Inspection on 29/11/05 for WCS - Mill Green

This inspection was carried out on 29th November 2005.

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 no outstanding requirements from the previous inspection report, but made 3 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 22/11/06

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 Sheila Briddick Unannounced Inspection 29th November 2005 09:30 WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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.V271237.R01.S.doc Version 5.0 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.V271237.R01.S.doc Version 5.0 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.V271237.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 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 well-maintained 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. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 29th November 2005 between the hours of 10.00am and 3.30pm. During this time the inspector had the opportunity to meet with the residents, observe the interactions between the residents, staff and their environment, tour the home and examine documents relating to the residents and the management of the home. Seven residents and three staff members were involved in the inspection process and their views are included in this report. The registered manager was present during the inspection visit. What the service does well: What has improved since the last inspection? Significant progress has been made in the assessment of needs and care planning programme for residents and ensures changing needs are monitored satisfactorily. Following a redecoration programme the environment is now more welcoming and safe for residents and staff. Medicine management in the home has been reviewed and residents receive their medicine by competent WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 6 and well trained staff. Staff supervision is now more structured and focussed to include appraisal of individual training needs. Staff spoken with felt there had been a big improvement in communication and of being able to discuss and resolve issues together at regular team meetings. 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. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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.V271237.R01.S.doc Version 5.0 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 There is a clear assessment procedure in place, which adequately provides the service with the information they need to know about a prospective resident to be sure they can satisfactorily meet individual needs. EVIDENCE: Care management assessments, or the home’s own assessment, are completed before any admission to the home is made. All people currently living in the home meet the criteria for the service provision and care planning shows the service is taking the necessary steps to ensure individual needs can be met. This includes ensuring staff have appropriate communication skills and linking in with District Nurses, Psychologists and GP’s to assess needs. The assessment tool used by Mill Green is thorough and covers all areas of health and social care. Residents are involved in the assessment process and their views included where possible. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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): 7, 6 and 9 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet needs. There is limited documented evidence of the good practice in this home of involving people in making decisions about their lives and the service provision. EVIDENCE: The care plans for residents have all been completed onto the newly introduced care planning system. The system is clear and ensures that resident’s needs are reviewed on a monthly basis and that any necessary action to meet changing needs is documented, actioned and reviewed. Staff spoken with felt the new system was ‘informative and makes you review needs’. Staff also felt that the system had encouraged better communication between staff members. Care plans seen were up to date and in good order. There is significant evidence of the service working closely with district nurses, occupational therapists, learning disability nurses, speech and language services and psychologists in planning care plan programmes to meet needs. Daily records are maintained for each service user and there is significant improvement of recording individual lifestyle activities and choices being made by residents. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 10 Residents said that they can discuss their individual views with staff and some progress has been made in providing opportunity for formal consultation with residents. This has included joint consultation with other professionals about the service. One resident spoken with was appreciative of this opportunity. Meetings with individual residents are documented and their views recorded however, final decisions and the outcomes of discussion is not being documented Residents have appropriate communication support they need to make decisions about their lives and this includes specialist communications support from outside agencies. Staff are developing good communication skills in the use of sign language to assist residents with specific needs. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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): 13, 14 and 17 There continues to be improvement in opening up opportunities for residents to participate in appropriate activities in the community. The dietary needs of residents is well catered for with a balanced and varied selection of food available that meets residents tastes and choices. EVIDENCE: Residents continue to be positive about the opportunities they have in accessing the community for a variety of activities. Contact has been made with the local college who are providing opportunity for residents to develop skills in computer literacy. This activity does not take place at the college but in a room at the home, however, residents were pleased to be developing skills and enjoy the activity. Through the summer residents have enjoyed trips to local pubs, speedway racing and shopping trips at Northampton. A resident talked about their plans to go on holiday abroad next year with staff support. Leisure and social activities for people with learning disabilities continue to be infrequent; however there is documented evidence to suggest that steps are WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 12 being taken to develop activities in this area. This includes linking in with services that specialise in developing person centred planning. The inspector joined residents for their lunchtime meal. The meal was a social occasion with staff sitting down to eat with residents. The meal was attractively presented and well balanced nutritionally. Residents spoken with were satisfied with the food provision in the home. The home has been without a cook for some time and an agency has been providing this cover. A person has been recruited to the post and will start employment week beginning the 3rd December 2005. The dietary needs of residents is well documented and reviewed on their care plan. Residents can choose whether to eat in their own living environment or with others in the shared lounge. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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): 20 Significant progress has been made at this home to ensure that medication is well managed and promotes good health. Assessment of skills to selfadminister medication could be more robust to ensure that residents and staff are not placed at risk of harm. EVIDENCE: Medicine Administration Records, (MAR), seen on this occasion were up-todate and in good order. This included ensuring a correct total of medicine held in the home and full and correct dosage of all prescribed medicine recorded and signed for. The procedure for receiving and returning medicines has been reviewed and amended and is now more thorough, including the procedure for receiving medicines for those receiving respite care. Medicine containers seen in stock were in pharmacy labelled containers. The Controlled Drug registered examined at random was accurately completed and reflected on the MAR chart. All staff have been assessed since the last inspection visit to ensure that they are maintaining their competency in medicine management procedures. A senior manager will ensure ongoing competency is monitored and documented. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 14 Residents are supported to be self managing with their medication if they wish although regular recorded evaluation on their ongoing ability to maintain competency does not take place. This was discussed with the manager and advice on risk management forwarded. Staff have written guidance on how to support residents who are self medicating, including insulin administration support. Staff do not sign to confirm they have read and understood the guidance. Procedures for action to be taken in the event of accident during this support have been actioned appropriately when necessary. The staff are working with District Nurses in agreeing protocols for the use of medicine to be administered ‘as required’, (PRN) which when completed will be included on the care plan. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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 Arrangements for protecting residents from harm are satisfactory and providing a safe environment which protects people from harm or abuse. EVIDENCE: The service has well established adult protection policy and procedures. This includes POVA and Criminal Record Bureau checks are completed for all staff prior to their working in the home. Staff attend training in the protection of vulnerable adults and have done so in the last twelve months. Residents spoken with felt safe in the home and have facilities in their room for keeping personal items safe. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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. Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for those living there. EVIDENCE: A redecoration and refurbishment programme has recently been completed which included decoration of shared areas and replacing carpets and flooring were necessary. Residents spoken with were pleased with the new appearance of the home. The lounge and dining area in particular presents a warm and welcoming place for people to have a meal and sit and relax. A patio area has been laid outside the lounge and is easily accessible for residents wishing to sit outside. Arrangements have been agreed for storing outside mobility equipment which individual residents use, this is in an unused area of the home during the winter months and an outside store will be available in the summer months. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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, 33, 34 and 35 A staff team who are motivated, approachable and competent to carry out the tasks expected of them is supporting the people living in this home. EVIDENCE: There were sufficient staff on duty at the time of the visit for activities to meet collective and individual needs to be carried out. Residents spoken with were happy with the way staff supported both their physical and emotional needs and could talk to managers and staff about any concern regarding their care. Comments included, ‘there’s been a lot of staff changes – but things have gone well’, ‘staff understand me well’ and ‘they are a nice group of staff’. Staff were observed to be good listeners and use communication appropriate to individual needs, this included use of deaf/blind signing. Staff spoken with felt team work and communication had much improved since the last inspection visit, especially with the implementation of the new care planning which ensured consistency in working towards individual aims and objectives. The newly introduced system for staff appraisal and supervision was seen. The structure includes a process for documenting induction, supervision, appraisal of training needs and observation of care practice. There is an established training programme for staff which includes NVQ in Care, Learning Disability Award Framework, (LDAF), and specialist training to WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 18 meet specific needs. This has included Huntington’s Awareness, Diabetes Care, Multiple Sclerosis, Dementia Care, and Catheter Care. 55 of the staff team have an NVQ in Care. The service offers employment to people who are under 18 years of age through an ‘apprenticeship’ scheme linking in to the local college to develop numeracy and literacy skills. Staff members employed in this way do not undertake any personal care work with residents or work alone and are supported by managers and staff through extended induction procedure. Comments from younger staff included, ‘ this scheme is helping me work towards a career in care’ and ‘I am going to college to learn sign language to help me communicate with residents’. All staff have a contract of employment and job description although this is not reflective of the role of staff members less than 18 years of age and not providing personal care. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 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): 39 and 42 Quality monitoring systems are gradually being introduced that will demonstrate whether this service is consistent in meeting it’s aims and objectives. These do not currently reflect the views of residents, or others involved in the care provision. EVIDENCE: The care planning system includes a process for documenting the changing needs of residents and the action being taken to meet the changed needs. It also includes a record of handover of staff shift, monitoring of protocols and guidelines for staff to follow. The manager is reviewing the system on a monthly basis and forwards a written report of evaluation, including a summary of targets achieved, to her senior manager. This is monitored again by the Provider as part of the Regulation 26 monthly visits to the home. An annual review event took place this year with Social Services, Healthcare professionals, Commission for Social care Inspection, and residents being invited. A report is to be published of the findings and outcome of the event. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 20 The manager has made arrangements for residents to meet monthly, however these meetings have not been well attended. A resident has offered to talk individually with other residents on a regular basis to seek their views of the service and report back to the manager. The manager hopes this will be more successful. There are no documented views about the care provision although the Housekeeper seeks feedback regularly about the standard of food and the environment and this is documented. Health and Safety management in the home is good. Regular checks and maintenance is taking place on equipment used, including hoists, electrical equipment, heating systems and the environment. Water temperatures are regulated and risk assessments are in place for the control of risk of Legionelle. Staff are trained in safe working practice in fire safety, food hygiene, moving and handling, infection control and medication. There is a maintenance budget and the environment was in general good repair. There was some repair necessary to the surrounds of a service well in a corridor floor, which had the potential to cause a fall from tripping on frayed carpet edges. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 21 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 3 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 WCS - Mill Green Score X X 2 x Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000004266.V271237.R01.S.doc Version 5.0 Page 22 Yes (in part) 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 YA13 Regulation 15 Requirement Timescale for action 28/02/06 3. YA20 13 5. YA42 23 The registered manager must review the lifestyle activity needs of residents with a learning disability through Person Centred Planning and identify a program of activity appropriate to the interests and social care needs of the service user. Risk assessments and 15/02/06 compliance checks in place for residents who are self medicate their own medicines must be reviewed with them on a regular basis to ensure ongoing competency. The flooring around the service 15/01/06 well in the kitchen corridor must be repaired and made safe. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 23 1. YA7 2. 3 4 5. YA20 YA20 YA32 YA39 It is recommended that documented discussion with individual residents regarding concerns they may have with care programmes include a record of the agreed outcome. It is recommended that staff sign they have read and understood all protocols in place for supporting residents with their medicines. It is recommended that the manager seek the advice of a pharmacist for clarification of Drug Classification. It is recommended that staff working in the home under the age of 18 years have a job description that specifies their role in personal care provision. It is recommended that the registered manager maintain a written record of feedback from residents regarding the service provision. WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 WCS - Mill Green DS0000004266.V271237.R01.S.doc Version 5.0 Page 25 - 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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