CARE HOME ADULTS 18-65
The Old Mill House 99 Pall Mall Chorley Lancashire PR7 3LT Lead Inspector
Val Turley Unannounced Inspection 20th July 2006 09:30 The Old Mill House DS0000005924.V297257.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 The Old Mill House DS0000005924.V297257.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. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Old Mill House Address 99 Pall Mall Chorley Lancashire PR7 3LT 01257 274678 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) dalesview@tiscali.co.uk Dalesview Partnership Miss Lisa Warburton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 6 service users to include: Up to 6 service users in the category LD (Learning Disability). The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 3rd March 2006 Date of last inspection Brief Description of the Service: The Old Mill House is currently registered to accommodate six service users with a learning disability. It has been home to the current service users for a number of years. Within the home there are five bedrooms, two single and one shared room on the ground floor, and two single rooms on the first. Bathrooms and toilets are located on both floors and a single room on the ground floor has en-suite facilities. The homes kitchen/diner is located at the rear of the building and the lounge at the front overlooks the road. There is a garden area to the side of the home. The home is situated on Pall Mall, which is one of the main roads leading into Chorley town centre. The town offers a range of leisure and shopping facilities which service users are supported to access. The home is one of a number owned by the Dalesview Partnership. At the time of the site visit the home had an acting manager in post. The current fees for the service are £600-£800 per week. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection of a service takes place over a period of time and involves gathering and analysing written information. A site visit was also made to the home as part of the inspection process and this involved observation of the service users living at the home and where possible discussion with them, discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. A questionnaire was completed by the acting manager prior to the site visit and questionnaires were received from all of the service users and comment cards from four relatives and two GP’s. These all provided information that is included in the report. As part of the inspection, the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus one of the service users living at the home. Records relating to that individual were inspected and discussion took place with the service user where possible. What the service does well:
The Old Mill House provided a comfortable, clean and safe environment for both the service users and the support staff. The home had a thorough preadmission process enabling it to make an informed decision as to whether it can provide an appropriate support service to a prospective service user or not. It had developed detailed care plans that are based on the needs, preferred routines and likes and dislikes of the service users. The health needs of the service users were attended to and staff supported them to attend medical appointments. The home supported the service users to participate in a range of activities both in the home and the community. Service users were also supported to maintain contact with their family and friends. The home was in the early stages of introducing person centred planning for all of the service users. This should complement the homes already person centred care planning approach. The staff team were well informed about the service users support needs and they were aware of the service users right to privacy and dignity, giving them appropriate guidance and support and including them in conversation. The service users were comfortable in the company of the staff and turned to them for help. Relatives found the staff approachable and were pleased to be kept informed of their relative’s progress.
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 6 Recruitment practices within the home were robust and all the necessary checks had been undertaken prior to a member of staff commencing work. The staff team had access to a variety of training opportunities. The home was well staffed with a settled staff team and had flexibility to have additional staff on duty if required. The home had an acting manager in post who had the qualities and skills to manage the home well. There were a number of quality assurance processes in place to ensure that the home was safe and ran in the interests of the service users. What has improved since the last inspection? What they could do better:
The home should continue to work towards having 50 of care staffing the home achieve a nationally recognised qualification in care. Training in personal and Sexual Relationships should also be made available. Staff rotas should reflect the status of each member of staff on duty so that individual responsibilities are clear. The homes recruitment policy and procedure must be reviewed and updated.
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 7 The manager should ensure that the homes services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. The results of all quality monitoring processes should be reviewed on an annual basis enabling progress and improvements to be measured and reported upon. 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 Old Mill House DS0000005924.V297257.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 The Old Mill House DS0000005924.V297257.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission process is in sufficient detail to ensure that prospective service users supports needs are fully assessed before their admission to the home. EVIDENCE: There had been no new admissions to the home since the last inspection, however documentation relating to the service users resident at the home indicated the home had a detailed pre-admission process enabling the home to decide if they could meet the service users support needs. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 10 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): 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. Care plans for service users living at the home were detailed and outlined their individual support needs, enabling staff to provide a safe and supportive environment. EVIDENCE: The file of one of the service users living at the home was examined in detail. The plan outlined the service users support needs in detail as well as guidance for the staff as to how those needs should be met. The plan also outlined the service users likes, dislikes and preferred routines. The care plan identified any possible risks linked to the activities the service user took part in and again provided guidance for staff as to the support they needed to provide. The service user had been included in the development of the plan and her family had also been consulted. Discussion with the service users key worker and observation of the staff providing support on the day of the visit indicated that her support needs were being addressed by the staff team. The service user was encouraged to make choices and decisions with the support of the staff.
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 11 Other files examined showed that the care plans included all the relevant information to enable staff to provide appropriate support in all aspects of the service users lives, including the management of challenging behaviour and any specific dietary needs. Comment cards received from relatives expressed their overall satisfaction with the care and support provided at the home and the approach and attitude of the staff. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefited from a flexible routine and their individual needs and preferences were provided for. EVIDENCE: The service users were supported to become involved in a range of activities both within the home and within the local community. The care plans included details of their preferred activities, such as attendance at a day centre, college and the leisure centre as well as the use of local shops, the cinema and parks. The service users also enjoyed holidays away together. On the day of the site visit a number of the service users went out shopping and swimming. The home was in the early stages of introducing person centred planning in the home and already the staff had recognised that this may result in changes to the way the individual service users spent their time. The service users were supported to maintain contact with their families and friends. A record was kept of this contact and staff were heard to talk to the service users about their families and contact they had with them. Additionally
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 13 information within the service user files showed the importance of family contact and involvement. The homes policy on personal and sexual relationships had been reviewed and updated since the previous inspection, providing support staff with more detailed and appropriate information. None of the staff at the home had received any training in this area, and it was recommended that this be undertaken to give staff additional knowledge. Staff were observed to include service users in conversations and to be aware of their right to privacy and dignity and the service users were clearly comfortable in the company of the staff. Service users were observed to be able to spend time alone if that wished. They had unrestricted access to all the communal areas of the home and were supported to become involved in basic household tasks. The individual dietary needs of the service users were clearly documented within the individual care plans and there was guidance available for staff within the kitchen. Meals appeared to be well balanced and nutritious and staff were observed to encourage service users to choose what they wanted to eat at meal times. There was also guidance in place for staff to support service users appropriately at meal times and this included in some cases arrangements for them to eat alone. Questionnaires received from service users did not raise any criticism about the home although as the communication skills of the service users were limited, the value of the questionnaires was limited. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 14 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support staff had a good knowledge of service users preferences and social, health and personal care needs and provided personal support sensitively and in accordance with their wishes. EVIDENCE: The individual care plans of the service users living at the home contained clear and detailed information regarding the service users health and personal care support needs, including their preferences as to how this support should be provided. Discussion with staff and observation of the staff during the site visit indicated that they were aware of the individual needs of the service users and worked hard to meet these needs appropriately. Information in service users files, including their health action plan, and discussion with staff indicated that the health needs of the service users were monitored and attended to as necessary. Service users were supported to attend medical appointments and each had an annual medical health check. Daily records were maintained to help staff identify any potential health difficulties that the service user may develop. Medication in the home was well managed and a requirement made at the previous inspection had been acted upon and a record was now kept of any
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 15 medication leaving the home with a service user. The home had also discontinued the practice of the secondary dispensing of medication reducing the possibility of service users being given the wrong medication. Comment cards received from two GP’s expressed an overall satisfaction with the home and its approach to managing the healthcare of the service users. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had good policies and procedures in place to ensure as far as possible the health and well-being of the service users. EVIDENCE: The homes policies and procedures relating to the Protection of Vulnerable Adults, including the management of challenging behaviour, had been reviewed and updated since the last inspection. This now provided staff with up to date information and guidance regarding their responsibilities and the action they must take should they become aware of any concerns or any allegations of abuse. The written information provided by the acting manager prior to the site visit indicated that most of the staff team had received recent training in this area and discussion with a member of staff indicated that there was an awareness of the action they must take. Service users were presented with opportunities were they could raise any concerns of their own including service users meetings, 1-1 support. The staff had developed a complaints procedure in an accessible format for the service users and this was kept on display in the kitchen of the home, enabling it to be accessed at any time. The home managed the service users monies well. A limited number of staff had access to their finances and a record with a receipt was kept of all transactions. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable providing a safe, pleasant and homely environment for the service users and staff team. EVIDENCE: The home was clean, well decorated, furnished and maintained and provided the service users and staff with a pleasant and homely environment. The home was well placed giving easy access to local facilities. Since the last inspection a number of improvements had been made to the home. The kitchen had been redecorated and the garden had been tidied up giving service users a pleasant area to sit outside the home. A handrail had also been fitted down the cellar steps reducing the possibility of any accidents to staff or service users. The laundry area was clean was equipped to meet the needs of the service users. Since the last inspection, guidance regarding the cleanliness of the laundry provided by the Environmental Health Officer had been made available within the laundry itself. A system had also been introduced to ensure that any environmental risk assessments are reviewed on a six monthly basis.
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 18 It was recommended that the home ensure that its services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 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): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes recruitment policy and procedure did not fully protect service users. EVIDENCE: On the day of the site visit the staff were observed providing support to the service users. They were seen to be sensitive in their approach and discussion with them indicated that they were well motivated and committed in their approach. They had a good knowledge of the service users support needs and in if they were a key worker had in-depth knowledge of the service user they had a specific responsibility for. A comment card received from a relative said that the staff always made her feel very welcome and kept her informed about her relative. The service users were seen to be comfortable on the presence of the staff and turned to them for support when they needed it. The training matrix indicated that the staff team had good training opportunities and it advantage of these. The home was continuing to work towards having 50 of its staff achieve a nationally recognised qualification in care. Induction training was provided for new staff and staff were subject to a three-month probationary period The file of a recently appointed member of staff was examined and it was noted that a the acting manager had ensured that all of the necessary checks had been undertaken prior to the member of staff commencing work at the home. The homes recruitment policy needed to be reviewed and updated to ensure that it reflected current good practice and guidance and protect the service users as far as possible.
The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 20 The staff team was well established and settled and this help to provide a consistent approach in the care provided. The staff team had a good knowledge of the service users and were able to share ideas through staff meetings and supervision with the acting manager. The rota indicated that there were always sufficient staff on duty to meet the needs of the service users although the rota should reflect the capacity of the staff working at the home so that the individual responsibilities of staff are clear. The manager recognised that the approach to staffing may have to be reviewed once person centred planning had been completed. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed with the safety and well being of the service users and staff being central to its approach. EVIDENCE: The acting manager, who had submitted an application for the position of registered manager, was well motivated and keen to support service users appropriately and improve the service generally. She was working towards an NVQ 4 in care and the Registered Managers Award and had a number of years experience in this field. The home had a number of quality assurance processes in place. It had achieved the Investors in People Award, which is a quality assurance award accredited by an outside body and was in the early stages of working towards the Investors in Excellence Award. A number of surveys had been undertaken and the views of the service users, their families and a number of involved professionals had been undertaken. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 22 The acting manager planned to publish the results of these surveys in the homes next newsletter. There were regular service users meetings and 1-1 support gave service users opportunities to express any concerns about the home. A senior member of the company made monthly monitoring visits to the home and reports of these were forwarded to the Commission for Social Care Inspection. The senior staff at the home had the responsibility of undertaking a number of regular checks at the home, including checks on the environment, the medication and the care plans. A questionnaire completed by the acting manager prior to the site visit indicated that the homes equipment and systems were appropriately maintained. The training matrix indicated that staff had all undertaken appropriate mandatory training to help ensure that working practices were safe and protected both the service users and the staff. Any accidents at the home were recorded and filed in accordance with data protection legislation. The home had also undertaken risk assessments for all safe working practices. Although standard 39 was found to have been fully met, it was recommended that the results of all of the homes quality monitoring processes be reviewed on an annual basis to enable progress and improvements to be measured and reported on. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 X 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 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 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 24 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 YA34 Regulation 13(6) Requirement The homes recruitment policy and procedures must be reviewed an updated. Timescale for action 31/08/06 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 Refer to Standard YA15 YA30 YA32 YA32 YA39 Good Practice Recommendations The staff team should receive training in respect of personal and sexual relationships. The manager should ensure that the homes services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. The registered person should continue to work towards having 50 of care staffing the home achieve a nationally recognised qualification in care. The staff rota should reflect the capacity of each member of staff on duty. The results of all quality monitoring processes should be reviewed on an annual basis enabling progress and improvements to be measured and reported upon. The Old Mill House DS0000005924.V297257.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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