Inspection on 22/11/06 for WCS - Mill Green

This inspection was carried out on 22nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

Other inspections for this house

WCS - Mill Green 26/10/09

WCS - Mill Green 29/08/07

WCS - Mill Green 29/11/05

WCS - Mill Green 12/07/05

WCS - Mill Green 27/04/05

WCS - Mill Green 01/12/04

WCS - Mill Green 02/04/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOME ADULTS 18-65 WCS - Mill Green Newbold Road Rugby Warwickshire CV21 1EL Lead Inspector Martin Brown Key Unannounced Inspection 22nd November 2006 10:00 WCS - Mill Green DS0000004266.V320063.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 WCS - Mill Green DS0000004266.V320063.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. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Mill Green Address Newbold Road Rugby Warwickshire CV21 1EL 01788 552366 01788 542655 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) Warwickshire Care Services Limited Ms Victoria Britton Care Home 15 Category(ies) of Learning disability (2), Physical disability (13), registration, with number Physical disability over 65 years of age (2) of places WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Mill Green is a registered care home providing personal care and support for 15 people with physical disabilities, 2 of whom can be over 65 years of age. 2 of the places available are for respite service provision. Residents’ accommodation is on the ground floor. The shared space in the home consists of a large lounge with dining area. Each service user has an en-suite toilet to their bedroom with two bedrooms having an en-suite shower facility with WC. There is one bathroom with assisted bath and two shower rooms, both with WC’s. In addition to the main kitchen and laundry of the home there is a domestic kitchenette and laundry room for use by residents. There are two office facilities used by management and staff. There are extensive wellmaintained gardens to the front and sides of the home and an internal garden used for leisure activities by residents. All bedrooms over look garden areas. The home is situated in Newbold on Avon, which is in the suburbs of Rugby in Warwickshire, and close to shops, local services and facilities. Fees per person range from £750 per week, up to £898 per week, depending on need. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. This includes information provided by the home, questionnaires returned by residents and relatives, and a visit to the home. Two feedback cards were returned by relatives, and both were positive in their responses. Seven questionnaires were returned by residents, some with the support of staff or an advocate, and these were overwhelmingly positive, but with one comment noted referring to ‘always being short of staff’. The pre-inspection questionnaire was completed and returned by the manager. The inspection visit was unannounced, took place on 23rd November 2006, between 10am and 2pm. A tour of the premises was made, relevant documentation was looked at, staff and residents spoken with, and observations of the home in action were made. All staff, management and residents were welcoming, helpful, and friendly throughout. What the service does well: What has improved since the last inspection? Refurbishment of the home continues. The garden is now much more attractive and accessible, and is a positive amenity for the residents. The employment of an activities organiser is improving the scope for both group and individual activities. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 6 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. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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 WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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. 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. Prospective residents can be confident that their needs and aspirations are assessed. EVIDENCE: There continues to be a clear assessment procedure in place, whereby the needs and aspirations of prospective residents are assessed prior to admission. Those residents asked responded positively regarding the choice of home, with one long-standing resident, in particular, making favourable comparisons with her previous home. The needs of regular respite residents are reviewed each time they spend time at the home. Their care plans are in the same format as those of permanent residents. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The changing needs and wishes of people in the home are reflected in their care plans, and they are supported to make decisions about their lives, and to take risks as part of an independent lifestyle. EVIDENCE: A sample of care plans were examined. These are kept in residents’ rooms, and all asked gave permission for them to be looked at. Care plans were upto-date, and regularly reviewed, with residents evidencing their agreement with signatures, or with the signature of a representative in some instances. Care files show evidence of health needs, specific risks being monitored and managed, and of residents being consulted and involved in decision-making regarding their own lives. For example, the falls that one person had had, and their circumstances, were recorded, and aids and outside advice was sought with a view to minimising them, but it was also accepted that this person’s condition, and her wish to mobilise as independently as possible, carried risks. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 10 The person concerned accepted this, and declared herself happy with the balance between the support offered by the home and her own choice and independence. At present, care plans are written in pen; the manager advised that these are to be typed in future, so that they are clearer for all to read. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a variety of activities within the home, although the availability of suitable transport would enable those with more acute mobility needs to have more options with activities outside the home. Residents benefit from meals that they enjoy. EVIDENCE: The home has an activities organiser who has that role three days a week. She explained how she worked with individuals on hobbies and activities that they were interested in. Several residents were enjoying activities in the home during the day, and several had been working with staff preparing items for sale for Christmas, to help raise funds for further activities. Residents said that they had enjoyed a Halloween party, and were looking forward to a Christmas party. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 12 Several residents enjoyed going out to activities such as Speedway, and shopping, but other residents, especially those with higher mobility needs, said that they would like to go out more to different places, but that transport is a problem. The activities organiser acknowledged that, at present, activities outside the home for some residents is limited by the availability of suitable transport. Shopping and socialising at present for many residents consequently tends to involve local shops and pubs within walking distance. Residents said that relatives and other visitors are always welcome by the home. The manager advised that involvement by relatives in reviews is encouraged, and evidence of this input was seen in care plans. Staff were seen to always knock on doors and treat residents respectfully, as well as to encourage them in tasks and chores that helped maintain and develop skills and independence. Residents’ comments on the food were all positive, ranging from ‘very good’ to ‘fabulous’. Menus showed a variety of wholesome food, and choices. I was advised that, other than one person who was being encouraged to lose weight, there was currently no-one on a special diet, other than one person on a ‘peg’ feed, which was seen to be managed appropriately, with district nurse support as required. Residents were seen to be enjoying a midday meal in congenial surroundings, in an unhurried way, with those in need of assistance being helped sensitively by staff. Some residents prefer to exercise the option of eating in their rooms. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal and health support in the ways in which they need and require. Medication is well-managed and self-medication is encouraged and supported. EVIDENCE: Throughout, staff were observed to be treating residents with respect and dignity, and to be aware of health and support needs, and to be addressing them and to be addressing them in a supportive and natural way. Residents spoken with were all very positive concerning the staff and the care and support offered, except for two comments that, at times, there were not enough staff. This was reflected, in the eyes of these residents, by the limited opportunities for those with restricted mobility to take part in activities outside the home. The manager advised that some of the problem currently lay with obtaining suitable transport. Personal support and staff awareness and communication for one resident with dual impairments was explained, and staff interactions with him were observed. Staff were all trained in ‘touch signing’ and were aware of the need to fully involve him and inform him at all times. This was helped by the availability of a ‘communicator’ during the day, with whose help he was able to demonstrate a keen interest in events near and far. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 14 One resident uses a ‘peg’ feed. The appropriate protocols, training, outside support and agreement were seen to be in place. Medication is kept in individual rooms, and accessed by staff, except where self-medication protocols have been agreed. A sample of Medication Administration Record Sheets were examined and tallied with medications dispensed. Where staff dispense medication, residents or their representatives have signed to indicate their agreement. One ‘as required’ medication had not been dispensed during the whole period of the recording looked at. It had been generally signed by staff as not dispensed, but there were a few gaps where nothing had been written in. The manager agreed that practice for this recording must be consistent, and that the protocol for recording ‘as required’ medication must be clear. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from harm. They can be confident that concerns and complaints are addressed by the organisation, although there is some way to go before residents can be confident that all issues raised are fully resolved. EVIDENCE: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from harm. They can be confident that concerns and complaints are addressed by the organisation, although there is some way to go before residents can be confident that all issues raised are fully resolved. The comments, complaints and concerns books freely accessible in the home were looked at and principally contained compliments from relatives. The manager advised that a survey of residents had shown dissatisfaction with the laundry, in that items were being mislaid. The manager advised that the service has been trying to address this, in response to these concerns, by having separate laundry staff, care staff doing it as a part of their duties, and residents being supported to do at least some of their own clothing washing. There were no concerns about laundry mentioned by residents during the inspection. Two residents raised concerns about shortages of staff at certain times. The annual review showed that a quarter of residents felt complaints had not been dealt with to their satisfaction. The manager advised that this may relate to ongoing problems in the management of laundered clothes. The manager showed me details of a current complaint, and explained how that was being addressed. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 16 Staff were able to show a good awareness of abuse issues, adult protection, and whistle-blowing. The manager was able to explain and show what preventative work had been undertaken to protect a vulnerable resident from possible outside abuse. WCS - Mill Green DS0000004266.V320063.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a spacious, clean, and hygienic environment. The homeliness of the service may be compromised by visitors attending training or using the upstairs of the building for other purposes. The noise occasioned by the current call bell system may be regarded as intrusive. EVIDENCE: The home is spacious and accessible for residents, with the downstairs of the building being used for the residents, with the upstairs now used as a storage and training facility for the organisation. This means that people other than the staff and residents of the home enter the home to use the upstairs at times. This, when raised, did not seem to concern residents, who were usually familiar with the visitors and felt sufficiently secure with them. The garden is attractively laid out and accessible to residents. The manager advised that this has been the case since an extensive refurbishment earlier in the year. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 18 The kitchenette adjacent to the dining room was in a poor condition, with one drawer fascia missing; limited storage space, and being generally ‘tired’ looking. A resident advised that the kitchenette was to be refurbished. This was confirmed by the manager, who also said that there were plans to redecorate a number of bedrooms and the rest of the corridor. The home was clean, uncluttered and free from unpleasant odours. The laundry was well-maintained, and the system for managing soiled laundry and guarding against cross infection was explained by staff. The call system results in a bell ringing throughout the building whenever a resident wishes or needs staff attention. These were seen to be answered promptly by staff. Those residents, who were asked if they found this noise a nuisance or intrusion, said that they ‘had got used to it’ and ‘usually didn’t notice it any more’. WCS - Mill Green DS0000004266.V320063.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well-trained, recruited, and supervised staff. Whilst rotas and observation on the day of the inspection indicated that the home has sufficient staff on duty, these numbers may not always meet residents’ expectations or aspirations, particularly those with higher levels of mobility needs. Residents are not well served at present by the laundry system. EVIDENCE: The pre-inspection questionnaire returned by the manager indicates that all staff have CRB checks, and training in relevant and required areas, with further training planned. Examination of a sample of staff files, and discussion with a number of staff helped to confirm this. Rotas, and the number of staff on duty on the day of the inspection, suggested that the service ensures that there are sufficient numbers of staff on duty to meet residents’ needs. However, some residents with high support needs felt that at times there were staff shortages, and this could result in some delay in them getting attention, and in accessing activities outside the home. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 20 One resident felt that staff shortages was a reason for there being limited opportunities to travel outside the home. The manager later advised that difficulties in obtaining suitable transport was more likely to be the cause of any limit on outside activities. The manager advised that there are recurring problems with the laundry, in that resident’s clothes go missing, or are damaged by being washed incorrectly. WCS - Mill Green DS0000004266.V320063.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-run home in which their safety and well-being is promoted. The home is working to ascertain residents’ views on the running of the home, as a first step, in some instances, to resolving issues that they find unsatisfactory. EVIDENCE: The home produces an Annual Review. The current one showed very positive responses from residents, but highlighted concerns in the laundry area and regarding complaints being resolved, which largely concerned the laundering of clothes. The pre-inspection questionnaire returned by the manager details up-to-date fire and other safety checks by the home, and, where relevant, outside professionals. A tour of the premises showed no indication of health and safety being compromised by any practices or aspects of the environment. WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 22 Cleaning materials and other hazardous substances were stored safely, staff were aware of procedures in the event of fire alarms sounding. A group of staff were having fire safety training on the day of the inspection. WCS - Mill Green DS0000004266.V320063.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 3 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 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 24 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 YA20 Regulation 15 Requirement There must be a clear protocol for the recording of administration, or otherwise, of ‘as required’ medication. The service must satisfactorily resolve shortcomings in the laundering of clothing to the satisfaction of residents. Timescale for action 28/12/06 2. YA32 16(2) 28/12/06 WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 25 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. Refer to Standard YA6 YA14 Good Practice Recommendations It is recommended that care plans are typed, rather than handwritten. The service is recommended to pursue the possibility to obtain suitable transport to enable residents, particularly those with high mobility support needs, to take part in more activities outside the home. The service should ensure it minimises any disruption to the home by people accessing the upstairs of the building. It is recommended that the home reviews the call bell system with the aim of making it less intrusive. It is recommended that the home reviews staffing levels, in relation to some residents’ perceptions of there sometimes not being enough staff available. 3. 4. 5. YA24 YA24 YA33 WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 WCS - Mill Green DS0000004266.V320063.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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