain if they need to do so. Staff are trained to recognise and report any allegations of abuse and these are followed up properly and referred to Social Services for investigation under the Safeguarding Adults Procedures. The service manager carries out regular checks of the home to identify any shortfalls in the way the home is operating. These reports are available in the home for the manager’s action. Satisfactory procedures are in place for ensuring that staff are properly vetted before they start work. This includes taking up references and Criminal Record Bureau checks to ensure staff are suitable to work at the home. Staff are provided with a good range of training to ensure they are equipped to carry out their work safely and give effective care. The manager reports that 65 of current staff now hold National Vocation Qualifications at level 2 or above and more staff are being trained. Staff are also being provided with equality and diversity training. This training helps them to see people as individuals with specific needs of their own. What has improved since the last inspection? Good work has taken place to improve the bathrooms so that they are better equipped and more accessible for people who need assistance to bath and shower. Some areas of the home have been redecorated to improve the home for people and repairs noted in the last report have been carried out. The lounge has been decorated and is comfortable and homely. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 7 Work has taken place to devise a paperwork format for staff to complete to show the progress that people are making at the home as part of their ongoing assessment. The acting manager said that this will be introduced shortly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 8 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 PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in recording and failure to issue recent contracts has compromised the rating for this group of Standards. EVIDENCE: An admission procedure has been written in the new service user guide. The acting manager explained that it is now the policy of the home to meet with service users and assist them to visit wherever possible before moving into the home but that this is not always possible due to the urgency of their placements. Two people confirmed they had been provided with opportunities to visit and be shown around the home before moving in. A team leader explained that relatives are issued with information about the home including the home complaints procedure and the Statement of Purpose describing the service provided at 4 Milverton Terrace. Social worker referral and assessment information was seen on people’s files summarising their main presenting needs at the time of the admission. These are faxed to the home and used to form the basis for the development of the care plan and interim risk assessments. Records are not currently kept of pre admission visits and pre admission care assessments carried out by the home. These records would help to more fully PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 10 demonstrate the actions taken to ensure that the home has properly considered people’s needs before they move in. The acting manager was able to illustrate how she has held back new admissions recently where she felt this would create an unsafe situation and agreed to keep the necessary records in future as evidence of actions taken. A member of staff at the home explained that a new recording format has been devised (copy seen) for capturing people’s ongoing changing needs and monitoring the achievement of individual’s goals whilst they are at the home. This is a positive development, as it should more clearly demonstrate the progress made by people during their stay at the home and for supporting recommendations for future placements. The service user guide has just been reviewed by the acting manager and she said that this will be issued to people very shortly and will include the terms and conditions of residency including fees, in the form of a contract. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are properly planned for and reviewed so that they can be met appropriately by staff. EVIDENCE: Two care plans were looked at and specific documents, such as behaviour guidelines and PEG feed protocols were also sampled on others files. The care plans checked were found to contain satisfactory levels of information to enable staff to meet people’s needs in a satisfactory manner. Care plans include a section summarising people’s preferred routines so that staff are clear about the manner in which people like their care provided. This is particularly important for people with significant communication needs in order that their preferences are understood and acted upon by staff supporting them. People’s communication needs are also recorded in the care plan. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 12 Review meeting notes demonstrate that the home meets with Social Workers and other professionals to review people’s progress, changes in their needs and discuss future placement options. The notes also show that the people at the home are included in their reviews along with any relatives involved. Similarly in house monitoring takes place between reviews at Care Team Meetings. This involves a meeting with the person at the home, their key worker and supervisor, to review and record recent events and issues to address. A person at the home said that he has not seen his care plan. The acting manager agreed to make arrangements for people who wished to so to see their care plans in future with support from staff, to help them to identify the relevant information in a sensitive manner. A team leader said that “residents meetings” take place occasionally but not everyone attends. It was not possible to find the meeting records to verify the content of these discussions. Since the site visit the manager has said that she intends to review the effectiveness of these meetings with a view to either restarting them or maintaining records of one to one consultations with people instead. Comments by two people at the home with good communication skills confirmed that the staff include them in everyday decisions about what they like to eat and where they wish to go. One person has a fluid chart and takes part in updating when taking drinks to enable them to take some control over their health needs. The acting manager explained that the person concerned took part in choosing the pictures (cups of tea) used on the chart to illustrate the fluids taken. A good range of risk assessments were seen taking account of people’s personal health needs and everyday living hazards that they may face, such as epilepsy, behaviour challenges, safety in the home and when out in the community. More detailed guidelines are in place where necessary, e.g. significant challenging behaviour. The acting manager explained that psychologist input and advice has been sought in the development of written behaviour guidelines for some people and undertook to arrange for psychologist to provide their signed agreement to verify this fact. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Strategies are necessary to promote the dignity of a person at the home. People are provided with a satisfactory level of activities though there is scope for increasing the variety of options available to people to expand their interests. Menus take account of people’s likes and needs so they are provided with meals that they enjoy and they receive a healthy diet. EVIDENCE: A team leader explained that two of the current people at the home attend day services part of the week and the others are supported by staff at the home to take part in activities at the home or venture out in the community. Two people at the home said they had been to the pictures the previous evening with friends at the home and confirmed that they are supported to go out shopping regularly and have meals out. One person explained they enjoyed doing work at a garden project one day a week and especially liked having an aromatherapy massage. Other examples given by people and recorded in daily PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 14 diaries included bowling, pottery, drives out, parks and walks, DVD evenings, art, games and puzzles. The acting manager explained that she is encouraging staff to come up new ideas for activities to provide more variety for people. Two people at the home like to attend church sometimes and receive support to do so. Comments by people at the home and staff confirm that support is provided for people to take part in domestic chores around the home to develop and maintain their independence. During the site visit a person at the home was seen to vacuum the hallway and prepare a cooked breakfast with support from staff. Entries in people’s records indicate that people are supported to maintain contact with their relatives. This was also verified in comments by people at the home. Several people visited relatives at Christmas time to enjoy family celebrations. In a questionnaire a relative comments “the staff have been very good at bringing my sister to Nuneaton to see me, when I am unable to get to Leamington”. As previously noted relatives are encouraged to take part in review meetings with social workers so that they can contribute to future plans and represent their interests, evidence of which was seen in review meeting notes. As previously noted guidelines are in place to manage the challenging needs of some people. On occasions this may involve restrictions being placed on individuals (e.g. locking cupboards to stop items being thrown at people are being destroyed or activities being conditional on positive behaviour). In these cases there is a need to ensure that the guidance is agreed with other relevant professionals, such as behaviour therapist / psychologist to demonstrate that the least restrictive measures are necessary are in place, balanced against any risks involved (in keeping with the Mental Capacity Act requirements). In a questionnaire a challenging behaviour specialist says “I have always found the team at 4 Milverton to be keen to seek specialist input when needed and accurate in applying guidance” On the day of the site visit one person was seen taking breakfast dressed in his underwear and T-shirt in the dining room. Staff explained that any insistence that this person must get dressed before breakfast would trigger significant challenges. This is borne out by information in the person’s care plan. Since the site visit the acting manager has agreed to seek further psychology input and identify strategies to enable staff to preserve the dignity of the person concerned. Staff were observed to close bedroom and bathroom doors appropriately when assisting people with their personal care. Comments by people at the home confirmed that they are happy with the food provided at the home. A team leader explained that the week’s menu is planned at the start of each week taking account of people’s likes and dietary needs and a copy of the menu is retained in the kitchen. Comments by staff PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 15 and people at the home confirmed that an alternative meal is provided if necessary, if people do not like what is on the menu. There is not currently a food taken record retained at the home to show any changes to the menu. A team leader agreed to address this. Dietician advice has been sought for a person with a health complaint and food supplements have been prescribed to support nutritional intake. Comments by the acting manager and a team leader explained that encouragement is being given for this person to eat healthy. This advice is also reflected in the person’s care plan. The person concerned was seen to cook his breakfast with support from staff and confirmed that this is routinely the case. Comments by people at the home confirmed that snack foods and fruit are commonly available in the home. A member of staff explained that people are encouraged to take part in some grocery shopping. This was also verified by several people and entries in day records. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home are provided with the support they need to meet their personal care and health needs and suitable arrangements are in place for the safe administration of medication. EVIDENCE: People were observed to rise in an unhurried fashion on the morning of the inspection and to take breakfast in a leisurely manner. Some people were seen to choose their breakfast and to take part in preparing it. Staff were seen to prepare breakfast for others where necessary. The people at the home were all dressed in age appropriate, well laundered, clean clothing and were well groomed, indicating they are supported to maintain a pride in their self-image. As previously noted people confirmed that they are supported to shop and choose their own clothing. Comments by people at the home indicate that they are able to choose when they wish to go to bed and enjoy age appropriate bedtimes. This was also confirmed by a team leader, who was able to give a good summary of people’s bedtime routines. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 17 A person with significant health needs confirmed that he is provided with good support to attend regular outpatients appointments several times each week. The team leader and a staff member were able to demonstrate a good knowledge of this persons needs and of the contact details of health professionals involved in the their care and monitoring. The records demonstrate that the home use has made appropriate use of the advice of health professionals involved where it has been necessary to access emergency healthcare for the person concerned. Helpful information relating to the persons condition was found in the care plan folder for staff to read. Entries in people’s health records confirm that they are provided with access to routine check ups, such as well person checks and dental checks. A member of staff and a team leader were able to explain their role in supporting a person with a PEG tube feed and staff have been trained by “homeward” nurses (suppliers of the equipment) to carry out this area of practice safely in accordance with safe practice protocols. A member of staff demonstrated a good understanding of the home’s medication procedures. The manager and staff explained that they had received training in the safe handling of medication training. Certificates and workbooks were seen on staff files verifying this fact. A member of staff explained that staff are trained and observed on a minimum of three occasions before they give out medication independently. This verified in records held on staff files. The medication cabinet was tidy and well ordered. The manager confirmed that due to the high support needs of the people at the home no one currently holds their own medication. A sample of current medication sheets were checked and indicate that staff are recording people’s medication correctly. Medication records include guidance about how people like to take their medication so that it is administered sensitively. A member of staff giving out medication explained that he is expected to check any gaps in the administration record and bring any errors to the attention of the manager. There were several medication errors earlier in the year since which time the manager has started an end of shift medication check to ensure medication has been given out correctly and reports that to date there have been no further errors. Copies of medication audits were seen on in the quality assurance file, including stock checks to account for medication in the home. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable procedures are in place for dealing with complaints and staff are trained to recognise and report suspicions of abuse to ensure that the people living at the home are kept safe from harm. EVIDENCE: There have been no complaints made to us about the home since the last inspection and the manager reports there have been no complaints to the home during the same time period. The service user guide has a complaints procedure for people to follow should they wish to do so but the acting manager explained that this has yet to be given to people and said this would be addressed very shortly. The acting manager confirmed that relatives have been provided with copies of the home’s complaints procedure so that they can represent people’s concerns where necessary. In a questionnaire a relative confirms she has been informed how to complain where necessary. Two people commented that they would see the acting manager or staff if they had any concerns. Staff confirmed they are provided with abuse training and some have recently attended whistleblowing training, informing them how to report any concerns they may have about care at the home. Staff have also been provided with challenging behaviour training to enable them to respond to behavioural challenges in a safe and appropriate manner. Verification of this training was seen in a sample of staff certificates and training information provided by the manager. Since the last inspection there has been one allegation of physical PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 19 abuse made against a member of staff. This matter was properly referred for investigation under local safeguarding procedures and the worker was suspended (as neutral act for the protection of both the service user and the worker) whilst the investigation was carried out. This indicates that the home takes appropriate action to protect people at the home and follow up their concerns. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst overall the home is clean and comfortable there is scope for making the homely in some area. Cleanliness and hygiene at the home is undermined by the presence of an odour in one bedroom. EVIDENCE: The lounge and dining room have been attractively decorated and provide spacious areas for people to relax in. The lounge looks particularly homely with domestic style furniture in place for people to sit in comfort. Good work has taken place to improve the front door steps which were cracked and in need of repair. Significant good work has taken place to improve bathrooms in the home making them more accessible and well equipped to meet the needs of people who require assistance when bathing and showering. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 21 People’s bedrooms vary in the extent to which they have been personalised and furnished. Whilst the majority of the bedrooms look quite comfortable contain pictures, equipment (e.g. sensory lights) and belongings three others were quite stark and more work could be done to support people to make these rooms to their liking. Similarly there is scope for providing more pictures and wall hangings in these bedrooms and other areas of the home such as the bathrooms, hallways and communal areas. Since the site visit the manager has explained that such items were temporarily removed whilst a new person at the home settled in as pictures were being thrown about, posing a risk to others. The acting manager and the service manager have confirmed that plans are in place to re introduce pictures now that the person concerned is looking more settled and at ease in the home. One person’s bedroom has a Perspex cover over the window to prevent the risk of the windowpanes being broken. Whilst this appears functional it also looks rather utilitarian. The same bedroom had padlocks on the wardrobe door. Whilst these are effective for securing the persons personal belongings they do not contribute a homely feel. Some of the furniture in the bedrooms is looking rather old and would benefit from upgrading. The service manager explained that there are proposals to purchase some new items of furniture during the coming year. A shaver was seen plugged into a shaver socket and the shaver was resting in the hand basin raising concerns that this could be a safety hazard. Since the inspection, the acting manager has reassured the inspector that all such sockets have been disconnected and do not present a hazard to people. One person’s bedroom had a strong odour. This was present in the morning and later in the afternoon after it had been cleaned and tidied. The acting manager has undertaken take relevant action to address this situation effectively to provider better conditions for the person who uses the room. The acting manager said that there are plans to replace the lounge carpet. The hall carpet also shows signs of heavy wear and would benefit from renewal. Staff were seen to make use of protective gloves and aprons and stocks of protective clothing were seen in various places in the home for staff to make use of. Overall the house was clean and fresh. A cleaning plan was seen for involving the people at the home in light cleaning tasks to encourage their independence and involvement in looking after the home. There was no soap available in one of the toilets for people to wash their hands after use. The home has a small laundry room that is equipped with a washer and dryer. In the annual quality assurance assessment the acting manager reports that there are plans to redesign the laundry room. A new washing machine and dryer were seen which, a team leader explained, are due to be plumbed in as PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 22 part of this work. The new machine has a sluice facility suitable for continence laundry requirements. The team leader explained that everyone’s clothes are laundered separately and individually named laundry baskets were seen for people to help in this regard. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained to equip them for their work and satisfactory recruitment procedures are in place to ensure that suitable staff are employed at the home. EVIDENCE: Comments by a team leader and staff indicate that the home continues to provide suitable staffing levels at the home and these are adjusted according to people’s needs. In the annual quality assessment the acting manager explains that wherever possible any extra staffing hours that are necessary are provided from within the staff team so as to promote consistency of care in the home and this flexibility is built into their contracts. This was verified by the team leader on duty and staff records. The rota shows that either the manager or team leader is available on all shifts so that staff receive the support they require. An on call rota is also available at night so that staff have a management team to refer to for help if required. The home provides a waking night worker and a member of staff sleeps in at the home to provide further assistance where necessary. A member of staff who has started at the home since the last inspection confirmed that induction training is being provided and this was also verified PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 24 by other staff and entries in staff training records. Similarly staff confirmed that they are provided with access to a good range of health and safety related training as well as care courses, including safe practitioner, first aid, food hygiene, moving and handling, fire, infection control, challenging behaviour, safeguarding against abuse, autism, epilepsy and equality and diversity. This was verified by sampling three staff members training certificates and training information provided by the acting manager. In the annual quality assurance assessment completed by the acting manager she reports that 65 of staff have now achieved National Vocational Qualifications at level 2 or above. These courses help equip staff to carry out their work in a safe and appropriate manner. Staff recruitment information was provided by the acting manager following the site visit for sampling. Copies of two recent staff recruits records were checked. In both cases the records confirm that staff have been subject to POVA first checks (vetting checks) and Criminal Record Bureau checks have been applied for prior to staff starting work at the home. Similarly in both cases references have been sought by which to help assess staff suitability for the job. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall suitable arrangements are in place for ensuring a quality service and for maintaining a safe living environment for people not withstanding the need to more closely monitor the testing of fire equipment. EVIDENCE: The Registered Manager is currently on maternity leave and her post is being covered by an acting manager. The acting manager has over 10 years experience of working with people with learning disabilities and holds the National Vocational Qualification level 3 and is currently completing the Registered Managers Award to further equip her for her role. Reports of monitoring visits, carried out by the service manager, are kept on file along with action plans that have been drawn up by the home manager to address any shortfalls that have been identified. As previously noted end of PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 26 shift medication checks are carried out and medication stock checks are undertaken by the acting manager. A team leader explained that the manager regularly walks the home and carries out checks of the environment but no records are currently retained. The acting manager agreed to keep records of home audits and checks in future as further evidence that she monitors the service. Staff confirmed that they are provided with regular planned supervision to support them in their work and personal development. The acting manager said that she has yet to send out questionnaires to survey the views of the people at the home, their relatives and professionals but said she would be doing so shortly, in order that these views can feed into the development of the home. In the annual quality assurance questionnaire, the manager reports that appropriate maintenance checks are being carried out to ensure that equipment is kept in safe working order. A landlord gas safety certificate is in place confirming that gas appliances have been safety checked and records were seen verifying that electrical equipment is in place at the home. A suitable clinical waste contract is in place for the home. A record of how water monitoring is being kept at the home so that hot water is kept at safe temperature levels to prevent the risk of scalding. The fire log was checked. The records show that fire alarms and lights are being tested intermittently but not on a consistent basis at the correct frequencies, i.e. weekly alarm tests and monthly lighting checks. The manager agreed to ensure that this is addressed to ensure that correct fire safety procedures are in place. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 27 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 2 2 2 3 x 4 x 5 1 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 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5 Requirement Timescale for action 15/04/08 3 YA16 12 (4) (a) People must be provided with contracts of terms and conditions so that they are clear about their rights and responsibilities. Take action to devise strategies 21/02/08 to assist staff to preserve the dignity of the person who was seen eating breakfast partially dressed. 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 2 3 Refer to Standard YA1 YA24 YA24 Good Practice Recommendations Include the current charges for the service in the service user guide / contract or as addendum to it, so everyone is clear about the costs of the service. Proceed with plans upgrade items of furniture in the home, in particular the old wardrobe with padlocks fitted to make it secure. Proceed with plans to re hang pictures in various areas of the home and help people to personalise their rooms where necessary so that people enjoy a more homely environment. DS0000004224.V357369.R01.S.doc Version 5.2 Page 29 PIA 4 Milverton Terrace 4 5 6 7 YA24 YA30 YA30 YA42 It is strongly recommended that an alternative solution is sought to the use of perspex sheeting, currently used in a person’s bedroom, to stop the window being broken. It is strongly recommended that daily checks are carried out to ensure that toilets are adequately stocked with necessary items to maintain hygiene. Investigate and eradicate the odour present in a bedroom to make it more pleasant for the person concerned. Proceed with pans to ensure that fire alarms are routinely tested weekly and lights are tested monthly to make sure they are operating effectively. PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI PIA 4 Milverton Terrace DS0000004224.V357369.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!