This inspection was carried out on 3rd March 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
The Old Mill House 99 Pall Mall Chorley Lancashire PR7 3LT Lead Inspector
Val Turley Unannounced Inspection 3rd March 2006 09:30 The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 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.V279419.R01.S.doc Version 5.1 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.V279419.R01.S.doc Version 5.1 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.V279419.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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. 18th October 2005 4. 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 the past fourteen 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 to the side of the home which currently houses a vegetable plot, this is maintained by one of the service users. 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. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in March 2006 by one regulation inspector. The inspection took 5 hours. The inspection involved observation of the service users who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection?
Since the last inspection several areas within the home had been decorated and new furniture had been purchased for one of the service users. Maintenance work had also been undertaken on the exterior of the home to ensure that a safe and comfortable environment was provided for the service users. The home had documents in place relating to the assessments undertaken prior to the admission of the service users.
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 6 Some improvements had been made to the way the medication in the home was managed when service users go on home leave. Risk assessments had been undertaken on all the windows that did not have restrictors fitted. 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 Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The pre-admission process is in sufficient detail to ensure that prospective service users supports needs are fully assessed before admission. EVIDENCE: Standard two was assessed at this inspection to determine if requirements made at the previous inspection had been acted upon. It was noted that a copy of the service users assessment of needs, including those undertaken by the care manager prior to admission, was kept for reference at the home. The assessments contained all of the necessary detail of the service user support needs. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Care plans for service users living at the home were not in sufficient detail to ensure that the support needs of the service users could be fully met. Not all activities were risk assessed to ensure as far as possible the safety of the service users. EVIDENCE: Standard 6 was partly assessed at this inspection to determine if a requirement made at the previous inspection had been acted upon. The files of two service users were examined and it was noted that not all of their assessed needs had been carried over to the care plan. The dietary needs of one service user had been identified within the health action plan but had not included within the plan, neither was there any guidance elsewhere in the home as to the specific needs of the service user. Specific challenges presented by a second service user had also been identified within the health action plan but again no information had been carried over to the care plan and a record of the challenges presented had not been maintained. These omissions left the service users at risk and did not provide the support staff with advice and guidance that would enable them to provide an effective and consistent approach. There were risk assessments in place for all activities undertaken within the home, when in the car and in respect of road safety ensuring as far as possible
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 10 that these activities were undertaken as safely as possible. The risk assessment process must however be extended to take into account all other activities that the service users are involved in e.g. swimming to help reduce any risks to service users associated with these activities. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15, 16 and 17 The home was managed to ensure that the service users rights and responsibilities were respected however the staff team would benefit from clear policy guidance to ensure they have an understanding of how best to support service users in their relationships. Not enough importance was placed on the specific dietary requirements of the service users and the impact that this had on the health and well being of the service users. EVIDENCE: There was evidence that the home had good relationships with families and that service users were supported to maintain these. Staff were heard to discuss family contact details with the service users. The homes policy, which dealt with service users personal, family and sexual relationships was limited in detail and guidance and as such must be fully reviewed. The service users were observed to be relaxed in the company of the support staff who spent time talking to them and interacting with them. Support staff asked permission before they entered service users bedrooms ensuring that they their privacy was respected. It was noted that service user were able to spend time alone in their rooms if they wished and guidance in respect of this was included within the care plans. Service users were able to move around
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 12 the house freely, choosing where they wished to spend their time. The service users were given some responsibility for household tasks and again guidance as to the support they needed was included within the care plans. The service users attended meetings where they were given the opportunity to comment on the meals provided at the home and to influence the menus. The minutes of these meetings were examined. Service users were weighed weekly as a means of monitoring their general health. Care plans included any strategies in place to ensure that the service users ate their meals in the most appropriate environment and that appropriate support was provided. A care plan and health action plan in relation to one of the service users individual dietary requirements and preferences was also examined. These were found to be inconsistent and provided conflicting information for staff. Care must be taken to ensure that guidance is in place were service users have specific needs and/or allergies to ensure that their health needs are appropriately met in terms of diet. Additionally where liquidised foods are provided to service users, evidence of the assessed need for this should be provided to ensure that the health and well being of the service user has been considered. Standard 12 was partly assessed at this inspection. It was noted that there was little documentation on the service users files to suggest that they were involved in community-based activities on a regular basis. Discussion with the staff suggested that these activities did take place however the range and frequency of the activities must be documented for each of the service users. This would enable staff to plan activities more effectively as well as enabling them to assess the success or otherwise of the activities undertaken. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The support staff had a good knowledge of service users preferences and personal care needs and provided personal support sensitively and in accordance with their wishes. The health and other support needs of the service users must be addressed more thoroughly to ensure that they receive appropriate and consistent support from the staff team. EVIDENCE: The files of two of the service users were examined and these contained good and detailed information of their personal support needs and their preferred routines. There was an emphasis on the need to maintain their privacy and dignity as well as on the need to allow them to make choices and decisions regarding clothes etc. Information on the files indicated that the service users received specialist support from number of health professionals including a speech and language therapist and physiotherapist. A record was kept of any health appointments kept by the service users. A key worker system was in place within the home enabling a continuity of support to be provided for the service users. Each of the service users had a health action plan in place that provided information regarding the service users health needs and any routine health screening that had taken place. As already identified in relation to standards 6 and 17 important health and support needs identified within the health action
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 14 plan were not always carried over to the care plans. Some of the information provided was conflicting and service users were left in a position of risk. Standard 20 was partly assessed at this inspection. A recommendation made at the previous inspection had been partly acted upon and a record of medication going home with service users for home leave had been maintained. These records must be dated and signed to safeguard both the service users and the support staff. Further work must also be undertaken by the home to ensure that medication going home with service users is sent home in containers provided by and labelled by the dispensing pharmacist. This would reduce the risk of any errors that may occur through the process of secondary dispensing which was adopted by the home at the time of the inspection. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The homes policies and procedures in respect of the protection of vulnerable adults did not provide the correct guidance for staff, leaving service users in a position of risk. EVIDENCE: The homes policy and procedure in respect of Adult Protection issues should be reviewed and amended. The policy gave incorrect information and guidance for staff as to the action they should take if they became aware of an allegation of abuse. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 16 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 The home was clean comfortable and homely and provided an environment that was suitable for its stated purpose. Risk assessments were needed to ensure the continued safety of the service users. The laundry in the home was well equipped but the hygiene arrangements were uncertain and clarification regarding this must be sought. EVIDENCE: Standard 24 was partly assessed at this inspection. A requirement made at the previous inspection had been acted upon and there were risk assessments in place for all none restricted windows. There was however no system in place to review the environmental risk assessments and a system should be introduced to ensure that this happens on a regular basis. The laundry of the home was inspected. It is situated in the cellar of the home and is accessed by steep steps. It was recommended that a rail should be installed on the upper part of the steps for the safety of the staff carrying laundry up and down them. The laundry was spacious and well equipped. The walls and floor were not of surfaces that could be easily cleaned and on the day of the inspection it was not possible to determine how the cleanliness of these surfaces was maintained. Details of the arrangements to maintain the hygiene of this area and so prevent the possible spread of infection should be forwarded to the Commission for Social Care Inspection.
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 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 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 The staff team were competent and had received relevant training to enable them to support the service users well although additional training must be provided to ensure that their skills are updated and their knowledge has a broader base. There is a recruitment policy and procedure in place however the home current practice with regards to staff records does not ensure the safety of service users. EVIDENCE: The staff were observed to spend time with the service users and to talk to them and explain things to them. The service users appeared to be comfortable in the company of the staff and approached them to ask for help and assistance. The staff team had attended a variety of training courses that had provided them with an understanding of the service users communication needs and consequently were able to support them more effectively. The home enjoyed good relationships with the health and social care professionals who supported the service users. The home was continuing to work towards having 50 of its staff team achieve a relevant qualification in care. Standard 35 was partly assessed at this inspection. The home had a training matrix in place that recorded all of the training the team had undertaken. From the records it was evident that training in moving and handling needed to be updated to ensure the safety of the service users and the staff team.
The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 18 From discussion with the staff it became clear that the home does not use agency staff to cover sickness or holidays. Instead the home deploys staff from the other homes within the group to cover these vacancies. As the home is legally required to hold recruitment records and details for each of the staff who work at there, this is an area that needs to be addressed. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 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 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 and 39 The home had an experienced manager who ensured that the home had a number of quality assurance processes in place aimed at improving the service provided and had plans to improve these in conjunction with other homes within the group. EVIDENCE: The manager of the home had achieved her NVQ 4 and had experience appropriate to the responsibilities she had at the home. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. The views of the service users and their families had been canvassed but unfortunately the results of this survey had not been dated. The inspector was informed that the organisation intended to undertake a quality assurance survey and publish the results in a newsletter that would be distributed to all interested parties. On an informal basis the views of the service users were sought on a daily basis with more formal service users meetings being held throughout the year. Policies and procedures were reviewed when necessary and when required and the service users were encouraged to participate in the inspection process. The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 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 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 X 23 2 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 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 2 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 2 3 X 3 X X X X The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(1) Requirement The registered person must ensure that all the service users needs are recorded on the care plan and the actions staff need to follow to meet those needs. (Timescale of 31/12/05 not met) The registered person must ensure that any activities in which service users participate are so far as reasonably possible free from avoidable risks. A programme of activities must be provided to meet the needs of the service users and a record kept of the activities the service users participate in. The homes policy regarding service users personal, family and sexual relationships must be reviewed. The registered person must promote and make proper provision for the health and welfare of service users in respect of their dietary needs. Unnecessary risks to the
DS0000005924.V279419.R01.S.doc Timescale for action 30/04/06 2. YA9 13(4)(b) 30/04/06 3. YA12 16(2)(n) 30/04/06 4. YA15 12(4) 30/04/06 5. YA17 12(1) 30/04/06 6. YA19 13(4)(c) 30/04/06
Page 22 The Old Mill House Version 5.1 7. 8. YA20 YA23 9. YA34 health or safety of the service user must be identified and as far as possible eliminated. 13(2) The registered person must ensure that medication is managed safely at the home. 13(6) The registered person must amend the policy dealing with vulnerable adult procedures, ensuring that the correct guidance is provided and inform staff of the changes. A copy of the amended policy must be forwarded to the Commission for Social Care Inspection. 17(2)Schedule The registered person must 4 keep a record of all staff employed at the Care Home, that includes all the checks required by law. 13(5) The registered persons must make arrangements all staff to receive training in safe moving and handling. 30/04/06 30/04/06 30/04/06 10. YA35 31/05/06 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. Refer to Standard YA24 Good Practice Recommendations The registered person should ensure that a system for reviewing all environmental risk assessments on a regular basis is introduced. A handrail should be installed down the cellar steps. Details of the arrangements in place to prevent the spread of infection within the home should be forwarded to the Commission for Social Care Inspection. The registered person should ensure that 50 of care staffing the home achieve an N.V.Q level 2 by 2005. 2. 3 4. YA24 YA30 YA32 The Old Mill House DS0000005924.V279419.R01.S.doc Version 5.1 Page 23 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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