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Care Home: Milbury The Leaves

  • 16 Balnacraig Avenue Neasden London NW10 1TH
  • Tel: 02084508906
  • Fax: 02084508906
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The Leaves is a purpose built detached property situated in a residential area in Neasden. The front of the property is paved and provides level access with off street parking for 4 cars. There is a garden at the rear of the property. The home is accessible by public transport. The nearest shopping centres are Neasden and Brent Cross. The home has its own transport. The home is registered to accommodate up to 7 residents and to provide personal care. At the time of the inspection there was 1 vacancy. The ground floor accommodation consists of a kitchen, an office/sleeping in room, a dining room, a lounge and one of the service users` bedrooms. The first floor accommodation comprises 6 single bedrooms. The home is equipped with aids and adaptations including a passenger lift, special wheelchairs and a specially adapted bath with a Jacuzzi facility. There are bathroom and toilet facilities on each floor. Fees charged for the service vary between £840 and £1,270 per week, according to an assessment of the needs of the individual resident. These figures were given on the 13th June 2008. Information regarding the service and fees may be obtained, on request, from the manager of the home.

  • Latitude: 51.556999206543
    Longitude: -0.25200000405312
  • Manager: Ms Kirija Uthayakumar
  • Price p/w: ~
  • UK
  • Total Capacity: 7
  • Type: Care home only
  • Provider: Milbury Care Services Ltd
  • Ownership: Voluntary
  • Care Home ID: 10714
Residents Needs:
Learning disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 13th June 2008. CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Milbury The Leaves.

What the care home does well A relative commented that everyone, " makes the residents feel that the Leaves is a happy, cheerful home to live in". Another relative commented that the staff, " all seem caring and have made sure (the resident) gets as much out of life as possible". One resident praised the, "great management by the manager, deputy manager and indeed the whole team". A health care professional commented that, "respect and individual attention is given to each resident" while another agreed that the home, "respected residents` individuality, rights and wishes". A person filling in the survey form said that, "there is a lot of interaction between the staff and residents" andthat, "the residents are always made to feel happy". One commented that teamwork and communication was good. A member of staff completing the survey form commented that the home is very comfortable for residents. Another said that the staff, "made sure the residents get to do things and that they are happy or comfortable in the home if they`re relaxing". One said that staff are provided with good training so that they are capable of giving the correct support to residents of different gender, race etc. Most of the residents use a wheelchair and the home has been adapted to provide a suitable environment for residents with physical disabilities. What has improved since the last inspection? Since the last key inspection the minor repairs and redecoration identified in the report have been carried out so that residents benefit from improvements in the environment. Residents have also benefited from an increase in the skills levels of members of staff as the home has reached the target of 50% of support workers achieving an NVQ level 2 or 3 qualification. What the care home could do better: Staff would benefit from receiving training in pressure care so that they are familiar with the signs that the skin is danger of breaking down. There should be a risk assessment in respect of the development of pressure sores, subject to regular review, in place for each resident that uses a wheelchair so that strategies to prevent or to minimise the risks are in place and are known and understood. Some minor redecoration is needed in the home to make good the damage where wheelchairs have caused scuffing. This would provide a more attractive environment for residents, although the overall appearance of the home is good. The home must be able to demonstrate that its recruitment practices are thorough and protect the residents by copies of all the required documents being kept on the staff files.A relative raised the issue of parking and commented that there is parking on the front driveway. However, when there are no spaces available on the driveway cars have to be parked away from the home, as parking in the street outside the home and in the immediate vicinity is for "residents only". CARE HOME ADULTS 18-65 Milbury The Leaves 16 Balnacraig Avenue Neasden London NW10 1TH Lead Inspector Julie Schofield Key Unannounced Inspection 13th June 2008 08:10 Milbury The Leaves DS0000017427.V366439.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 Milbury The Leaves DS0000017427.V366439.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. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milbury The Leaves Address 16 Balnacraig Avenue Neasden London NW10 1TH 020 8450 8906 020 8450 8906 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) Voyage.com Milbury Care Services Ltd Ms Kirija Uthayakumar Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 11th April 2007 Date of last inspection Brief Description of the Service: The Leaves is a purpose built detached property situated in a residential area in Neasden. The front of the property is paved and provides level access with off street parking for 4 cars. There is a garden at the rear of the property. The home is accessible by public transport. The nearest shopping centres are Neasden and Brent Cross. The home has its own transport. The home is registered to accommodate up to 7 residents and to provide personal care. At the time of the inspection there was 1 vacancy. The ground floor accommodation consists of a kitchen, an office/sleeping in room, a dining room, a lounge and one of the service users’ bedrooms. The first floor accommodation comprises 6 single bedrooms. The home is equipped with aids and adaptations including a passenger lift, special wheelchairs and a specially adapted bath with a Jacuzzi facility. There are bathroom and toilet facilities on each floor. Fees charged for the service vary between £840 and £1,270 per week, according to an assessment of the needs of the individual resident. These figures were given on the 13th June 2008. Information regarding the service and fees may be obtained, on request, from the manager of the home. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 3 star. This means the people who use this service experience excellent quality outcomes. The inspection took place on a Friday in June and consisted of 2 visits to the home. The first visit started at 8.10am and finished at 1.10pm. The second visit started at 2.10pm and finished at 5.10pm. During the inspection we spoke with the manager and members of staff. Records were examined and the care of a number of residents was case tracked, a tour of the building took place and compliance with the statutory requirements identified during the previous key inspection in April 2007 was checked. We also saw some of the activities taking place that day. As most of the residents in The Leaves were unable to give direct feedback on the quality of care received we spent time there observing the care practice and the interaction between residents and members of staff. Survey forms were sent to relatives and at the time of writing the report 4 of these had been returned. We also received 5 survey forms from health care professionals and 5 survey forms from members of staff. We would like to thank everyone for their assistance and for their comments during the inspection. We have also received the Annual Quality Assurance Assessment (AQAA) that the CSCI sends to services for the service to complete. What the service does well: A relative commented that everyone, “ makes the residents feel that the Leaves is a happy, cheerful home to live in”. Another relative commented that the staff, “ all seem caring and have made sure (the resident) gets as much out of life as possible”. One resident praised the, “great management by the manager, deputy manager and indeed the whole team”. A health care professional commented that, “respect and individual attention is given to each resident” while another agreed that the home, “respected residents’ individuality, rights and wishes”. A person filling in the survey form said that, “there is a lot of interaction between the staff and residents” and Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 6 that, “the residents are always made to feel happy”. One commented that teamwork and communication was good. A member of staff completing the survey form commented that the home is very comfortable for residents. Another said that the staff, “made sure the residents get to do things and that they are happy or comfortable in the home if they’re relaxing”. One said that staff are provided with good training so that they are capable of giving the correct support to residents of different gender, race etc. Most of the residents use a wheelchair and the home has been adapted to provide a suitable environment for residents with physical disabilities. What has improved since the last inspection? What they could do better: Staff would benefit from receiving training in pressure care so that they are familiar with the signs that the skin is danger of breaking down. There should be a risk assessment in respect of the development of pressure sores, subject to regular review, in place for each resident that uses a wheelchair so that strategies to prevent or to minimise the risks are in place and are known and understood. Some minor redecoration is needed in the home to make good the damage where wheelchairs have caused scuffing. This would provide a more attractive environment for residents, although the overall appearance of the home is good. The home must be able to demonstrate that its recruitment practices are thorough and protect the residents by copies of all the required documents being kept on the staff files. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 7 A relative raised the issue of parking and commented that there is parking on the front driveway. However, when there are no spaces available on the driveway cars have to be parked away from the home, as parking in the street outside the home and in the immediate vicinity is for “residents only”. 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. Milbury The Leaves DS0000017427.V366439.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 Milbury The Leaves DS0000017427.V366439.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the resident, prior to admission to the home, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. A programme of preadmission visits to the home enables the prospective resident to sample life in the home and to decide whether the service provided is acceptable. EVIDENCE: The last admission to the home took place in November 2006 and during the previous key inspection in April 2007 we examined the case file of this resident. We were satisfied that prior to their admission the funding authority provided information, which included an Assessment Summary, a Nursing Assessment, the minutes of a Care Plan Meeting and a Review Report. In addition the manager, the deputy manager and a senior support worker had visited the prospective resident, in the care home that they were living in at the time the referral was made. The manager completed a Milbury Assessment Form, with the assistance of the key worker and senior staff Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 10 working in the other care home. The assessment was thorough and gave a comprehensive picture of the needs of the prospective resident. Copies of all these documents were on file and there was evidence that family members had supported the resident during the pre-admission process. The information given by the family was recorded on the Prospective Service User form. Since then a vacancy has occurred in the home and the manager said that a new “Pre-Admission Assessment of Need Form” had been developed by Voyage and we saw a copy of the form. Again the questions enabled a thorough assessment and would give a comprehensive picture of the needs of the prospective resident. The manager confirmed that the remainder of the process remains the same. A referral has been made recently. We saw the information forwarded from the local authority. The prospective resident’s family have been asked to visit the home, with the person’s social worker. This visit will take place before the manager and members of staff visit the prospective resident. (Present at this interview will be the family and the person’s social worker). Prior to the admission of the most recent resident to the home there was a record of the prospective resident making a number of visits to the home, including an overnight stay. The visits gave the resident the opportunity to view the accommodation, meet the staff team and meet the residents currently living in the home. There were opportunities to join residents for a meal and to take part in any activities in the home. The manager confirmed that this process will be used for the new referral and that records of the content of these visits i.e. the reaction of other residents, the views of staff on duty and how the prospective resident responded will be recorded. We were also told that the family will accompany the person on the person’s first visit to the home and that the family will be invited to a social event where other residents’ families will be attending so that the new family can get to know every one. It is also an opportunity for them to talk with people that have a relative that is living in The Leaves and to ask any questions that they may have. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 11 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Evaluating care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed and regular reviews of the placement confirm that the care home continues to be able to meet the individual needs of the resident. Residents have the opportunity to exercise choice in their daily lives. Responsible risk taking contributes towards the resident leading an independent lifestyle. EVIDENCE: We looked in detail at 2 resident’ case files. These were large ring binder files. The files contained a new individual support plan. The content of the form mirrors the pre-admission document. There is a very useful “Professional Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 12 Support Network Page” and there are photographs of the key people that support the resident. The support plan includes information about the resident’s preferred daily routine, their likes and dislikes and their interests and hobbies. There is a copy of the resident’s weekly plan and photographs of recent outings. The information included under “My Communication” was invaluable as most residents are unable to communicate verbally. It informed members of staff how the resident communicates, what the resident understands and how the resident will let the member of staff know if they don’t understand something. There was a plan of support, which addressed personal, social and health care needs. It identified the needs of the resident and set out what the member of staff needed to do to support the resident and how to deliver the support. Short term and long term goals were detailed and each need included risk assessments as an integral part. Throughout the documents in the case file there were photographs and illustrations to make the information more userfriendly. We discussed review meetings with the manager and for each of the 6 residents living in the home there was evidence of regular 6 monthly review meetings being held. Family members were invited to attend and, where possible, a representative of the placing authority also attended. The manager spoke of maintaining good working relationships with the care managers in the local authority and keeping in touch, by telephone, between meetings. As residents are unable to communicate verbally the manager has requested advocacy services to support the residents. There is a list on the residents’ case files of decisions taken by the resident and an example of this was a resident wanting a friend to visit them. (This friend was visiting the resident on the day of the inspection and they enjoyed each other’s company). None of the residents are able to manage their own finances and the company is the appointee for 3 of the residents. The financial records of 2 of the residents for which Voyage is the appointee were examined. Record sheets were up to date and included details of income and expenditure and the running total after transactions. The 2 residents each had a savings account and statements of the account were available. The manager confirmed that a representative from head office called on an unannounced basis to audit financial records. Case files contained a general risk assessment, a people handling assessment and risk assessments tailored to the individual needs of the resident. There was evidence that these were subject to regular reviews and the reviews were up to date. Risk assessments identified the hazard, the people that may be harmed, strategies in place, the likelihood of occurrence and what, if any, further action may be required. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16, 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents attending day care services are provided with an opportunity to develop their social skills. Taking part in activities and therapies and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are encouraged to make decisions and their wishes are respected. A varied and wholesome diet is offered to residents so that their nutritional needs are met. EVIDENCE: Four of the 6 residents attend a day centre from Monday to Thursday each week. They attend a half-day session each day. An outreach worker visits the Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 14 home on a Friday to facilitate a music session. Although one of the other 2 residents living in the home would like to attend a day centre, and the manager is trying to arrange a placement, the remaining resident has decided that she would rather not attend. Her wishes have been respected and a programme of activities has been drawn up for her, based on her preferences and interests. A masseur and an aroma therapist visit the home when all the residents are present. The home has the use of a mini bus and a driver and the vehicle was being used on the day of the inspection. As most of the residents use a wheelchair when out in the community, due to the size of the vehicle, the driver has to make 2 trips if all of the residents are taking part in the same activity outside the home. Residents make use of resources and facilities in the community including the church, shops, shopping centres, the library, restaurants, pubs etc. Some residents like to go out for a walk and during the inspection some residents went to the local shops for an outing. Rotas are arranged so that staff are available to escort residents. Within the group of care homes owned by the company those in the same local authority and in the neighbouring local authority exchange invitations for events that they are hosting e.g. garden parties, pre carnival party etc. The manager said that this year the 3 areas for care homes to concentrate on are food, gardens and social events. We saw photographs that had been taken when residents had visited a park and when residents had enjoyed a barbeque in the garden and the manager said that last year residents had enjoyed outings to Woburn and to a music festival. Some of the festivals are celebrated in the home e.g. Halloween, Pancake Day, Easter, Christmas etc. Residents are also able to attend the Apple Club disco. As there were a number of new staff joining the staff team last year the manager had not arranged holidays for residents. She is hoping to arrange a holiday or a long weekend for some of the residents this year but facilities for bathing are an important factor that needs to be considered. A visitors’ notice was on display in the entrance hall. It reminded visitors that they were welcome at any time and that they would be asked to sign the visitors’ book when then arrived at the home and when they left. No notice was required when making a visit but a resident may not be ready to receive a visitor when the visitor arrived. Visitors were also reminded that the resident may choose not to meet with the visitor and that the wishes of the resident would be respected. Most of the residents receive visits from members of their families and family members and friends of the resident are invited to social events e.g. birthday parties. On the day of the inspection one of the residents received a visit from a friend. Although staff knock on the resident’s bedroom door before entering most of the residents are unable to call out and to invite the member of staff to enter. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 15 Members of staff have to read the body language of the resident and the facial expressions to gauge whether their visit is welcome. Residents are encouraged to take part in daily routines, where possible, and 2 of the residents may help to set the table or to clear their plate and cup away to the kitchen when they have finished eating. One resident may help to load their washing in the machine. Each day one of the residents has a turn to go into the kitchen when the evening meal is prepared although they may just watch the activity and enjoy the cooking smells etc. It was noted that there was good interaction between residents and members of staff on duty. Residents can choose whether they wish to take part in an activity and members of staff gave examples of how individual residents did this. Residents’ wishes are respected. The home has a 4-week rolling menu cycle. We saw that the menu was varied and balanced. Last year the menus were reviewed by the dietician and healthy eating is promoted in the home. Residents are able to have an alternative to the meal being prepared, if they wish. Lunch is a choice between a sandwich and a light cooked meal and the evening meal is a cooked meal. All residents need a soft diet as they are at risk of choking. One resident is a diabetic. We spoke with the member of staff that was preparing the evening meal. She confirmed that she had attended food hygiene training. The meal being prepared consisted of salmon in a white sauce, mashed potatoes and mixed vegetables. The dining room is sufficient in size for residents to eat in comfort. Several residents need assistance with feeding. One resident prefers to eat on their own and this is respected. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 16 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive assistance with personal care in a manner, which respects their privacy. Risk assessments and training for staff in pressure care are needed to assure residents that all their health care needs can be met. The general well being of residents is promoted by assistance or support from staff in taking medication, as prescribed. EVIDENCE: We examined case files and saw that they contained information for staff about the way the resident preferred to be supported and there was information about preferred daily routines. When one resident has a shower they prefer the shower to start with their feet and then to work upwards towards the head. Assistance with personal care was given in private and preserved the dignity of the resident. The staff team consists of male and female members of staff and female residents receive assistance with personal care tasks from a female Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 17 member of staff. It was noted that residents were clean and tidy and smartly dressed. Choice of clothing is offered where possible, although as most residents are unable to communicate verbally members of staff interpret the wishes of the resident. Technical aids and equipment are provided to assist with transfers and with personal care. There was evidence that when necessary, specialist support and advice is sought e.g. from the dietician, the physiotherapist, speech therapist etc. The home has a system of key working and when we spoke with members of staff they were able to explain to us what this involved. One of the relatives that completed a survey form commented that the resident, “always appears clean, comfortable, contented i.e. good skin care, hair washed and brushed, seen always smiling, lipstick, nail varnish – I think that speaks for itself”. All of the 5 health care professionals that completed a survey form agreed that the service respected the resident’s privacy and dignity. We saw that case files contained evidence of access to health care services. Appointments had been made with the dentist, optician and chiropodist. Medication reviews had taken place and residents had received a flu jab, if they wished. A discussion took place with the manager regarding a resident that had developed a pressure sore. The manager said that a referral was made to the GP on the day that the skin had broken down. The first recorded sign of a problem was when members of staff noted that there was “redness” the day before the GP was notified. Although pressure sores can develop quickly it is possible that there was a gradual development over time. This was the first time that a resident had a pressure sore and staff had not received training in respect of pressure care. We discussed pressure-relieving equipment used in the home and how to support residents that are at risk of developing pressure sores. Risk assessments are needed. Five health care professionals completed a survey form and when asked whether residents’ health care needs are met by the home or whether the service seeks advice and acts on it to manage and improve residents’ health care needs, 4 people ticked “always” and 1 person ticked “usually”. The storage of medication was safe, secure and orderly. The monitored dosage system is in use and the blister packs were examined. These had been appropriately opened prior to the inspection, according to the time of day and the day of the week that they were examined. Records were checked and they were up to date and complete. A photograph of the resident was attached to the relevant blister pack and to the MAR sheet. The record book also contained a copy of the medication procedure, a list of staff that are judged competent to carry out the task of administering medication to residents and a record of the medication that was not contained in the blister packs, with Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 18 evidence that these items were audited on a regular basis. There were comprehensive guidelines in respect of the medication prescribed and its side effects. Staff files contained the assessment of competence that is carried out by the manager. Members of staff on duty confirmed that they had received medication training. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 19 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place to protect the rights of the residents. An adult protection procedure and training in protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. EVIDENCE: There were copies of the complaints procedure on display in the home in 2 different formats. One format was user friendly and in the form of a poster that was called “Letting Us Know What You Think”. The other format was a clear written procedure, which included timescales for the different stages of the procedure and contact details for both the CSCI and company head office. As most residents cannot verbally express their concerns the home has applied for advocacy services for each of the residents and in the event of a complaint being made by a family member, on behalf of a resident, the advocate would provide support to the resident. No complaints have been recorded since the last inspection. Three relatives completing survey forms said that they had been told how to make a complaint if they needed to although 1 resident said that they couldn’t Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 20 remember. One relative said, “The manager is always encouraging me to voice any concerns I may have”. When asked whether the service had responded appropriately if they had raised any concerns 2 relatives said “always” and 2 relatives said “usually”. When health care professionals were asked on the survey form if the home had responded appropriately if they had raised concerns about the care, 3 people selected “always” and 2 people selected “usually”. The 5 members of staff that completed survey forms agreed that they knew what to do if someone raised concerns about the home. One member of staff wrote, “I would follow Voyage’s complaints procedure”. An adult protection procedure is in place and there was simple, clear information regarding vulnerable adults on the notice board outside the office. The manager has been trained to train members of staff in respect of adult protection procedures and her certificate of achievement was available. Staff on duty confirmed that they had received training in adult protection procedures and that this was updated on a regular basis. Three staff took part in discussions with us and they were able to describe their responsibilities in respect of the procedure and linked it to the whistle blowing procedure. It was noted that protection of vulnerable adults training forms part of the induction training programme. A new member of staff referred to the El Box training and said that she had completed the protection of vulnerable adults training and that the training included how to recognise the signs of abuse, how to report concerns and what records are necessary. Non-violent crisis intervention training is also provided for staff. The manager said that she would be attending training in respect of safeguarding adults for independent sector managers. The AQAA recorded that protection of vulnerable adults is a regular agenda item during staff meetings. No incidents or allegations have been recorded since the last inspection. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 21 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is comfortably furnished and provides a pleasing environment in which they can relax and enjoy themselves, although some minor redecoration is needed. Good standards of cleanliness provide residents with hygienic surroundings. EVIDENCE: During the inspection a tour of the premises took place. Generally the upkeep of the home was good. It was furnished and decorated to a good standard and provided a comfortable and “homely” environment for residents to relax in and enjoy. Residents each have their own single bedroom and the décor in the bedrooms varied to reflect the personality of the resident. The premises were safe, bright and airy. Some scuffing caused by wheelchairs means that Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 22 redecoration is required to the lower part of doors, doorframes and some parts of corridors. Some of the woodwork is pitted and chipped away and will need making good, before redecoration. There was a hairline crack in the plasterwork on one of the main walls and on the window wall in the vacant bedroom. Five of the six residents use a wheelchair. A passenger lift enables residents to access all of the facilities inside the home and there is level access at the front and at the rear of the building. Aids and adaptations are in place to meet the needs of residents. The home benefits from a beautiful garden. There are borders that are arranged to give pleasure to residents and these include a sensory section with scented plants. There is also a large vegetable patch where the produce grown is used in the preparation of meals. The home won the company’s homegrown vegetable competition last year. We saw when we were walking around the premises that all areas were clean and tidy and free from any offensive odours. Relatives and health care professionals commented positively on the cleanliness of the home. The manager has recently undertaken an infection control refresher training course. Staff on duty during the inspection confirmed that they had also had training about infection control procedures. Laundry facilities are situated on the ground floor and access does not involve carrying laundry through areas where food is stored, prepared or eaten. The washing machine has a sluicing cycle. Hand washing facilities are also present in the laundry room. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A programme of NVQ training for members of staff assures residents that care practices are based on an understanding of the residents needs. Staffing levels in the home assure residents that there are sufficient members of staff on duty each day to support the residents and to meet their needs. The safety and welfare of residents is compromised by the lack of references on staff personnel files, as the service is unable to demonstrate that these have been obtained prior to members of staff working in the home. Residents benefit from support given by members of staff that are skilled and trained. EVIDENCE: A discussion took place with the manager regarding NVQ training. Since the last key inspection the home has met the target of a minimum of 50 of the staff team with an NVQ level 2 or 3 qualification. The manager said that 3 other members of staff would enrol for NVQ training as part of a rolling Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 24 programme of training. When we spoke with members of staff on duty, 2 of the 3 support workers had completed their level 2 training. At the start of the inspection there were 3 members of staff on duty in addition to the manager and 2 student nurses were on placement in the home. The hours of the student nurses were supernumerary. The manager said that as on the day of inspection she sometimes works a shift in the home as part of monitoring the quality of care. In the afternoon the 3 members of staff handed over the care of the residents to 3 other support staff. On each shift there is a designated shift leader. A copy of the rota was available for inspection. Each night there are 2 members of staff undertaking waking night duties. Female residents receive assistance with personal care from female carers. Care staff undertake domestic tasks during the day, when some of the residents attend day centre. One carer on the early shift is allocated the task of preparing the lunch and one carer on the late shift is allocated the task of preparing the evening meal. Staff confirmed that staff meetings take place on a monthly basis. We looked at the personnel files of 4 members of staff that have been appointed since the last key inspection. We saw that each file contained an application form, proof of identity (passport details) and evidence of a satisfactory enhanced CRB disclosure. The right to reside and to work in the UK had been established, where necessary. Files did not contain evidence of 2 satisfactory references as the manager said that records were now being held centrally. It was recorded in the AQAA that the company had appointed a regional training and development manager. The manager said that the home received a print out from the training department each quarter to advise her of the training courses available for staff. Training needs are identified during the annual staff appraisals and staff files included copies of these. Individual training profiles are kept so that there is a record of what each member of staff has attended and the print out identifies when named members of staff are due for refresher training. We looked at a sample of training profiles to confirm that mandatory and refresher training had been undertaken. Induction training is based on the Skills for Care “Common Induction Standards”. The Training and Development Plan for 2008-9 was seen. Five members of staff completed a staff survey form and they all agreed that the training that they received was relevant to their role, helped them to understand and to meet the individual needs of the residents and kept them up to date with new ways of working. During the inspection we spoke with members of staff and they confirmed that they received training in safe working practice topics, protection of vulnerable adults, medication and epilepsy. We spoke with a newer member of staff and they confirmed that they had found the induction training “useful”. We saw that a member of staff was using the El-Box system of training during the inspection and was Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 25 working, after their shift had finished, to complete the module. They told us that it was a thorough method of training. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 26 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 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager demonstrates her competence and commitment to a quality service by continuing to develop her understanding, skills and knowledge through further training. Systems are in place to gather feedback on the quality of the service provided to enable the service to develop in ways that meet the changing needs of the residents. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents and regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. EVIDENCE: Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 27 The manager is a qualified nurse and has successfully completed the RMA. Previously she has completed the Advanced Management in Care qualification and holds a City and Guilds teaching certificate for adults with learning disabilities. She is also a qualified trainer in the protection of vulnerable adults and in manual handling. Since the last inspection she has attended a number of short training courses and workshops to update her care practice and these include training in infection control procedures, the Mental Capacity Act, fire safety, food hygiene and medication. In addition, the manager was runner up in the “Trained Manager of the Year Award – 2006” which had been organised by Care Choices as part of their Care Training Excellence Awards 2006. The home provides placements for student nurses and the day of the inspection coincided with the last day of a student nurse’s placement. We read the comments in the feedback book and noted their positive themes. One student had written, “you have taught me to value people and embracing differences in individuals during this placement. You have taught me to always work in a way that will promote dignity, respect and individual choice. Your presence just brightens the whole house”. Members of staff that completed staff survey forms commented on the “open door system” that the manager had and that they were able to talk to the manager about their ideas. They confirmed that regular supervision sessions, staff meetings and appraisals take place. The company forwards copies to the CSCI of the monthly Regulation 26 visit reports. The manager showed us a copy of the Annual Service Review and Development Plan for 2007-8. She said that the home would host an open day in the summer and invite families, members of staff and residents to attend. Comments and feedback on the quality of the service would be sought so that developments in the service are in accordance with the aims and objectives of the home. The open day forms part of the review process and feeds into the next development plan. Areas reviewed include the décor, the practice within the home and staffing within the home. Scoring in the décor section in the 2007-8 plan resulted in the purchase of a new bath. The manager referred to some of the areas for development in the AQAA. Families have other opportunities to give feedback, which include review meetings, informal visits to the home and during contact with the manager and members of staff. The placing authority may use review meetings or informal contact with the home to give feedback and it is recommended that the home send a quality assurance questionnaire to the care manager(s) of the residents. Members of staff may give feedback during staff meetings, supervision sessions and informally to the manager. They are also sent a questionnaire that is returned to the regional office and then, after analysis, feedback is given to the home. Verbal feedback from residents is very limited Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 28 and all members of staff are continually looking at the resident’s body language and facial expressions and other means of communication to gauge the resident’s satisfaction. The home is to be commended for the systems in place to ensure that training in safe working practice topics and regular servicing of equipment take place at the correct time. Staff on duty confirmed that they had undertaken training in manual handling, fire safety, first aid and food hygiene. Records demonstrated that the fire alarm system is tested on a weekly basis and that fire drills are held on a monthly basis. There were valid certificates for the testing of the lift, hoists, assisted bath, the portable electrical appliances, the electrical installation, the Landlords Gas Safety Record, the fire extinguishers and the fire precautionary systems in the home. There is a fire risk assessment in place and we saw that it had been reviewed in September 2007. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 29 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 4 3 X 4 3 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 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 4 X 3 X X 4 X Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 30 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 YA19 Regulation 18(1) Requirement To assure residents that members of staff have a knowledge and understanding of pressure care, training must be provided. To assure residents that their needs are promptly identified and addressed, risk assessments for developing pressure sores must be completed for residents using a wheelchair. To assure residents of an environment in the home that is maintained to a good standard some making good and redecoration is required where wheelchairs have scuffed the lower part of doors, door frames and some parts of corridors and where there are hairline cracks in the vacant bedroom. To demonstrate that recruitment practices promote the safety and welfare of residents, copies of 2 references must be kept on the personnel file of each member of staff. Timescale for action 01/09/08 2 YA19 12(1) 01/09/08 3 YA24 23(2) 01/10/08 4 YA34 19(1) 01/09/08 Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 31 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 Refer to Standard YA14 YA24 YA33 Good Practice Recommendations That annual holidays or long weekends are planned for residents for 2008. That one of the parking spaces in the driveway is designated for visitors’ use only and is marked accordingly. That quality assurance questionnaires are sent to members of the placing authorities. Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Milbury The Leaves DS0000017427.V366439.R01.S.doc Version 5.2 Page 33 - 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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