Care Home: Milestone

What the care home does well The standards assessed at this inspection showed that the home makes sure that: 1. The Manager is making a wide range of improvements in practice and procedures within the home that have had and will continue to have positive benefits for the residents and for the staff group. 2. The needs of men who want to move to the home are thoroughly assessed by staff before they move to the home. 3. There are care plans in place that are based on the areas of need that have been identified before someone moves to the home and that the residents are fully involved with.4. Generally there are good systems in place to monitor how medication is held and given out to service users. Service users are supported to selfmedicate when they have been assessed as able to do this safely by staff and other members of the care team. 5. The communal areas of the home are large enough for the number of service users and they are kept clean and tidy. The decorations and furnishings within the home are very good and generally that standards are high. 6. Rooms and flats are large enough and have enough toilet and bathroom facilities to meet the standard. 7. The home is fully staffed and there are enough staff on duty at all times. What has improved since the last inspection? Specific areas of improvement identified in this report are as follows: 1. Care Plan reviews now monitor the success or otherwise of the care plan objectives and they are revised in the light of the review findings. 2. Photographs of residents are attached to each of the resident`s files and to their MAR sheets. 3. Risks assessments are identified in the care plans and risk assessments are addressed by appropriate care plan objectives. 4. Guidance has now been put in place on the medication records for each resident who uses PRN medication. 5. An inventory is now completed for each resident of their valuable belongings and is kept on the residents` files. 6. Water temperatures are now monitored regularly, faults are reported immediately and where temperatures exceed the prescribed limits immediate action is taken to rectify the problem. What the care home could do better: Specific areas for improvement identified in this report are as follows: 1. The Manager must ensure that the process already started continues so that all staff are asked to sign to say that they have read and had a chance to discuss the home`s policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. 2. Certificated evidence must be held on each member of staffs file for all training qualifications achieved, including NVQ, nursing and social work qualifications. 3. The Manager must ensure that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. 4. The Manager must ensure that the actions identified in a fire risk assessment carried out on 19.9.08 are met. CARE HOME ADULTS 18-65 Milestone 1 Milestone Court, Wales Close London SE15 2SL Lead Inspector David Halliwell Unannounced Inspection 18th November 2008 09:30 Milestone DS0000007104.V373228.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 Milestone DS0000007104.V373228.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. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milestone Address 1 Milestone Court, Wales Close London SE15 2SL 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) 020 7639 8628 turning-point.co.uk www.turning-point.co.uk Turning Point London & S.E.Region Delrene Walker Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 14 27th February 2008 Date of last inspection Brief Description of the Service: Milestone provides accommodation and care for 14 men who have a forensic mental health background. The home is purpose built and divided into two blocks. The first block has accommodation and facilities for six service users in rooms and the second block has 8 self-contained flats. The communal areas are accessible to all service users, including wheelchair users but some of the rooms and flats are not. There is no lift at the home. The home is off the Old Kent Road close to Peckham and New Cross. There are nearby facilities and services including public transport, shopping, leisure, health and social care support. The Manager told us that fees for a place at the home are £880.36 per week. The home makes the reports of the Commission’s inspections available in the reception of the home. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The stars quality rating for this service is excellent. This means that people who use these services experience excellent quality outcomes. Service users said that they like to be called residents. This was an unannounced inspection visit of the service at Milestone. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 3 staff and the Manager and 3 of the residents. A completed AQAA was received prior to the inspection. No enforcement activity has occurred since the last inspection. There have not been any changes in the ownership or management of Milestone, Turning Point remain the provider agency. The Manager is registered with the Commission for Social Care Inspection as the Manager. 4 requirements have been made as a result of this inspection, 3 of which are repeat requirements and should be addressed within the new timescale if enforcement action is to be avoided. Feedback on the requirements was fully explained to the Manager at the end of the inspection visit. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. We were very impressed by the commitment and enthusiasm of the Manager and of the staff group and of the quality of the services being provided at Milestone. The Manager told us that the cost of a placement at Milestone is £880.36 per week. What the service does well: The standards assessed at this inspection showed that the home makes sure that: 1. The Manager is making a wide range of improvements in practice and procedures within the home that have had and will continue to have positive benefits for the residents and for the staff group. 2. The needs of men who want to move to the home are thoroughly assessed by staff before they move to the home. 3. There are care plans in place that are based on the areas of need that have been identified before someone moves to the home and that the residents are fully involved with. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 6 4. Generally there are good systems in place to monitor how medication is held and given out to service users. Service users are supported to selfmedicate when they have been assessed as able to do this safely by staff and other members of the care team. 5. The communal areas of the home are large enough for the number of service users and they are kept clean and tidy. The decorations and furnishings within the home are very good and generally that standards are high. 6. Rooms and flats are large enough and have enough toilet and bathroom facilities to meet the standard. 7. The home is fully staffed and there are enough staff on duty at all times. What has improved since the last inspection? What they could do better: Specific areas for improvement identified in this report are as follows: 1. The Manager must ensure that the process already started continues so that all staff are asked to sign to say that they have read and had a chance to discuss the home’s policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. 2. Certificated evidence must be held on each member of staffs file for all training qualifications achieved, including NVQ, nursing and social work qualifications. 3. The Manager must ensure that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. 4. The Manager must ensure that the actions identified in a fire risk assessment carried out on 19.9.08 are met. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 7 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. Milestone DS0000007104.V373228.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 Milestone DS0000007104.V373228.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): Standards 1, 2 & 5 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective residents will receive the information that they need to make a decision about living at Milestone. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process and each resident does now have an individual and appropriate contract with the home. EVIDENCE: Standard 1 – The new resident’s handbook / service user guide that has been drawn up now includes appropriate and useful information in an accessible format for the residents. The Manager explained that a copy of the newly developed guide has been laminated and is now held in the lounge area of the home so that residents can easily make reference to it when necessary. A copy was shown made available for us to see for information. At the last inspection it was recommended that details of the Commission for Social Care Inspection needed to be included in the complaints section. This amendment has since then been made. During the course of the inspection Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 10 residents who spoke to us confirmed that they do have access to the new guide. This means therefore that residents and prospective residents have sufficient information available to them to make a choice about where to live and the services they will receive. Standard 2 – Since the last inspection 5 new residents have been admitted to the home. We reviewed the files of 4 of the residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out with skill and sensitivity by the senior staff with regards to the needs of the people concerned. The Manager told us that they ensure a needs assessment and care plan is obtained from the referring authorities for each new resident placed at Milestone. Evidence of this was seen by us on the resident’s files. The completed AQAA also confirms this and says, “… We ensure that a thorough assessment takes place before a new service user moves into Milestone. All referral documentation i.e. risks assessment / CPA reports / care plans are gathered prior to our formal care needs assessment. The assessment is carried out by senior workers in the home with input from the potential service user / family / friends /advocates and external professionals.” The combined information from these sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The Manager explained to us that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing any admission the Manager allocates a key worker to each resident who will work with them on developing the home’s care plan and making sure it meets the identified needs. Residents were seen by us to have been involved in the assessment process having had the opportunity to express their wishes and preferences and to comment on their identified needs. Signatures of the residents and dates were seen on the assessment paperwork confirming their involvement in the process. Family and close relationship needs of the resident’s files inspected had been included in the assessment and care planning processes. When we spoke with one of the residents it was clear from what he told us that he had been and is still fully involved in the process and that he is very satisfied with the outcomes of his care package as a result. Standard 5 – At this inspection, having reviewed 4 of the resident’s individual files, we found that all the residents at Milestone now have a fully completed written contract. This is also confirmed in the AQAA. Milestone DS0000007104.V373228.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): Standards 6, 7, & 9 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. EVIDENCE: Standard 6 – through the course of this inspection it became clear to us that the central focus of the services provided at Milestone is on the residents and how their needs, wishes and preferences can be most effectively be met where-ever possible. Residents were seen by us to be fully involved in the needs assessment and care planning processes. Care plans are based on the needs assessments that had been drawn up both from the Care Programme Approach needs assessment and Milestone’s own Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 12 needs assessment. Inspection of the care plans evidenced this and we were impressed with the quality of the care plans seen. They had been clearly divided into sections (relating to the identified needs) with care plan objectives and action plans which addressed the needs and set out identified milestones with review dates, so that clear monitoring and review could then be achieved. 3 monthly reviews by the care staff team were evidenced on the files and involvement of each of the residents in these reviews was also evident. They confirmed their involvement in the review and care planning process at interview with us. Inspection of the review reports showed that changing needs of residents had been identified and that appropriately revised care plan objectives had been drawn up together with the resident. Key workers were seen to actively provide 1:1 support; to revise the care plans as necessary and to keep the residents informed. Formal 6 months reviews are planned and held with the clinical teams and the residents. The residents have their own key workers and the Manager said that residents can choose their key workers if they wish. Residents confirmed that they are happy with their key workers and find them helpful, supportive and friendly. Standard 7 – Over the course of this inspection we saw that staff asked residents what they wanted to do and to make decisions about their daily lives. The Manager told us that residents do have their own residents meetings and that meetings are minuted. The minutes of these meetings were shown to us by the Manager. The records show that meetings are held monthly, they indicate who has attended the meetings and what issues have arisen and discussed. This means that residents are enabled to make decisions about their lives with assistance as needed. Standard 9 – The care planning process includes the use of risk assessments that were seen and inspected on each of the 4 resident’s files. They are evidently used as a pre-admission assessment tool and following admission, being used to assist residents to be appropriately supported to take risks as a part of developing a more independent lifestyle wherever possible. Any identified risks are managed positively to help the residents lead the sort of lives they aspire to as much as is realistically possible. These risk assessments are agreed with the resident and the relevant professionals who both sign the risk assessment form. This all helps residents to be assured that they will be supported to take risks as part of developing a more independent lifestyle wherever this is possible. Milestone DS0000007104.V373228.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): Standards 12, 13, 15, 16 & 17 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. EVIDENCE: Standard 12 – The Manager said that in order to ensure that each resident is involved in daily activities appropriate to their needs and wishes, key work staff draw up with the resident an individual activities care plan. These were seen by us on the resident’s files inspected. They record the activities of each resident and link the activities with their care plan objectives and what they say they want to do. Inspection of the resident’s files showed that the Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 14 resident’s care plan objectives do identify activities that are appropriate to the resident’s age and cultural needs. Residents interviewed by us said that they participate in the activities they wish to do. Residents told us that if they wanted to do an activity, staff would support them to do so. The Manager told us that as a part of trying to maintain continuity for the residents in their daily lives and to support their rehabilitation, where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. 2 residents said, “We do much more here than we did where we lived before”. We were also informed via the AQAA and by the Manager that there are now 2 members of staff who co-ordinate activities for residents at the home. One of these staff members were interviewed and they told us about the varied and interesting outings and activities that have been arranged with the residents over the last few months. These activities are seen to help residents integrate with the community and to help them to feel a part of it. Residents told us that they have enjoyed the different experiences that they had from these activities. From the care plan review it became evident that significant relationship links for the residents are recorded in the care plans and that the importance for the residents of these links is not underestimated. Visitors are made welcome when they come to the home. Information about local activities was seen on the notice boards within the home and staff who were interviewed said how they support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. One member of staff at the time of the inspection talked about the importance for the residents to get out and about and socialise with other people. Residents were seen to be supported and enabled to take part in appropriate activities and that they are able to express their wishes and be listened to and responded to with active and appropriate support. Standard 13 – Milestone actively encourages residents to develop and maintain social, emotional and independent living skills where ever possible as a part of their rehabilitation package. Staff were seen to be actively supporting residents to make informed choices about the things they want to do and the activities they need to do. The central location of the home off the Old Kent Road in London makes access relatively easy for those residents who are able and want to use public transport. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 15 The Manager informed us that all residents are registered to vote and are encouraged to use their votes. Residents confirmed with us that they are supported and enabled to vote. From information seen in the care plans and from discussions held with staff and residents, they do seem to be engaged as much as is possible with their local community and this will be likely to expand as their skills and abilities increase. The Manager said that most of the residents attend day centres / work experience / voluntary work, outside of the home for a variety of reasons that all help to contribute to their well being and to their successful rehabilitation. This was also confirmed by the residents and by information received in the AQAA. Standard 15 – Interviews with 2 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Milestone. Residents told us that they are enjoying the opportunities that they experience at Milestone. Staff interviewed said that they encourage these visits and are sometimes involved in helping their resident’s sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged and use the visitor’s book to sign in. We saw information made available within the home about local activities for residents to take up if they wish. Standard 16 – Appropriate policies were seen by us to be established within the unit that do ensure that service user’s rights to privacy, respect and dignity are respected. Those residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, that staff use their preferred form of address and that staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner and staff confirmed in interview that they understand how to respect the privacy and dignity needs of the residents. Interviews both with staff and residents confirmed that residents participate in household chores as a part of the rehabilitative process and this participation was supported in the residents care plans. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 16 Standard 17 – The Manager explained that during the week residents shop and cook for themselves with support as appropriate and as needed from staff. This is seen as an important part of the rehabilitative process that should enable residents to live more independently at a later date. However on Sundays all the residents and staff eat together. Residents will prepare these meals sometimes with staff assistance and both the residents and staff told us that they really enjoy these occasions. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19, & 20 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 18 – Residents who were interviewed at this inspection confirmed with us that they receive their care in the way they prefer. They said that they are able to decide themselves about their daily routines and this was backed up by project workers who were also interviewed. Staff ensure that care support at Milestone is person centred, flexible, consistent and is able to meet the changing needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 18 wear and what they will do during the day. One resident said, “I get together with my key worker and we agree what I’ll be doing over the week. I get this plan and that helps me to remember what I’m doing”. Another resident said, “I go to college most days, I’m learning skills to help me get a job and live more independently. That’s what I want to do and they (the staff) are helping me”. A member of staff interviewed, explained how when drawing up the weekly activities chart, which is based on the care plan, they work through the programme together in order to gain the residents approval and commitment to the plan and to understand their choices. Activities plans were seen on each of the 4 resident’s files inspected. They covered the following areas: external leisure, education, employment, training and hobbies and leisure pursuits within the home. For each of these areas outcomes and goals had been identified by the resident and had been written down so that it was clear what they want to achieve from their individual programmes. The plans were seen to be up to date, having been reviewed on a regular 3 monthly basis. Copies of these plans were seen in the resident’s rooms and as already indicated residents told us that they had been fully involved in the construction of their plans. Standard 19 – With regards to the health care of the residents the Manager told us that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. The AQAA completed by Milestone tells us that, “Work in partnership with local care teams such as Southwark High Support Rehab Teams means that the work at the service is complimented by that of external professionals. They support residents by providing access to specialist support such as substance misuse, offending behaviours and mental health.” Given the complex needs of the residents living at Milestone this ongoing support is essential. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks take place at the GP surgeries. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with us said that they go to see their GPs as and when necessary and that they have the monthly meetings with their clinical teams. They said they prefer not to go to the dentist. The Manager told us that an optician visits Milestone quarterly. Forms are in place to monitor residents’ visits to these healthcare professionals. Standard 20 - The unit’s policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. A member of staff who was interviewed indicated that they were aware of the policy and know Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 19 what the procedures are when administering medication to the residents. A list of staff signatures was available in the medication records so as to clearly identify the signatures recorded on the MAR sheets. The Manager told us that staff only administer medication to the residents once they have completed training to do with the safe handling of medicines. The Manager said that some residents do self medicate but with supervision, she also said that risk assessments are completed for those residents who self medicate and who are unsupervised. This is welcomed as it should help to minimise any potential hazards for the resident or others. Inspection of the medication records MAR sheets found no unexplained gaps and the Manager explained that staff who administer any medications are required to sign the MAR sheet records immediately after the residents have been given their medications. 3 staff who were interviewed accurately described the appropriate medication procedure as outlined in the home’s policy document. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident and therefore assist in the protection of residents. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate and although controlled drugs are not currently in use within the home there is appropriate provision for doing so i.e. there is a lockable metal cupboard within a locked metal cabinet. The Manager said that Lloyds the chemists provides quarterly checks on the medication procedures carried out at Milestone and they have offered to provide external training for staff. Training records provided by the Manager shows that staff received in 2008 Turning Point’s own internal training on the safe handling of medications within the home. PRN guidance was also seen to be provided appropriately on the medication records. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 20 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): Standards 22 & 23 were inspected at this inspection. Quality in these outcome areas are good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – The 4 residents who spoke to us at this inspection all individually confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed said they thought that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. We asked the Manager to see the home’s complaints record, no complaints had been registered in the record book since the last inspection in February 2008. However evidence seen at previous inspections as to how complaints had been dealt with to the satisfaction of all parties shows that the outcome is that the home learns from complaints in order to improve its service and all the residents know that their complaints and concerns will be listened to and dealt with appropriately. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 21 Standard 23 – The Manager advised us that there is a policy for the Protection of Vulnerable Adults and that staff have been provided with training and guidance about what actions they need to take if the need arises. We saw the policy in the Unit’s policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. Training records seen by us for 2 of the 3 staff whose files were inspected evidenced that 1 staff member had not received POVA training from an authorised trainer in the last year. However the Manager advised us that this member of staff had in fact received POVA training along with most of the other staff team. The Manager must therefore ensure that certificated evidence is held on every staff file that supports that staff member’s attendance for the training they have received. POVA training helps to ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Milestone. At the last inspection it was recommended that the Manager ensure an inventory for each resident is kept on the residents’ files of their valuable belongings. This has now been completed and evidence was seen on each of the 4 residents files inspected. This is welcomed as it will help protect both the residents and staff from abuse. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 22 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): Standards 24 & 30 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at Milestone are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. EVIDENCE: Standard 24 – Together with the Manager we reviewed all areas of the home to assess the quality of the environment and décor. The home is split up into 2 main units. The first has bed-sit type rooms for 6 residents and the second unit has 8 one bed roomed self-contained flats. Each has a small kitchen area, lounge, bathroom etc. and in addition to this there is a large communal area and practice kitchen. There is generally a comfortable atmosphere and units are individually decorated with input from residents with regard to choice of colour and furniture. Those residents that we spoke to about this said they were generally happy with their rooms. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 23 The home was found to be clean and hygienic. 3 resident’s bedrooms were inspected with the permission of those residents. They all told us that they are happy with their rooms and that they like living at Milestone. This means that residents live in a homely and comfortable environment. The bathroom on the first floor in the main block needs a new bath panel and this was discussed with the Manager. She said that a replacement would be installed in the near future. General maintenance throughout the home was seen to be good. The Manager told us that since the last inspection a new company has been contracted to carry out all the home’s maintenance. Any faults or repairs are noted in the home’s maintenance book by staff and they are then attended to by the contracted company. No problems were identified with this system at this inspection. The home was seen to be clean and no unpleasant odours were noted. At the last inspection a requirement was made to ensure that regular checks are carried out to ensure that hot water temperatures are maintained within the prescribed limits. At this inspection we asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They indicate that regular testing is carried out each week as required and that hot water temperatures now fall within the prescribed limits to ensure the safety of the residents. A senior member of staff told us that they regularly review the recording process of water temperatures and ensure that faults are reported immediately where temperatures exceed the prescribed limits so that immediate action is taken to rectify the problem. For this reason the requirement is now met. Standard 30 – The Manager showed us the home’s infection control procedure, which seems to be working effectively. This means that the residents live in a clean and hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Laundry is not taken through areas where food is prepared. The home has appropriate sluicing facilities and these were seen by us to be appropriate. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 24 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): Standards 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff and by the home’s recruitment policy and procedures. Some improvements are still required in the recruitment and training of staff, however service users benefit from well supervised and well supported staff. EVIDENCE: Standard 32 – The Manager told us that 2 new staff members had joined the staff team at Milestone since the last inspection. 3 of the 11 staffing files were inspected and this included the 2 new staff members. The Manager told us that each new staff member has to go through Turning Point’s induction training programme. An induction work book is completed over a 6 month time period and evidence was seen on the staff files inspected that this had been carried out. The induction programme is very comprehensive in the coverage of work roles and of the organisation generally. One member of staff told us, “Induction training was very, very good. It covered the aims and objectives of Turning Point as an organisation and also my own role and function within Milestone. I found it really helpful”. Another Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 25 member of staff said, “It was important for me so as to be able to get into the new role effectively, the process covered the unit’s policies and procedures, aspects of health and safety and the general housekeeping procedures”. At the last inspection a requirement was made that all staff be asked to read and discuss the homes policies and procedures so that there is increased awareness about the support the policies and procedures offer to staff in different areas of the work within the home. The Manager could not confirm that all staff had been asked to sign to say that they had read, had a chance to discuss the policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. At this inspection the Manager told us that this process has now been started and evidence was seen to confirm that 4 of the home’s policies have been reviewed in this way. The Incident and accident policy; the Lone Working Policy; Care and support policy; the policy covering compliments, complaints and concerns had been discussed with staff in September and October 2008. Some further work remains however in this area to ensure that all the key policies and procedures are covered in this way and for this reason the previous requirement remains in place. A new timescale has been set within which the Manager must ensure the requirement is met. The Manager told us that she has drawn up an “at a glance” training matrix that identifies for each member of staff all the training that they have received and that which is planned for the forthcoming year. This is a very useful management tool as it sets out the exact position with regards to staff training at Milestone. The Manager explained that there most of the training programme is provided by internal Turning Point trainers. The courses provided for staff include: 1. Care of medicines, 2. 1st Aid, 3. Risk assessment, 4. Health and safety, 5. Fire safety, 6. Manual handling, 7. Food hygiene, 8. Drug awareness, 9. Equality and diversity, 10. POVA. The training matrix referred to above identifies that most of the staff group have received this training within the last 3 years and the level of certificated evidence has improved since the last inspection, although some gaps were found where staff were said to have received training but certificates were not available for inspection. The previous requirement made at the last inspection therefore remains in place so that whenever a staff member receives training a certificate of attendance is filed on their individual staffing file. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 26 With regards to staff and their NVQ training, the Manager told us that staff have completed their NVQ training at level 2 or above or have parallel qualifications such as a nursing or social work qualification. Residents interviewed told us that staff are approachable and we saw staff taking time to deal with resident’s questions. Standard 34 – The Manager told us that the home has good recruitment polices and procedures in place. At the last inspection we were informed that recruitment information for staff recruited prior to November 2006 would be held centrally because Turning Point conducted all recruitment processes then at their headquarters. However for all new appointments, information will be stored in the home. As a part of this inspection we selected 3 staff files including 2 of the new staff member’s files. Inspection of these staff files showed that most of the appropriate documentation was available for inspection. Information on file showed that CRB checks had been carried out and the CRB reference numbers had been stored on the files. However expiry dates for these checks for 2 of the 3 files inspected were unavailable at the time of this inspection and this means that current validity of the CRB status could not be properly confirmed. Employment contracts were also missing from 2 of the 3 staff files inspected. It is understood that these contracts are probably held at Turning Point’s Headquarters. A form of identification such a passport or birth certificate was missing for 1 member of staff’s file. It therefore remains a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. Standard 35 – As already indicated earlier in this report there is a structured induction programme that is offered to all new staff and documentary evidence of this was seen in the staffing file review and was also supported by staff who were interviewed. The Induction programme is seen to be comprehensive covering: • Safe working practices • The workers role • Meeting the needs of service users • The home’s policies and procedures. The Home’s management prioritise training and facilitate staff members to undertake training beyond the basic requirements. Training certificates were seen in most cases by us, confirming that staff had attended the stated courses. However it has been required earlier in this report that certificates are gained for all staff training and held on file. This is valuable for the staff Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 27 member in that it provides documentary evidence of the training input they have received and helps to document their CVs. The Manager told us that she has introduced a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. A further positive development in the training field would arise if all staff who have undertaken training are asked to evaluate the experience they have had, how they have benefited from it and how they believe their work with residents may have of improved. A summary of the results of this sort of evaluation could be drawn up, as it would provide excellent feedback on the strengths and weaknesses of the training experience. Feedback to the trainers from the summary should help to ensure more appropriately trained staff at Milestone and better care delivered to the residents in meeting their needs. Standard 36 – The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools comprehensively cover the areas that are required in order to implement an effective supervision process. Inspection of the supervision records that are held on staffing files showed that staff have received regular and formal supervision. Areas of discussion included: • Resident’s issues • The key working process • Monthly reports on progress made by key workers with care plans • Daily activities and outings for residents • Employment and training needs • Holidays and leave • Work performance issues. This means that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups should be properly met. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 28 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): Standards 37, 39 & 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. With the developing quality assurance system they may be confident that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 – The Manager has 2.5 years experience of management experience at Milestone. She holds her registered managers award at NVQ level 4, a post graduate Diploma in Forensic Mental Health, as well as a BA Hons in Sociology. The Manager demonstrates a good level of competence in the management and running of Milestone. The systems that are in place Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 29 ensure that the home is “fit for purpose” and meet the required standards being both efficient and effective. This reflects positively on the Manager and also on the staff team all of whom have developed and managed these processes well. The residents spoken to by us felt that the home is being well run and evidence seen supports this view. The homes records and administration systems were seen to be in very good order and overall the impression was positive. Interviews with staff reflected a positive and caring approach towards the residents. Service users can therefore be assured that they are benefiting from a well run home. Standard 39 – The Manager told us that at present there are a number of quality assurance mechanisms in place at Milestone that together constitute the home’s quality assurance process. The Manager referred to the internal quality assessment tool (IQAT) that when fully developed will monitor the agencies performance against each of the key National Minimum Standards under the Care Standards Act 2000.. This will provide a very useful tool for future inspection and in the completion of the AQAA documents. The Manager explained that in addition to this a resident’s survey has been carried out that sought their views on different aspects of the care and support provided at Milestone. As well as this there are the weekly and monthly audits covering the following areas: • The Manager’s weekly file audit – these are checks carried out regularly on administration and recording systems that are used for the running and management of the home, including for example medication records checks; healthcare appointments; concerns and complaints; and other health and safety checks. • Care plan audit monthly – checks carried out on progress being made with resident’s individual care planning targets and with file order. There is as well as this a business Plan that the Manager explained links Milestone in with the overall quality assurance objectives of the parent agency Turning Point and vice-versa. On inspection of the business plan we could see the agency’s (Turning Point) overall objectives and Milestone’s specific QA objectives set out together in the business plan. Objectives have timescales set against them, success criteria, and a lead person tasked with ensuring implementation of the plan objectives. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 30 Some further discussion was had with the Manager as to what other elements might be usefully included in order to ensure a complete approach to developing quality assurance processes. Some suggestions were: • Questionnaires for residents, relatives and referring professionals seeking their feedback on different aspects of the service. For instance residents might be asked for their views on the environment within the home, the effectiveness of the care support they receive etc. Professionals who have referred people to Milestone could be asked about the effectiveness of the service in meeting the Care Programme Approach care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. • A review of any accidents that have occurred. • Issues raised by residents at community meetings. • Issues raised by staff at staff meetings. A summary and analysis of the key points arising from these areas mentioned above could then be used to inform the annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. Standard 42 –We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager said that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. A fire risk assessment had been carried out on 19.9.08 that identified a number of actions required to ensure all risks are covered. These actions included: • The need for fire evacuation training for all staff, • The need for staff training on the use of fire equipment, such as fire extinguishers. These actions now need to be addressed and it is required that the Manager ensures all staff receive this training preferably from an authorised external trainer. Up to date and satisfactory pass certificates were seen for: Boiler & Gas – 27.6.08 Electrical installation – April 2007 Portable electrical appliances – 1.9.08 Fire alarms – 21.4.08 Fire equipment – 1.9.08 A water and legionnaires test was last carried out on 17.7.08. Records were seen that confirmed regular tests had been carried out for the: Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 31 Fire alarm – weekly, last record seen 17.10.08 Fire extinguishers Emergency lighting - last record seen 15.8.08 Accident records were checked by the Inspector. They had been completed appropriately and Regulation 37 notices sent out as required. At the time of this inspection no fire doors were seen to be wedged open and the fault on one of the fire doors into the residents lounge identified at the last inspection has since been repaired. Generally the building appeared to be secure. All of this means that residents benefit from a competently run and accountable management of the services at Milestone. Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 32 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 4 2 4 3 x 4 x 5 4 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 2 33 x 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 x 3 x 3 x x 2 x Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 Regulation 12 (1) (a) & 18 (1) (c) (i) Requirement The Manager should ensure that all staff are asked to sign to say that they have read and had a chance to discuss the home’s policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. Certificated evidence must be held on each member of staffs file for all training qualifications achieved, including NVQ, nursing and social work qualifications. The Manager must ensure that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Milestone and be held on the staff files for review and inspection. A fire risk assessment had been carried out on 19.9.08 that identified a number of actions required to ensure all risks are covered. Timescale for action 01/05/09 2. YA32 12 (1) (a) & 18 (1) (c) (i) 19 (1) (b) & (4) 01/04/09 3. YA34 01/01/09 4. YA42 16 01/01/09 Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 34 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 Milestone DS0000007104.V373228.R01.S.doc Version 5.2 Page 35 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. 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