Inspection on 16/05/05 for The Mill House

This inspection was carried out on 16th May 2005.

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 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

The Mill House 03/01/07

The Mill House 20/09/05

The Mill House 31/01/05

The Mill House 24/08/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 The Mill House Cliff Top Ingham Lincs LN1 2YQ Lead Inspector Alison Marshall Unannounced 16 May 2005 12:00 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. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Mill House Address Cliff Top Ingham Lincs LN1 2YQ 01522 730130 01522 730153 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) Thelma Turner Homes Limited Mrs L L Gaskin Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31 January 2005 Brief Description of the Service: Mill House is an adapted detached property, situated on the edge of the village Ingham. Local facilities include a post office, village shop, GP surgery and public house. The home has its own mini-bus to enable residents to access other facilities within the community. The property stands in its own grounds and gardens, which includes aviaries, with birds of prey and other small animals that service users care for.The home provides accommodation for 8 service users who have a learning disability and accompanying challenging needs and behaviours. Communal facilities are on the ground floor, as is one service users bedroom. All service users have single room accommodation, with one room having en-suite facilities. A detached bungalow at the front of the main building offers separate accommodation with en-suite facilities for 2 service users working towards independent living. There are car-parking facilities to the front of the building. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between 12 noon and 6.30 pm. Time was spent talking with the service users, looking at records, and talking with the manager and staff. One service user showed the inspector around the premises. This was a positive inspection with only one requirement being made. The manager, staff and service users were very open to the inspection and made it a very enjoyable experience for the inspector. What the service does well: What has improved since the last inspection? What they could do better: There were 10 staffing vacancies which meant that the home was reliant on agency staffing to maintain staffing levels on shifts. Although this had no major impact in terms of meeting the day to day needs of the service users it was starting to show in terms of not all records being as up to date as they should have been. It was also difficult to introduce improvements and The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 6 developments to the service. Service users did notice the ‘different faces’ but did not feel that it impacted on the support they received. The kitchen and laundry areas were looking worn and shabby. The fridges and freezers were locked due to a number of the service users having prader willi syndrome. These were all kept in an area next to the kitchen. It would look more homely if these were kept behind one door rather than having them all on display. 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 Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 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 The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 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) None of these standards were assessed. EVIDENCE: Assessment of services user needs was addressed at the previous inspection in January 2005. No new service users had been admitted since this time. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 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 9 Service user individual needs were promoted and documented appropriately. EVIDENCE: Each service user had an individual detailed care plan. Of the two seen, one had been reviewed on virtually a weekly basis to reflect the changing needs of the service user. From the documentation and from discussion with the service user it was clear that she was fully aware of the plan, the changes and why it had changed and the goals towards which she was working. There were associated up to date risk assessments to complement the care plan. Monthly key work sessions held between the individual service user and key worker further documented the work that had been done. However, another care plan seen had not been reviewed for a number of months and key worker sessions had not taken place. The manager explained that this was primarily due to the staffing situation (See section on staffing). However, the monthly audit carried out by the manager ensured that care plans were reviewed within 6 months. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 10 Discussion with service users confirmed that although they were aware of and signed their care plans they were not always aware of the monthly report produced by the key worker. A system of points was used to encourage positive behaviour and engagement in aspects of the care plan. The points for each ‘activity’ were individually agreed by the service user with their key worker ensuring that they were relevant to each service user. The points accumulated were translated into individual ‘rewards’. The service users were very clear about the system and how it worked and described it as fair. Service users were less clear about ‘ABCs’ and how they worked. These were incident forms that were completed by staff for negative behaviours and also resulted in points being lost. The manger agreed that it would be an agenda item at the next service user meeting. Service users stated that they enjoyed living at Mill House. In particular those living in the semi-independent bungalow said that they really appreciated the freedom and the independence: they ‘wouldn’t change a thing’. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 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, 14, 15 and 16 Service users had busy and varied lifestyles with opportunities to engage in a range of educational, vocational and leisure activities. EVIDENCE: Each service user had a weekly timetable that had been drawn up by them with their key worker. This ensured that although there were some group activities there was also dedicated individual time. There were other timetables for household tasks such as helping to prepare the meals and clearing up afterwards. Service users spoken with said that they had enough to do and that they were supported with individual activities and hobbies. The weekly timetables showed that service users were out at a number of different education or vocational establishments during the week. These included local colleges and the company’s farm. All service users were encouraged to clean their own rooms, and to do their own shopping, washing and ironing. Family and friends were encouraged to visit at any reasonable time. Service users were supported to maintain contact through visits, telephone calls and The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 12 letters. Staff provided appropriate guidance and support to service users with regards to personal relationships to ensure they had sufficient information on which to make safe choices. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 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 standard(s) 18, 19 and 20 Service users received personal and health care in line with their needs and independence in all areas was encouraged. EVIDENCE: Service users stated that they felt that they received the care they needed and that staff encouraged and worked with them to achieve as much independence as possible. Five of the service users had prader willi syndrome. Details specific to their care and support needed were included in their individual plans. Staff had received appropriate training and were aware of the specific issues relating to the syndrome. Files showed that there were good links with other health professionals. Medication records and storage were satisfactory ensuring that all medication was administered safely and correctly. The pharmacist visited every three months. At the last visit on 18 April 2005 the pharmacist report showed that administration records were good and storage and stock control was good. Although there were some information regarding the administration of PRN medication on individual service user files it is recommended that specific guidelines are drawn up and kept with the medication records. Only staff that had received training administered medication. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 14 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) 23 There were good systems in place to ensure the safety of service users. EVIDENCE: There were appropriate policies and procedures in place regarding the protection of vulnerable adults and staff had received training in these. Discussion with staff showed that they had a clear understanding of the procedures. Physical restraint was rarely used: there were only two recorded incidents since the last inspection. Any such incident was recorded and the manager monitored all records. Service users confirmed that restraint was rarely used and said that they felt safe at the home. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 15 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 and 30 Some parts of the home were in very good condition; other parts were in need of redecoration and refurbishment. EVIDENCE: The semi-independent bungalows were well maintained and the occupants were very happy living in them. Each flat contained a large bedroom, en suite shower and toilet and an open plan lounge with kitchen area. The kitchen areas were well provided for with cooker, microwave, fridge and washing machine. Each service user had taken care to decorate and furnish them with their own personal belongings and seemed very proud of their flat. The main building had plenty of communal space. The lounge had recently been redecorated and refurbished and looked very modern, clean and bright. The service users said that they enjoyed using this room and had been involved in choosing the new colours and furniture. The kitchen was outdated and looked shabby and staff said that it was difficult to keep clean. There was a separate area to the kitchen where a number of fridges and freezers were stored. These were locked due to the service users needs associated with prader willi syndrome. The manager felt that it would The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 16 be much more appropriate and homely if these could be secured behind a separate door rather than having them on display. The laundry area, although well provided for in terms of washing machines and dryers, was also in need of refurbishment. Not all of the bedrooms were seen as some service users were out and others did not want them to be seen. Those seen were large and had been personalised by the occupants. They all expressed satisfaction with their rooms. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 17 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) 32, 33 and 34 Service users were well supported by a small competent dedicated staff team but the home was reliant on agency staff. This meant that there were some inconsistencies in practice and that it was difficult to implement developments in the service. EVIDENCE: The home had 10 staff vacancies which meant that the home was reliant on agency staff to maintain staffing levels. There was generally at least two agency members of staff on every shift. The manager had drawn up a recruitment plan to address the difficulties with regards to recruiting permanent staff and had tried some different approaches. In addition she had produced a report detailing the issues and some solutions for the company to consider. All service users spoken to said that they saw a number of different faces but they did feel that they still received the support they needed. The manager felt that the home was reliant on the good will and commitment of the permanent staff to cover and undertake overtime to ensure that the support was still provided. Staff spoken to confirmed that they felt this way too. Good recruitment practices were in place and staff files for permanent and bank staff contained all of the documentation required by law. The home had an written signed agreement with the agencies used that they would carry out The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 18 all of the recruitment checks required by law on the staff they provided. Discussion took place with the manager regarding ways of improving practice around the use of agency staff to ensure that the staff were suitable to work with the service users: this included a signed induction, a profile for each person detailing their experience and training and to see sight of the Criminal Records Bureau check. Eight staff were working towards the National Vocational Qualification. The manager had established a training programme and expected that staff would achieve the qualification within the timescales she had identified. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 19 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) 38 and 39 The home was well managed and there were systems in place to ensure that service users views were sought regarding the running of the home. EVIDENCE: Service users and staff were positive about the manger and her open and approachable nature. From observation it was clear that there were good relationships between the manager and the team. The manager was very positive about the inspection process and was committed to improving the service provided. There was a comprehensive audit system in place which ensured that all records were monitored on a regular basis. Service user questionnaires were used on a regular basis to seek their views on a wide range of issues. The manager had produced an annual report available to all stakeholders detailing the changes that had been made over the past year and some of the targets for the following year. Discussion took place regarding ways of developing this: including making the targets more specific and measurable and how to more fully involve service users, staff and stakeholders in the process. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Mill House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x x x x C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 21 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 33 Regulation 18(1)(b) Requirement The registered person must ensure that there are sufficient numbers of permanent staff recruited and employed to ensure that service user needs are met at all times. Timescale for action 01/10/05 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. 4. 5. 6. 7. Refer to Standard 6 6 20 23 23 23 34 Good Practice Recommendations The registered person should ensure that monthly key worker reports are signed by the individual service user. The registered person should ensure that all service users are fully aware of ABCs and how they are recorded. The registered person should ensure that there are written guidelines for the administration of PRN medications and that these are kept with the medication records. The registered person should consider refurbishing the kitchen. The registered person should consider enclosing all the fridges and freezers behind one lockable door. The registered person should consider refurbishing the laundry room. The registered person should introduce a signed induction for each agency staff to include recording that they have C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 22 The Mill House 8. 39 seen the CRB. The registered person should ensure that the targets in the annual development plan are specific and measurable. The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unity House, The Point Weaver Road, off Whisby Road Lincoln LN6 3QN 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 The Mill House C53 CO4 The Mill House V228085 160505 Stage 4.doc Version 1.30 Page 24 - 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!